Health Insurance After a Spouse Dies

Start with where your coverage comes from

Find your insurance card, the last premium notice, or a pay stub that showed a health deduction. The name printed there tells you which office holds your coverage. If you cannot tell, call the benefits or human resources office at your spouse’s employer and ask two questions: was I covered through this plan, and on what date does that coverage end?

More than one row can apply. A 66-year-old on a spouse’s work plan may have a COBRA notice and a Medicare window running at the same time, and the two clocks do not wait for each other. The sections below take each row in turn.

Coverage through your spouse’s job: COBRA

COBRA is the federal law that lets family members keep job-based health coverage for a limited time after certain events. The death of the covered employee is one of them. The U.S. Department of Labor says the covered spouse and dependent children may be eligible to continue their existing health coverage for up to 36 months, and that the plan should notify them of their right to buy that coverage.^[1]

First, check whether COBRA applies to the plan. COBRA generally applies to group health plans of private-sector employers with at least 20 employees and of state and local governments. It does not apply to plans sponsored by the federal government or by churches and certain church-related organizations. Federal employees have a similar federal law and should contact the personnel office serving their agency. Many states have their own laws, sometimes called mini-COBRA, for employers with fewer than 20 employees. To check, the Department of Labor sends readers to the state insurance commissioner’s office.^[2]

The notice chain, and the dates to write down

Here is how the paperwork moves. After a death, the employer must notify the plan within 30 days. Once the plan has that notice, it must send the family an election notice within 14 days, and the notice should name the plan’s COBRA administrator.^[2] The plan must give you at least 60 days to choose, counted from the date the election notice is provided or the date you would otherwise lose coverage, whichever is later.^[2] Multiemployer plans can set some of their own notice time limits; the plan documents say which.^[2]

Write down two dates: the day the election notice arrived, and the day your old coverage ends. Each person covered under the plan has an independent right to elect.^[2] If no notice arrives, call the employer’s benefits office and ask whether the plan was told about the death.

What it costs and when the first payment is due

COBRA often costs more than the employee paid, because employers usually pay part of the cost for active workers. The plan can charge up to 102 percent of its cost for the coverage. It cannot require a payment when you elect. It must give you at least 45 days after the election to make the first payment, and a grace period of at least 30 days for each later payment.^[2] Ask the administrator for the monthly amount in writing before you decide.

If you have health coverage through your own job

If your own employer offers a health plan, you and any dependents may be able to join it through special enrollment, a chance to sign up without waiting for the plan’s next open season, after losing coverage on your spouse’s plan.^[1] The Department of Labor’s guide lists three conditions: you were eligible for that plan before, you had other coverage when it was first offered to you, and you ask within 30 days of losing the other coverage.^[2] Call your benefits office early and ask what proof it wants.

For questions about a private employer’s COBRA rules, call the Department of Labor’s Employee Benefits Security Administration at 1-866-444-3272. For a state or local government plan, the guide lists the Centers for Medicare & Medicaid Services at 1-877-267-2323, extension 6-1565.^[2]

A HealthCare.gov Marketplace plan

HealthCare.gov lists the “death of a family member” as one way of losing coverage you had through a spouse that may qualify you for a Special Enrollment Period. It also says that if someone on your Marketplace plan dies and that causes you to lose your current plan, you qualify.^[3]

The timing works in both directions. If your coverage has already ended, pick a plan within 60 days after the date it ended, and coverage starts the first day of the month after you pick. If it will end soon, you can pick a plan within 60 days before the end date, and coverage starts the first day of the month after the old coverage ends and you pick a plan.^[4] If the 60 days pass, you wait for the next Open Enrollment, November 1 to January 15, unless another Special Enrollment Period applies.^[4][3] If your Special Enrollment Period is turned down, you can appeal.^[3]

Papers that prove the lost coverage

After you apply, the Marketplace may ask you to send documents. Your eligibility notice will tell you. If it does, you have 30 days after picking a plan to send them, and you cannot use the new coverage until the Marketplace confirms eligibility and you pay the first premium.^[4]

The documents must show your name and the date the coverage ended.^[5]

Send photocopies, never originals. If you cannot get any of the listed documents, HealthCare.gov offers a letter of explanation form instead.^[4]

COBRA and the Marketplace together

Being offered COBRA does not make you ineligible for Marketplace coverage or for a tax credit, and HealthCare.gov suggests comparing the cost of the two before deciding.^[2][6] Know one rule before you sign anything. Outside Open Enrollment, ending COBRA early by your own choice, including by stopping payments, does not open a Special Enrollment Period. When COBRA runs out, you get 60 days to enroll in a Marketplace plan.^[6][3]

The two clocks count from different days. The Marketplace’s 60 days run from the date your job-based coverage ends, and the COBRA election period runs from the later of that date or the date the notice is provided, so the two deadlines can differ.^[4][2] Write both down.

