HEALTH INSURANCE AND DIVORCE
How will I be treated if I come off my spouse’s plan?
Is legal separation treated the same as divorce?
Who is responsible for the children’s insurance coverage?
Who decides?
First things first
Being a woman is not considered a ‘pre-existing’ condition. Although before 2024, you could be forgiven for thinking so. Before the implementation of the Affordable Care Act, the cost of health insurance was far higher for women than for men and did not include either pre- or post-natal care.
Nowadays, adults of any gender are treated even-handedly in health insurance matters, whether in partnership, marriage, divorce, or separation and if children are involved, their welfare is placed foremost.
However, it is a fact that a substantial proportion of the American population (in some states, more than 50%) is enrolled in group (employer-sponsored, ESI) plans. The evidence suggests that fewer married women than married men {Social, Economic, and Housing Statistics Division U.S. Census Bureau) enroll in group plans, and more women enroll in their spouse’s plan than men. As a consequence, it would be no surprise to find that when faced with divorce or separation, women where children are involved are more anxious about the issue of health insurance than men.
How will I be treated if I come off my spouse’s plan?
Regarding health insurance, federal law dictates that coverage ends when you are divorced. You must also advise your insurers before this date. Any claim made after that date might be regarded as fraudulent.
When one spouse provides healthcare during the marriage for the other and any family members, one of the most daunting things a spouse may face is the prospect of getting replacement coverage. It may be possible to include existing arrangements in the divorce settlement. By agreement between spouses, it may be possible to continue existing arrangements until the next open enrollment (November 1st). In any case, divorce triggers the opportunity for a 60-day personal enrollment period (SEP) when you can enroll in the plan of your choice.
Is legal separation treated the same as divorce?
Like many other aspects of divorce, the law varies from state to state. In some states, it is illegal for one spouse to drop the other from the family health insurance plan, even if a legal separation is in place. In others, legal separation is treated in the same way as divorce (see above).
In every state, an employer will cease to cover a spouse following a divorce (or legal separation) under their employee healthcare policy. Check with your legal advisor or your health insurance broker.
Who is responsible for the children’s insurance coverage?
It is the parents’ joint responsibility to establish how the child’s (children’s) healthcare will be managed. Still, ultimately, the court will decide how the cost of health insurance for any dependent children will be divided following divorce (or legal separation). It would be advantageous to both parties if this could be amicably negotiated and agreed upon beforehand.
Many factors come into play when determining who is responsible for child health insurance after divorce. The specific arrangements can vary depending on state laws, court orders or agreements, and the individual circumstances of the parents and children. Understanding these factors is essential to establish a clear plan for providing health insurance coverage for the children.
These are some of the critical factors a divorce court would take into account in determining the responsibility for child health insurance: –
Court Orders or Divorce Agreement
If a court order or divorce agreement is already in place, it may outline the responsibilities and obligations related to child health insurance. These documents can guide who should provide the coverage and how the costs will be divided.
Income and Financial Situations
The income and financial situations of the divorcing parties are significant factors in determining to what extent each party will be responsible for child health insurance. For example, one parent may have a higher income and better access to affordable health insurance options; they may be expected to assume the primary responsibility for providing the coverage.
Employment and Employer-Sponsored Coverage
If only one parent has access to employer-sponsored health insurance that covers dependents, they may be expected to include the children under their plan. If both have access to group insurance, it makes sense to share the costs of the more favorable plan.
Cost-Sharing Agreement
It may be possible to agree to share the costs of child health insurance, e.g., by splitting the premiums and out-of-pocket expenses in agreed-upon percentages between each parent. The terms of the cost-sharing agreement should be documented and agreed upon by both parties.
Availability of Federal/State subsidies
When one or both parents do not have access to affordable employer-sponsored coverage and when a joint household income becomes two separate incomes, government/state subsidies,e.g., premium tax relief, are more generous, and programs like Medicaid or CHIP may also become an option for providing health insurance for the children.
Summary
Determining how you will share the economic responsibility for child health insurance should always put the children’s best interests first. Considering their healthcare needs, the parent’s financial capabilities, and any existing legal agreements or court orders is essential. In some circumstances, it may be helpful to include a family law attorney mediator or a trained health insurance specialist to help establish a fair and effective plan for child health insurance.
