Health Insurance After a Death: COBRA, Marketplace, and Medicare Options
Losing a loved one can also mean losing your health insurance. If you were covered through a family member's employer plan, you need to act quickly to avoid a gap in coverage. This guide walks through every option available to you.
Time-Sensitive: Act Within 60 Days
Most health insurance options after a death have a 60-day enrollment window. If you miss this window, you may have to wait until the next Open Enrollment Period (November 1 to January 15) or go without coverage. Make this one of your first priorities.
Your Options at a Glance
COBRA
Continue employer coverage for up to 36 months
Cost: Up to 102% of full premium
Deadline: 60 days to elect
ACA Marketplace
New plan with potential subsidies
Cost: Varies; subsidies available
Deadline: 60 days to enroll
Medicare
For those 65+ or with qualifying disabilities
Cost: Part A free for most; Part B ~$185/month
Deadline: 8-month SEP
Medicaid / CHIP
For lower-income individuals and children
Cost: Free or very low cost
Deadline: Apply any time
COBRA Continuation Coverage
COBRA (Consolidated Omnibus Budget Reconciliation Act) allows dependents of a deceased employee to continue the same group health plan they had before the death. This means you keep the same doctors, the same network, and the same coverage.
Key COBRA Facts
How to Elect COBRA
- 1.Notify the employer. The employer must notify the health plan within 30 days of the employee's death. If the employer does not do this, contact the plan administrator directly.
- 2.Receive the COBRA election notice. The plan must send you a COBRA election notice within 14 days of being notified of the death.
- 3.Elect COBRA within 60 days. Complete the election form and return it to the plan administrator.
- 4.Pay the first premium within 45 days of electing COBRA. Subsequent premiums are due within 30 days of each due date.
Tip: You do not have to decide immediately. You have 60 days to elect COBRA, and coverage is retroactive. This gives you time to compare COBRA costs with marketplace plans. If you need medical care during this window, elect COBRA and pay retroactively to ensure coverage.
State "Mini-COBRA" Laws
Federal COBRA only applies to employers with 20 or more employees. However, most states have their own continuation coverage laws (often called "mini-COBRA") that cover smaller employers. Coverage periods and rules vary by state.
States with notable mini-COBRA provisions include:
California
36 months (Cal-COBRA)
New York
36 months
Texas
9 months
Illinois
12 months
Florida
18 months
Massachusetts
36 months
Contact your state's Department of Insurance to learn your state's specific rules.
ACA Marketplace Special Enrollment Period
The death of a family member who provided your health insurance is a qualifying life event that triggers a 60-day Special Enrollment Period (SEP) on the ACA marketplace. You can enroll in a new plan through healthcare.gov or your state's marketplace.
Marketplace Advantages
- Premium tax credits. Based on your household income, you may qualify for substantial subsidies that reduce your monthly premium. Many people qualify for plans under $100/month.
- Cost-sharing reductions. If your income is below 250% of the federal poverty level, Silver plans come with lower deductibles and copays.
- Guaranteed coverage. Marketplace plans cannot deny coverage or charge more based on pre-existing conditions.
- Plan choice. Choose from Bronze, Silver, Gold, and Platinum tiers based on how much coverage you need.
How to Enroll
- 1.Go to healthcare.gov (or your state's marketplace if your state has its own)
- 2.Create an account or log in
- 3.Report the qualifying life event (death of a family member)
- 4.Provide documentation (death certificate, proof of prior coverage)
- 5.Compare plans and select coverage
- 6.Coverage begins the first of the month after plan selection
COBRA vs. Marketplace: Which Is Better?
| Factor | COBRA | Marketplace |
|---|---|---|
| Monthly cost | $600 to $2,000+ | $0 to $500+ (with subsidies) |
| Subsidies available | No | Yes |
| Same doctors/network | Yes | May differ |
| Coverage duration | Up to 36 months | Renewable annually |
| Enrollment deadline | 60 days | 60 days |
For most people, marketplace plans with subsidies will be significantly cheaper. However, if you are in the middle of treatment and need to keep your current doctors, COBRA may be worth the higher cost in the short term. You can also start with COBRA and switch to a marketplace plan during the next Open Enrollment Period.
Medicare Transitions
Medicare applies in several scenarios after a death. Your situation depends on your age and how you were previously covered.
If You Are 65 or Older
If you were covered under your deceased spouse's employer plan and delayed enrolling in Medicare Part B, you have an 8-month Special Enrollment Period (SEP) to sign up without a late enrollment penalty. This 8-month window starts the month after employer coverage ends.
- Medicare Part A: Free for most people (if you or your spouse paid Medicare taxes for 40+ quarters). Enroll through Social Security.
- Medicare Part B: Standard premium is approximately $185/month in 2025. Covers doctor visits, outpatient care, preventive services.
- Medicare Part D: Prescription drug coverage. Enroll during the same SEP. Monthly premiums vary by plan.
- Medigap (Medicare Supplement): Consider enrolling in a Medigap plan during your 6-month open enrollment window to cover out-of-pocket costs.
