UPDATE: Health Insurance Options with Divorce

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Graphic of health insurance cardUPDATE May 2021. One of the biggest divorce issues is determining the health insurance options that are available for the family during the separation and after the divorce.

The Affordable Care Act (also referred to as “ObamaCare”) was passed in 2008, making health insurance accessible to everyone.

Before that law, health insurance was largely only available through an employer, if the company offered it. However, the ACA is often modified when government administrations change. Please read the federal government website, HealthCare.gov, to find out the latest regarding this legislation and how to obtain health coverage through it. Also check their page on “No Health Coverage” to determine whether you will pay a penalty when you file your federal income taxes if you had no health insurance for the tax year.

Note the discussion below applies only to residents of New York State. If you live in another state, please check your state’s health care web site for information.

Options for Children’s Health Insurance Coverage

Children do not typically lose health insurance at divorce. They remain eligible as the child of both parents and can be enrolled in the health plan of either.

New York statutes create an obligation for each parent to contribute to the cost of health insurance based on a prorated amount as part of the child support determination. If a noncustodial parent is required to pay health insurance for a child, she is only required to pay insurance costs as long as she is paying child support for that child.

There are two options for enrolling your children in health insurance if they are under the age of 19 and are residents of New York State, Children’s Medicaid and NYS Child Health Plus. Eligibility for each program depends on gross family income.

How to Apply:

Health Insurance for Divorcing Adults

New York does not require health insurers to provide health insurance for divorced spouses. When the divorce becomes final, the ex-spouse who was covered under their spouse’s employer’s health plan will no longer have health coverage and will have to enroll in their own policy.

Health Insurance Options Available to Divorcing Individuals

One option is insurance under COBRA. COBRA is a law that allows a spouse who was formerly covered under his/her spouse’s plan to obtain coverage from the same insurance company. However, the premiums can be quite expensive because the spouse’s employer does not contribute to the cost. The couple’s separation agreement can address the issue of health insurance and state the arrangements to which the couple agreed regarding covering the cost.

Other options for enrolling in a health insurance plan are:

The rest of this post focuses on obtaining health insurance through the NYSOH Official Health Plan Marketplace.

Obtaining Health Insurance Outside the Open Enrollment Period

In general, you can only change your health insurance coverage during the annual Open Enrollment Period.

However, various changes in your life trigger a Special Enrollment Period (SEP). One of the qualifying events is losing health insurance coverage because your spouse will no longer include you on his or her policy after you are legally separated or divorced.

The NYSOH Official Health Plan Marketplace

The Marketplace offers the option for individuals and families to purchase health insurance directly from insurance companies. The site’s navigation helps you find the plans that meet your needs. You may also find out what plans are available in your county via the NYS Qualified Health Plan Map.

Depending on your taxable household size, adjusted gross income (AGI), and county of residence, you may apply for a program called the Essential Plan. It offers the same essential health benefits as the main plans but is designed to be more affordable if you meet criteria for income relative to household size. For example, a household of 1 individual who has an annual income of $23,540 or less will pay $20/month. This plan provides individuals a benefit of having no deductible and low co-payments for all needed health care services.

Sources of Help in Health Insurance Enrollment

In-Person Assistors (IPAs)/Navigators provide in-person enrollment assistance to individuals, families, small businesses, and their employees who would like help applying for health insurance through the Marketplace. IPAs/Navigators provide culturally competent, linguistically appropriate, and disability accessible enrollment services. They are available at convenient times, including evenings and weekends, at no cost to enrollees.

Authorized brokers can also assist in choosing the right plan for you. There is no fee to you; the broker receives a commission from the insurance carrier.

Once you are enrolled in your chosen plan, this excellent graphic on Using Your Insurance to help you work effectively with your health care provider and insurance company.


Photo credit: CanStockPhoto.com

This blog and its materials have been prepared by BJ Mediation Services for informational purposes only and are not intended to be, are not, and should not be regarded as, legal or financial advice. Internet subscribers and online readers should not act upon this information without seeking professional counsel.

About the Authors: BJ Mann is grateful for Mark Shannon’s assistance in writing this article. He is a Senior Marketplace Advocate at Bond Financial Network located in Pittsford, NY. Mark specializes in providing individuals, families and small business owners with affordable health insurance options by utilizing both the traditional group marketplace and the newer individual marketplace. For more information, contact Mark via 585-248-5870, ext. 157 or marks@bfninc.net.

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