If you just lost your spouse and got health insurance through them, you don’t need to be uninsured now. The death of a policy holder is a Qualifying Life Event (QLE) that allows the surviving spouse and dependents to be able to get Marketplace insurance. QLEs trigger what is known as a Special Enrollment Period (SEP), which allows you to enroll in Marketplace health insurance (also known as Obamacare plans or Affordable Care Act plans) at a time outside of the annual Open Enrollment Period.
Here’s more about what to know about how to get health insurance after the death of a spouse.
How does the death of a spouse trigger a Qualifying Life Event?
Qualifying Life Events for Special Enrollment Periods can be triggered by changes in the nature of your household. And the death of a spouse who is the health insurance policy holder in your household is one such kind of change. Grab our free guide to see the full list of the Qualifying Life Events (QLEs).
If you lost your existing health insurance as a result of a death, you may have a QLE. And this QLE may prompt a Special Enrollment Period (SEP), allowing you to sign up for your own ACA-compliant Obamacare plan through the Marketplace.
Typically, SEPs trigger a 60-day period in which you can apply and get covered through the Marketplace.
You can see plans, prices, and what subsidies you’re eligible for by entering your zip code below.
What happens during a Special Enrollment Period?
While typically you can only enroll in health insurance through the Marketplace once a year during the annual Open Enrollment Period, there are exceptions. If you have a Qualifying Life Event like the death of a policy holder, you may be able to enroll during a Special Enrollment Period.
You may need to verify your eligibility and submit certain documents to confirm your QLE. If you have lost your health insurance coverage as a result of not being covered through a spouse’s plan as a result of the death of the policy holder, you will need a letter from your health insurance company showing the termination or upcoming termination of your coverage. Grab our free guide here to see what documents you need to submit for a QLE.
After your QLE is verified, you will be able to shop the Marketplace just as you would during Open Enrollment Period. You can compare available plans and premiums, and see what premium tax credits you may be eligible for.
Remember, you will have 60 days from your QLE for your Special Enrollment Period (SEP). Don’t miss this deadline—after the close of your SEP, you will need to wait for the next Open Enrollment Period to enroll in Marketplace insurance if you still have not enrolled.
What are my other options for health insurance?
To get Marketplace insurance (aka Obamacare or Affordable Care Act insurance), go to healthsherpa.com or call us at (872) 228-2549. You also have a couple other options listed below.
COBRA health insurance
One other option might be COBRA health insurance. If you have and then lose job-based health insurance through an employer, including through the death of a policy holder, you may be offered COBRA coverage. To qualify for COBRA continuation, you must have a “qualifying event.” Losing benefits previously available to you through the policy holder’s employer is such a qualifying event.
With COBRA health insurance, you can keep the health insurance you had for 36 months after the qualifying event by paying 100% of the premiums associated with it, plus a 2% administrative fee. This means you will be paying more for this same coverage than you once did, since no employer is covering any portion of your monthly premium.
Many people like COBRA health insurance because they can continue the coverage they’re familiar with. However, for most people COBRA coverage will be substantially more expensive than coverage available through the Marketplace.
You can get our guide to COBRA here.
Medicaid health insurance
Depending on your income level, you may also qualify for Medicaid health insurance. Medicaid is a program jointly funded by the federal government and the states to provide health insurance coverage to low-income Americans. Medicaid eligibility is determined based on income level. Adults, children, pregnant women, the elderly, and people with disabilities all can become Medicaid recipients.
You can see if you’re eligible and apply for Medicaid here.
Each state sets up and administers their own Medicaid program and determines the scope of services provided. This is based on a broad set of federal guidelines.
Federal law requires that all Medicaid programs cover a certain set of “mandatory benefits.” These benefits include inpatient and outpatient hospital services, nursing facility services, home health services, physician services, and laboratory and x-ray services. Also mandatory are family planning services, nurse midwife services, certified pediatric and family nurse practitioner services, freestanding birth center services (when already licensed and recognized by the state), and smoking cessation counseling for pregnant women.
You can get our guide to Medicaid here, and you can enter your zip code below to see if you’re eligible for Medicaid.
Medicaid eligibility
The Affordable Care Act (ACA) allowed states to choose to expand their Medicaid programs to cover low-income adults. Whether or not you qualify for Medicaid, and what the income limits are, depends on whether your state expanded Medicaid and whether you meet any other criteria (for example, if you are pregnant, are parenting a child under the age of 19, or have a disability.).
So far, 37 states and DC have chosen to cover otherwise ineligible adults through their Medicaid programs, although two states – Idaho and Nebraska – have not yet implemented the expansion. In most of these states, anyone making less than 138% of the Federal Poverty Level can qualify for Medicaid. That’s $17,608 for an individual and $36,156 for a family of four. In the 14 states that have chosen not to expand their Medicaid programs, adults usually do not qualify for Medicaid unless they meet additional conditions.
As of January 2020, 49 states cover children with incomes up to at least of 200% of the the Federal Poverty Level through Medicaid. (That would be an annual income of $43,440 for a family of three.) Additionally, 34 states cover pregnant women with incomes at or above 200% of the Federal Poverty Level (FPL).
And 32 states cover parents and other adults with incomes up to at least 138% FPL as a result of the ACA’s allowance of Medicaid expansion to low-income individuals. A few additional states have also opted in to Medicaid expansion, but their programs have not been implemented yet.
Applying for Medicaid
You can apply for Medicaid at any time, even outside of the annual Marketplace Open Enrollment period.
Through HealthSherpa, you can immediately find out whether you qualify for Medicaid based on your income, where you live, and whether your state has opted into Medicaid expansion. You can get started by entering your zip code here.
If you’re eligible, you can start your Medicaid application through HealthSherpa. Once you’re finished, your application will be submitted to your state’s Medicaid agency. They will review your information and send you an official letter of determination within a few weeks. However, if you don’t hear from them, we always recommend giving them a call.