How long does COBRA last? It seems like a simple enough question, but when is anything simple? When it comes to COBRA coverage, you need to understand why COBRA coverage is being offered to really understand how long COBRA lasts.
Reason 1: Termination or reduction in hours
When group coverage is lost due to termination or a reduction in hours, qualified beneficiaries must be provided with 18 months of continuation coverage from the date of the qualifying event. This is the most common and well understood COBRA coverage period.
Reason 2: Qualifying events affecting spouse and dependent coverage
In addition to termination, a spouse or dependent can experience a qualifying event causing them to lose coverage through the covered employee’s plan. Key qualifying events include:
- Covered employee becomes entitled to Medicare;
- Divorce or legal separation of the spouse from the covered employee;
- Death of the covered employee.
- Loss of dependent child status under the plan rules. Under the Affordable Care Act, plans that offer coverage to children on their parents’ plan must make the coverage available until the adult child reaches the age of 26.
In each of the above scenarios, the spouse or dependent is eligible for up to 36-months of coverage.
Reasons 3 & 4: Secondary qualifying events
Since things are never black and white anyways, we thought we would muddy it up a little bit. In addition to “qualifying events”, qualified beneficiaries can be affected by “secondary qualifying events”. This means that the original coverage period may be extended (or affected) due to an additional event which occurred in relation to when COBRA was initially offered.
Extension due to disability
The original COBRA term can be extended up to 11 months if the covered employee becomes disabled in the first 60 days of COBRA continuation coverage. This means, if you become disabled, you and your family may extend your COBRA coverage for an additional 11 months, but you may be required to pay up to 150% of the premium cost for those additional 11 months.
Medicare coverage prior to COBRA event
If the covered employee became entitled to Medicare less than 18 months before the qualifying event (aka termination), COBRA coverage for the employee’s spouse and dependents is adjusted based on the date the employee became eligible for Medicare. This means if the spouse or dependent was eligible for 36 months of coverage, it would be reduced by the number of months the covered employee was entitled to Medicare.
Let’s go through a scenario with Joe.
Joe was entitled to Medicare in January 2019, but continues on his employer’s health plan. He retires June 1, 2019. He enrolls in Medicare, but his wife, Jane, intends to continue the benefit. His wife would be eligible for 31 months (36 months less 5 months past since Joe was entitled to Medicare.)
Reason 5: State mandated coverage period
States may require that the COBRA coverage period is extended beyond the Federal coverage periods. States may also require “mini-COBRA” plans which affect employers with less than 20 employees as required by Federal COBRA.
Reason 6: Employer’s choice
Employers are entitled to offer a longer COBRA coverage period than required by Federal or State laws. It must be consistently applied for all qualified beneficiaries.
Avoid the muddy areas with a little help!
While the question “How long does COBRA last?” seems simple, COBRA is not always black and white. However, hopefully you can reduce the grey or muddy areas. When in doubt, contact our COBRA support team or check out the Department of Labor COBRA FAQ.
You can also browse our COBRA blogs for more information. Start with Understanding How Medicare and COBRA Interact or 6 Reasons Besides Job Loss You’re Eligible for COBRA.
For more guidance on simplifying the complexity of benefits for maximum savings and peace of mind, subscribe to the Benefit Resource Blog today.