Health Insurance Options with Divorce
One of the biggest divorce issues is determining the health insurance options that are available for the family during separation and after divorce.
With the passage of the nationwide Affordable Care Act, health insurance is accessible to everyone.
Before that law, health insurance was largely only available through your employer, if the company offered it.
Note this discussion 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.
Children’s health insurance needs may be met by a state program called Child Health Plus, which is now available through the NYSOH Marketplace (discussed below). That plan can significantly decrease a family’s out-of-pocket costs while increasing the benefits for children. If you have children under the age of 19, Child Health Plus can provide a cost savings that will help you manage health insurance costs, regardless of whether you are divorced.
If your family income is too high to qualify for Medicaid, yet you cannot afford private coverage, the Children’s Health Insurance Program (CHIP) may help. It was established in 1997 to provide new coverage opportunities for children.
Health Insurance for Divorcing Adults
First, be aware that choosing not to obtain health insurance means you will pay a penalty for not being covered when it comes time to file your federal income taxes.
New York does not require health insurers to provide health insurance for divorced spouses, so one spouse may lose health insurance when she divorces if she was covered by her husband’s plan. New York law even requires divorcing spouses to acknowledge they are aware they will no longer be allowed to receive health care coverage under a former spouse’s insurance plan once the divorce is final.
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:
- Through your employer’s benefits program.
- An individual or family policy through the “New York State of Health” Official Health Plan Marketplace.
- State programs like Medicaid.
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, usually Nov 1 of the current year to Jan 31 of the following year.
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 2016 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.
- NYSOH Marketplace Individuals & Families FAQ
- “New York State Health Insurance Rules When Getting a Divorce“
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 firstname.lastname@example.org.