With the increasing cost of medical care in the United States, health insurance is a must for seniors.
Unfortunately, divorce can cause major problems with
health insurance benefits, especially for seniors with
limited financial resources.
It is not unusual for a spouse
to have been a stay-at-home parent and have no health
insurance benefits. A spouse's employer or former
employer often provides health insurance. Upon divorce
the insurance will no longer cover the former spouse.
In a divorce, a court may order a spouse to pay the health
insurance premium for the dependent spouse, but this is
not always financially feasible or ordered if the marriage
has not been a long one.
Aside from the dependent
spouse purchasing his or her own individual health
insurance policy, the options are limited. COBRA continuation
coverage, Medicare and Medicaid may provide
some help for seniors after a divorce.
Federal law known as COBRA permits a dependent
spouse to continue his or her health coverage if current
coverage is terminated due to a "qualifying event,"
including divorce or legal separation from the covered
employee/spouse. A dependent spouse can elect COBRA
continuation coverage for 36 months from the date the
divorce or legal separation is final.
While COBRA does not define the term "legal
separation," in Ohio a legal separation does not occur
until the separation is actually finalized by the court and
the parties receive a "decree of legal separation." Parties
considering a legal separation in the hopes of retaining
health insurance coverage should also read the insurance
policy language very carefully.
Some insurance companies
now include language which causes coverage to end upon
legal separation. Simply living apart, waiting for the
divorce to be final, or entering into an informal separation
agreement does not make the separation a "legal
separation" recognized by the state.
should continue throughout this period, which is why
many seniors considering divorce may elect to stay married.
Whether triggered by divorce or legal separation,
continuation of coverage under COBRA is expensive. A
monthly premium must be paid by the dependent spouse.
The premium is equal to 100% of the premium paid by
the former spouse's employer, plus an administrative fee.
Average COBRA premiums exceed $400 a month for
individuals, making the COBRA continuation coverage
in some instances too expensive.
COBRA coverage ends after 36 months, a divorced
spouse will eventually have to purchase their own insurance
or rely on Medicare or Medicaid benefits if eligible.
For seniors divorcing near or after age 65, Medicare may
be the only affordable health care coverage available.
Medicare is a federal program that pays for certain health
care expenses for people aged 65 or older. People who
are disabled or have permanent kidney failure can get
Medicare at any age.
Individuals must pay deductibles
and co-payments, but much of their medical costs
are covered. Medicare is an important source of postretirement
health care for many. Medicare has four parts:
Most individuals do not pay a monthly premium for Part
A coverage because they (or their spouse) paid Medicare
taxes for at least 10 years. This is called "premium-free
Part A." People who are not eligible for premium-free
Part A may be able to buy Part A for a monthly premium
if they have received Social Security disability
benefits for 24 months.
- Hospital insurance (Part A) helps pay for inpatient
hospital care and certain follow-up services.
- Medical insurance (Part B) helps pay for doctors' services,
outpatient hospital care and other medical services.
- Medicare Advantage plans (Part C) are available in
many areas. People with Medicare Parts A and B
can choose to receive all of their health care services
through a provider organization under Part C.
- Prescription drug coverage (Part D) helps pay for
medications doctors prescribe for medical treatment.
A former spouse who has not
worked and is not eligible for Medicare in her or his
own right may qualify for Medicare (and Social Security
retirement benefits) if the parties were married for at
least 10 years.
Unlike Part A, everyone must pay a premium for Part
B Medicare. For those new to the Medicare program in
2011, the Part B premium monthly cost is $115.40. In
Ohio, you may be able to get some help with the payment
of Medicare premiums if you qualify for one of the four
"Medicare Savings Programs."
To qualify a single individual
cannot have assets over $6,680 and income more
than $928 or $1109 monthly depending on the program.
Medicare Part C or a Medicare Advantage Plan is like an
HMO or PPO. They are offered by private companies
approved by Medicare and the plan will provide all of
your Part A and B coverage, plus offer extra coverage
such as vision, hearing, and dental. Usually you will pay
one monthly premium for the services included.
Prescription drug coverage, Part D, is available to anyone
who has Medicare Part A or Part B. Joining a Medicare
prescription drug plan is voluntary and you pay an
additional monthly premium for the coverage. The cost
of Part D coverage varies greatly.
Medicaid is a joint federal and state program which
provides health coverage to low-income people, including
children up to age 19, pregnant women, people with
disabilities and the elderly (age 65 and over). Medicaid
is a means-tested program, based on limited income
and financial resources.
In Ohio, an individual over
65 or an individual at any age with a disability may
qualify for Medicaid if their income is less than $589 a
month and have assets less than $1,500. Countable assets
include checking and savings accounts, IRAs, stocks, and
basically all money and property or any item that can be
valued and turned into cash.
Some property is exempt,
such as the home in which an individual lives, household
and personal belongings, and an automobile.
A Medicaid spend-down program is also available for
those who meet all Medicaid eligibility guidelines except
their income is too high. Individuals may use monthly
paid or incurred medical expenses to qualify for Medicaid
coverage for the remainder of the month. The program
is similar to paying a monthly deductible or out-ofpocket
Unlike Medicare, an individual need not pay a monthly
premium for Medicaid coverage. The Medicaid program
provides coverage for services including hospital stays,
physician services, dental services, and nursing home
stays. Prescription drug coverage is also provided under
Staying Together for Insurance?
Divorce is difficult at any age. For seniors struggling
financially and facing health issues, loss of insurance
coverage is devastating. Before deciding to divorce, you
may want to review potential coverage under COBRA,
Medicare and Medicaid.
If you are currently covered
under your spouse's health insurance, contact the plan
administrator regarding the cost of continuing coverage
For more information regarding
Medicaid, contact your county Job and Family Services.
1-800-MEDICARE provides answers to Medicare
This article was written by Deborah Dallmann, Esq., a staff
attorney in Legal Aid's Elyria office who handles family,
benefits and education cases.
It is reprinted with permission from The Alert, a publication of The Legal Aid Society of Cleveland.
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