If You Are Under 65
You are generally not eligible for Medicare unless you have a qualifying disability (after a 24-month waiting period) or have end-stage renal disease or ALS. Your options include:
- COBRA continuation coverage (up to 36 months)
- ACA marketplace plan with potential subsidies
- Medicaid if your income qualifies
- Your own employer's plan (adding yourself during a special enrollment triggered by the death)
If the Deceased Had Medicare
The deceased person's Medicare coverage ends on the date of death. Notify Medicare by calling 1-800-MEDICARE (1-800-633-4227). If the deceased was enrolled in a Medicare Advantage plan or Part D prescription drug plan, contact those plans directly as well. Return the deceased's Medicare card to Social Security or destroy it to prevent fraud.
Medicaid Eligibility After a Death
A death in the family often changes household income, which may make you newly eligible for Medicaid. Unlike COBRA and the marketplace, you can apply for Medicaid at any time; there is no limited enrollment period.
Medicaid Basics
- Income threshold: In states that expanded Medicaid, adults with income up to 138% of the federal poverty level qualify (approximately $20,783 for an individual or $43,056 for a family of 4 in 2025).
- Coverage: Comprehensive, including doctor visits, hospital stays, prescriptions, mental health, and more. Little or no cost to the enrollee.
- How to apply: Through healthcare.gov, your state Medicaid office, or by phone.
- Non-expansion states: 10 states have not expanded Medicaid. In these states, childless adults often do not qualify regardless of income. Check your state's specific rules.
Children's Health Insurance Program (CHIP)
CHIP provides low-cost or free health coverage to children in families with incomes too high for Medicaid but too low to afford private coverage. If a parent's death reduces household income, children may newly qualify.
- Age: Covers children up to age 19
- Income: Typically up to 200% to 300% of the federal poverty level (varies by state; some states cover up to 400%)
- Cost: Free or very low premiums and copays
- Coverage: Doctor visits, hospital care, dental, vision, prescriptions, mental health
- Apply: Any time at healthcare.gov, by calling 1-800-318-2596, or through your state CHIP program
Adding Yourself to Your Own Employer's Plan
If you have your own employer but were covered under your spouse's plan, the death of your spouse is a qualifying life event that allows you to enroll in your employer's health plan outside the normal open enrollment period.
- Notify your employer's HR department as soon as possible.
- Most employers require you to enroll within 30 days of the qualifying event (shorter than the 60-day COBRA/marketplace window).
- You can add your children to your employer plan at the same time.
- Employer plans often have lower premiums than COBRA because the employer subsidizes part of the cost.
Health Insurance Action Checklist
- 1Determine how you were covered. Was it through the deceased's employer, your own employer, Medicare, Medicaid, or a private plan?
- 2Check your deadline. COBRA and marketplace both have 60-day windows. Your own employer may require action within 30 days.
- 3Compare your options. Get the COBRA cost from the plan administrator, then check marketplace prices at healthcare.gov with estimated subsidies.
- 4Check Medicaid eligibility. Your household income may have changed. Apply at healthcare.gov or your state Medicaid office.
- 5Enroll in coverage. Choose the best option and complete enrollment before your deadline expires.
- 6Check children separately. Your children may qualify for CHIP even if you do not qualify for Medicaid.
Frequently Asked Questions
How long does COBRA coverage last after a death?
When an employee dies, their dependents (spouse and children) can continue the employer's group health plan through COBRA for up to 36 months. This is longer than the 18-month period available for voluntary job loss. You must elect COBRA within 60 days of the loss of coverage and can pay premiums retroactively to avoid any gap.
Can I get marketplace insurance after my spouse dies?
Yes. The death of a spouse or family member who provided your health insurance is a qualifying life event that triggers a 60-day Special Enrollment Period on the ACA marketplace (healthcare.gov or your state marketplace). You may qualify for premium tax credits and cost-sharing reductions based on your income. You are not required to use COBRA; you can go directly to the marketplace.
Is COBRA or marketplace insurance cheaper?
In most cases, marketplace insurance with subsidies is significantly cheaper than COBRA. COBRA premiums are the full cost of the employer plan (up to 102%, including a 2% administrative fee), which typically ranges from $600 to $2,000+ per month for family coverage. Marketplace plans with premium tax credits can cost much less, sometimes as low as $0 per month for lower-income households. However, COBRA may offer better provider networks or lower deductibles.
What happens to Medicare when a spouse dies?
If the deceased spouse had Medicare, their coverage ends on the date of death. The surviving spouse's own Medicare coverage is not affected. If the surviving spouse was covered under the deceased spouse's employer plan and is 65 or older, they have an 8-month Special Enrollment Period to sign up for Medicare Part B without a late enrollment penalty. If the surviving spouse is under 65, they should explore COBRA, marketplace, or Medicaid options.
Can children get health insurance after a parent dies?
Yes. Children can be covered through COBRA (up to 36 months), added to the surviving parent's employer plan (death is a qualifying event), enrolled in a marketplace plan during the 60-day Special Enrollment Period, or covered by the Children's Health Insurance Program (CHIP) or Medicaid if the family income qualifies. CHIP covers children up to age 19 in all 50 states.
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