Understanding Divorce as a Qualifying Life Event for Medical Insurance Providers


  • For medical insurance providers, divorce is considered to be a qualifying life event for a special enrollment period.
  • Changes to the ACA may cause variation in circumstances, depending on medical insurance providers.
  • Medical fees and child coverage should be ironed out in the divorce decree.

For individuals experiencing a divorce, there already is a lot to have to sort through during the process. Between dividing assets and sorting through all of the ins and outs of child custody, the experience can create chaos for those looking to make sense of many of the logistical odds and ends that divorce can create.

In some situations, it is more about how outside entities interpret the event of your divorce. One of those is health insurance providers.

The event of a divorce can cause classification issues for these providers, who are required to handle the logistics of complicated situations like divorce. As far as insurance is concerned, many providers look to define specifics of life situations, in order to avoid the confusion of how to proceed.

Insurance providers tend to define divorce as a Qualifying Life Event (QLE). Depending on the provider or employer involved, there may be different stipulations and qualifications to follow.

ACA and Qualified Life Events

For health insurance providers, qualified life events make you eligible for special enrollment periods through your providers. Under the Affordable Care Act, there are four basic categories – loss of health coverage, changes in household, changes in residence, and other – that qualify for life events.

In the instances of losing health coverage as a qualifying life event, it would have to be an existing plan. These include individual plans, job-based plans, and student plans. These also are for those have lost eligibility for Medicaid, Medicare, or Children’s Health Insurance Program or for those that have lost coverage through a parents plan by turning 26 years old.

For those changing residence by moving to a different ZIP code or county, moving to or from the place where they attend school, working seasonally causing a move to or from the place where they work and live, or moving to or from a shelter or other form of transitional housing, you are eligible for the qualifying life event.

Under the category marked ‘other,’ the events that are eligible for the qualifying life event are changes in your income that affect the coverage that you qualify for, membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder, the acquisition of U.S. citizenship, leaving incarceration, and AmeriCorps membership starting or ending.

In instance of changes within the household, like getting married or divorce, having a baby or adopting a child, or a death in the family. It is important to understand how to proceed during the challenges that you already are facing during the divorce experience.

COBRA and Child support

With the obligation of paying for an ex-spouse’s health insurance, courts are looking to maintain the status quo in policies and practices that were in place prior to the filing of the divorce. Until the decree is finalized, this can require the utilization of the Consolidated Omnibus Budget Reconciliation Act (COBRA), for a continuation of coverage for a maximum of 36 months. This bridges the insurance coverage, until the ex-spouse can acquire coverage of their own.

In cases where child support is involved, it can be dependent on the state and the way it is calculated. Some states assign child support as a straight percentage of the noncustodial income. This child support is separate from your health insurance obligation, and without a change in your income, a judge will rarely adjust child support.

Some states approach child support as a pro rata percentage of both parents’ income, which combines both parents’ income, determines, what amount of this joint income is typically spent on child rearing, and assigns child support based on the secondary parent’s percentage share of that combined income.
This form of child support takes into account expenses like health insurance coverage, and any increase in coverage could be grounds to have the child support obligation readjusted.

Divorce decree

Divorce decrees can be key in helping to understand how medical expenses are sorted. In many states, the decree includes the language that specifies what to do about medical expenses and what health insurance plan children of divorce fall under.

If the order specifies that these expenses will be divided one-half by both parties like it does in some states, then when you get the bill (assuming the bill is in your name) from the medical provider, you can seek reimbursement from your ex-spouse for one-half of the expense.

Clarification and support

In clarifying medical insurance and the expenses that may be left up in the air, it gives you, an individual experiencing the divorce process, the ability to solidify the language of the divorce decree before it becomes final.

It also is important to consult with your attorney on any concerns that you may have, as it pertains to insurance and medical expenses that may be in dispute during the divorce.

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