If you and your spouse were on a Marketplace plan together

Report the death to the Marketplace as soon as you can. A death is one of the household changes HealthCare.gov asks enrollees to report.^[7] A smaller household can change the savings you qualify for. If you do not report the change and keep using advance premium tax credits (a tax credit you can take in advance to lower your monthly premium), you may have to pay back the difference when you file your federal tax return.^[19]

Medicaid, and states with their own Marketplace

If you qualify for Medicaid or the Children’s Health Insurance Program, you can enroll any time of year.^[6] Some states run their own Marketplace, and how you apply depends on whether yours does. HealthCare.gov’s state page sends you to the right place.^[8] The deadlines above are HealthCare.gov’s. If your state runs its own Marketplace, confirm the deadline with it.

Age 65 or older: the Medicare Part B window

This section is for one situation. You are 65 or older, you put off Medicare Part B because a job-based plan based on your spouse’s current work covered you, and that plan or Part B covered you in every month since you first became eligible for Part B. Federal rules tie this window to coverage based on current employment.^[10] Social Security’s definition leaves out COBRA continuation coverage, and it treats a retiree plan as coverage based on former employment, so neither one counts toward this window.^[20] If you have Medicare because of a disability, separate rules apply.^[10] In that case, or if you already have Part B or are not sure which applies, ask Social Security or a SHIP counselor before you rely on the dates below.

Social Security’s policy manual states the rule for a death. If your spouse’s job-based plan covered you when your spouse died, you can sign up during the 8 months that begin the month after the month of death.^[9] For a death in March, the window runs from April through November. Social Security and Medicare.gov call this a Special Enrollment Period for Part B. Part B coverage starts the month after Social Security gets your completed forms, so the date they arrive sets your start month.^[11]

COBRA does not pause this clock. Medicare.gov says the 8-month window starts even if you choose COBRA or other coverage that is not Medicare.^[11] The Department of Labor adds that choosing COBRA instead of Medicare may mean a late-enrollment penalty, and may mean a gap in coverage if you later want Part B. It also says that enrolling in Medicare before COBRA ends may let the plan end your COBRA.^[2] If you miss the 8 months, Medicare.gov says you wait to sign up, may go months without coverage, and may pay a monthly penalty for as long as you have Part B.^[11]

Forms and proof for Social Security

If you already have Part A, sign-up in this window uses two forms sent together: the Request for Enrollment in Part B (CMS-40B) and the Request for Employment Information (CMS-L564). If you do not have Part A yet, ask Social Security which forms apply.^[12] You complete Section A of the CMS-L564, and the employer or the plan completes Section B. Both forms are on the Medicare.gov enrollment forms page.

If the employer or plan cannot provide that proof, Social Security accepts other documents, including:^[13]

• tax returns that show health insurance premiums paid
• W-2s with pre-tax medical contributions
• pay stubs with health premium deductions
• health insurance cards with a policy effective date
• explanations of benefits paid by the plan
• statements or receipts for premium payments

Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), which handles Part A and Part B sign-up, and ask where to send the forms. The worksheet’s call log has a line for the answer.^[15][18]

Drug coverage and Medicare Advantage

Once you have Medicare, leaving coverage from an employer or union, including COBRA coverage, gives you 2 full months after the month that coverage ends to join a Medicare drug plan, or, if you have Part A and Part B, a Medicare Advantage Plan.^[14] The next section lists free counseling for choosing among plans.

Free help and the phone numbers in one place

State Health Insurance Assistance Programs (SHIPs) help people with Medicare and their families choose a plan, review coverage, understand costs, and file a complaint or appeal.^[15] SHIP counseling is one-on-one and comes at no cost to you; find your state’s program at shiphelp.org.^[16] For Marketplace questions, HealthCare.gov lists local help at localhelp.healthcare.gov as well as its call center.^[3]

Every number in this table belongs to a government office or a government-funded program.

Other guides that may help

Health coverage is one call among many in the first months. The surviving spouse checklist organizes household bills, income and provider calls. The Social Security after a death guide covers survivor benefits, which are a separate claim from Medicare. The death notification log tracks every office and company you tell.

For bills the person left behind, medical bills included, the debts after death guide explains when family members are and are not responsible.