Understanding How Health Insurance Works After the Death of a Spouse

Health insurance is the last thing on your mind when your wife or husband passes away. But it’s something you must think about to ensure continued coverage.

“When you’re grieving, few things make sense, yet you may want to start thinking about alternative health insurance options," said Tara Stombaugh, Director of Consumer Sales and Client Services with Avera Health Plans.

What to Do When a Primary Policyholder Passes Away

In many cases, one spouse provides the coverage for both partners and the entire family. If that person dies, the surviving spouse may face a sudden loss of coverage. The death of a policy holder is most often a qualifying life event. It opens a 60-day special enrollment period for you and your family. The period is usually 60 days; it can vary with some private insurance providers.

If the deceased spouse received health coverage from an employer, the surviving spouse should:

• Contact the employer or its human resources department
• Explain the situation and ask if there is a grace period
• Ask about alternatives and options that may be offered
• File any paperwork or complete online forms to ensure coverage continues, if possible

You may need a letter from your health insurance company showing the termination or upcoming termination of coverage. Get that information and submit it. Remember that you may need a copy of the death certificate to ensure completion of these steps.

What to Do When a Dependent Passes Away

If you provided coverage for a loved one who dies, contact your insurance provider. They can guide you through the process to update your coverage. To make changes you’ll need a certified death certificate. Make sure you receive an electronic version of this document, as you’ll likely need to upload it.

While death of a spouse is a qualifying event federally, some insurance plans require an update in less time. This could include changes to a medical flexible spending account or one focused on dependent care.

If you get your insurance as an employee, contact your HR team. They can guide your enrollment changes for your loved one who passed. You may need to make additional changes, such as for life insurance no longer needed.

If you and your loved shared a Medicare supplement plan together, contact your insurer so they can adjust the rate.

Your Options for Coverage

If you must switch plans, you’ll have options including enrolling in your employer-sponsored plan. If that’s not an option, you can also consider plans through the Federal Marketplace.

You may be eligible to continue coverage through the Consolidated Omnibus Budget Reconciliation Act, or COBRA. For a limited time, COBRA lets you maintain coverage, yet this coverage often comes with significant costs. You may need to pay the full premium, including the portion previously covered by the employer.

The extended coverage can continue for 36 months, and most employers with 20 or more full-time employees offer COBRA for spouses and dependent children. Usually you must sign up 60 days from the day your loved one passed away.

Other Federal Programs that Help Widows and Widowers

Consider eligibility for government-sponsored insurance programs, including Medicaid.

Eligibility is based on income, and the loss of a spouse's income due to death may change the surviving spouse's eligibility. Exploring options through Medicaid or other state-sponsored programs can ensure continued access to health care services. Medicare is another option for those who are 65 or older.

An insurance agent can help you during this difficult time and answer your questions.