If you are recently divorced, you might be exploring health insurance options. Fortunately, divorce is a Qualifying Life Event (QLE) that activates a Special Enrollment Period (SEP). Special Enrollment Periods allow you to enroll in Marketplace Health Insurance, known as Obamacare plans or Affordable Care Act plans, outside of the standard yearly Open Enrollment Period (OEP). The following will answer frequently asked questions about getting insurance after a divorce is finalized…

What Makes Divorce A “Qualifying Life Event?”

Qualifying Life Events for Special Enrollment Periods are initiated by changes made in the nature of your household– a divorce being one of those. If you have become legally separated or divorced and no longer have health insurance, you might have a Qualifying Life Event (QLE). Such QLE could prompt a Special Enrollment Period (SEP) enabling you to sign up for your own ACA-compliant healthcare plan through Marketplace. You should be aware that a divorce only qualifies as a QLE if you’ve lost your health insurance during the divorce process. If you were not insured prior to the divorce, or you were able to keep your health insurance after everything was finalized, it will not count as a QLE. In most cases, SEPs initiate a 60-day period in which the divorcees are able to apply for insurance and receive coverage through Marketplace. After you’ve applied, it will ask you to verify the SEP.

What Happens During The Special Enrollment Period (SEP)?

Typically, you are only able to enroll in health insurance through Marketplace once a year during the Open Enrollment Period. However, there are some exceptions to this rule– like having a Qualifying Life Event. This includes a divorce or legal separation which enables you to enroll during a Special Enrollment Period. We advise verifying your eligibility with the Marketplace prior to going through the entire enrollment process. You will be asked to submit certain documents to confirm your Qualifying Life Event. If you have lost your health insurance coverage because you are no longer going to be covered under a spouse’s plan as a result of your divorce, you will need a letter from your health insurance company showing the termination or impending termination of such coverage. You might also be asked to present the company with additional documents pertaining to your divorce. Once your QLE has been verified, you are able to shop on the Marketplace just as you would during the annual Open Enrollment Period. You can compare plan options and premiums and see what premium tax credits you could be eligible to receive.

Reminder: You only have 60 days from your QLE to participate in the Special Enrollment Period.  After this SEP closes, you will have to wait until the next Open Enrollment Period to enroll in Marketplace insurance if you are still uninsured.

COBRA Health Insurance

Another option to consider is COBRA Health Insurance. If you have insurance but then lose job-based health insurance through your employer, including losing access to your former spouse’s employer’s insurance, you might be offered COBRA coverage. To be eligible for COBRA coverage, you are required to have a “qualifying event.” Losing your health insurance coverage because of your legal separation or divorce including benefits that were previously offered to you through your ex-spouse’s employer is a qualifying event. COBRA health insurance allows you to keep the health insurance you had for 36 months after the qualifying event by paying 100% of the premiums associated with it. In addition, you will have to pay an administrative fee. Unfortunately, this means you are expected to pay more for the same coverage than you previously did since you do not have an employer covering any portion of your monthly premium. Many people choose COBRA Health Insurance as it allows them to get the coverage they need while they focus on the other things they have going on in their lives. Unfortunately, COBRA coverage tends to be substantially more expensive than the coverage options found on Marketplace.

Medicaid Health Insurance

Your annual income after your divorce will determine your eligibility for Medicaid health insurance. Medicaid is a program funded by both the federal government and the states to provide health insurance to low-income Americans. Medicaid is completely income based. Children, adults, elderly, expecting women, and people with disabilities may all become Medicaid recipients. Each state has their own Medicaid program for which they determine the range of services they will offer. These are centered around a broad set of federal guidelines as to what coverage should be offered. Federal law requires that all Medicaid programs must cover a certain set of mandatory benefits. This includes: inpatient and outpatient hospital service, home health services, nursing facility services, physician services, as well as x-ray and laboratory services. Additional required coverage includes family planning services, certified pediatric and family nurse practitioner services, nurse midwife services, freestanding birth center services (must be licensed and recognized by the state), and smoking cessation counseling for pregnant women.

Eligibility Requirements For Medicaid

The Affordable Care Act (ACA) allowed states to expand their Medicaid programs out to low-income adults. Each state offers their own requirements to qualify for Medicaid which includes income requirements, whether or not the state expanded Medicaid, and if you meet other criteria such as being pregnant, disabled, or if you are raising a child under the age of 19. At the time of this article, 38 states and the District of Columbia have chosen to cover otherwise ineligible adults through their Medicaid programs. In most of these states, anyone that makes less than 138% of the Federal Poverty Level may qualify for Medicaid. That is $18,754.20 for an individual and $38,295 for a family of four. In the 12 states that have chosen not to expand their Medicaid programs, adults do not qualify for Medicaid unless they meet additional conditions. 49 states cover children up to at least 200% of the Federal Poverty Level through Medicaid and 34 states cover pregnant women with incomes at or above 200% of the Federal Poverty Level (FPL). In addition, 38 states cover parents and other adults with incomes up to at least 138% FPL because of the ACA’s allowance of Medicaid expansion to low-income individuals.

How To Apply For Medicaid

You are able to apply for Medicaid at any time – even outside of the annual Marketplace Open Enrollment Period. Rollins Insurance can help you determine whether or not you qualify for Medicaid based on your income, where you live, and whether your state has adopted the Medicaid expansion. If you are eligible, you can start your application through Rollins Insurance. When you’ve completed the application, it will be submitted to your state’s Medicaid agency. The agency will review all of your information and send you an official letter of determination in a few weeks. If you do not hear back from them outside of that period, we suggest calling them to see where your application stands.

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About Rollins Insurance 

Rollins Insurance is an independent insurance agency providing our clients the best prices with the most coverage possible since 2008. We represent multiple A-rated insurance companies to make sure we deliver the most competitive rate packages to our clients in Kentucky and Ohio. We find that most people are under-insured and over-paying when we meet them. We love what we do and our primary business is Personal Auto, Homeowners, and Life and Health insurance. We are a family-owned and managed business that specializes in providing needs-based insurance services.
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