COBRA Insurance Eligibility

Learn who qualifies and can enroll in COBRA Insurance

COBRA Eligibility

Understanding if your qualify for COBRA insurance is an important step to take while you determine if COBRA is the right health insurance plan for you. Knowing your options will help you to make smart decisions for yourself and your family. If you realize that you are not qualified to continue your health insurance with federal COBRA, it is important to always check to see if your qualify with state COBRA insurance. Many states offer mini COBRA plans that extend coverage beyond the federal requirements.

Under the federal COBRA law there are three basic criteria for qualifying and being eligible to continue coverage with COBRA. They are:

  • Your group health insurance plan must be covered by COBRA,
  • A qualifying event must happen,
  • And you must be a qualified beneficiary eligible for coverage
Qualifying Plan

Under the qualifying plan requirement for federal COBRA insurance, the group health insurance plan that you had with your previous employer must have covered at least 20 full time employees or their part time equivalents.

Qualifying Event

The qualifying event is the reason that you are losing health insurance coverage. Depending on if you are the employee or someone covered under their health insurance plan, there are different qualifying events. For an employee, an eligible qualifying event includes quitting, retiring, or being terminated from a job without the presence of gross misconduct (i.e. theft, sexual harassment, or another serious offense). A qualifying event for an employee can also be having your hours reduced to an amount that no longer qualifies you for group health insurance.

A spouse, child, or another dependent who was covered by the employee’s plan qualifies if the employee qualifies (i.e. quit, was terminated, or retired), but there are also additional reasons for which they may be eligible. These include the covered employee becoming eligible for Medicare, the death of the covered employee, or divorce from the covered employee. Additionally, if a child loses their “dependent child” status, usually due to age, they can also qualify for COBRA insurance.

Qualifying Beneficiary

Quite simply, the qualified beneficiary is who is eligible to continue health insurance. In almost all circumstances this includes anyone who was covered by the plan on the day of the qualifying event. Normally this means the covered employee’s spouses, children, and other dependents. While on COBRA insurance, any new children can also be added to the COBRA plan.

Summary of Eligibility for COBRA Insurance
Qualifying Event Qualifying Beneficiary COBRA Term Length
Qutting, retiring, being terminated from a job or having hours reduced Employee 18 months in most circumstances
Divorce or legal seperation Spouse, child, dependent 36 months
Death of employee Spouse, child, dependent 36 months
Covered employee eligible for Medicare Spouse, child, dependent 36 months
Loss of “dependent status” with plan Child, dependent 36 months

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