FAQs on COBRA Continuation Health Coverage for Workers

COBRA is a federal law that allows workers and their families to temporarily keep their health coverage in certain situations, such as job loss, a reduction in hours, or other job and life transitions.⁽¹⁾

Many group health plans are required to offer COBRA for a limited time to covered employees, their spouses, and dependent children. If you’re laid off or your hours are cut, COBRA helps bridge the gap in coverage until you can enroll in a new health plan.

You usually pay the full premium for COBRA. The total premium includes both the share you used to pay as an active employee and the amount your employer used to contribute, plus two percent.

However, some employers may agree to pay part or all of the cost as part of a severance package. This isn’t required. 

Cost is an important consideration when electing COBRA. If you want to find out exactly how much COBRA will cost, contact your plan sponsor.

Your health plan is covered by COBRA if your employer is one of the following:

• A private-sector employer or employee organization, such as a union, with 20 or more employees.
• A state government.
• A local government.

COBRA does not cover plans sponsored by the federal government or by churches and certain church-related organizations.

Many states have similar laws to COBRA, often called “mini-COBRA.” These laws apply to health plans that provide benefits under insurance contracts and may cover employers with fewer than 20 employees. Check with your state insurance commissioner's office to see if this coverage is available.

Yes, before choosing COBRA continuation coverage, consider other health coverage options that may be more affordable or offer better benefits for you and your family. These include:

• A spouse’s, parent’s, or dependent’s own group health plan: You may qualify for coverage in another group health plan if you exercise a special enrollment right within 30 days of losing your job-based health plan. Coverage would become active on the first day of the month after you exercise your special enrollment right.
• The Health Insurance Marketplace: The Marketplace is a government-run platform where you can compare and purchase private health insurance. You may qualify for tax credits or cost-sharing reductions to lower your premiums and out-of-pocket costs. You must select a plan within 60 days of losing your job-based coverage. Choosing COBRA does not prevent you from enrolling in the Marketplace later if you qualify for a new special enrollment. Learn more or apply at HealthCare.gov or call (800) 318-2596 TTY (855) 889-4325.
• Medicaid and the Children’s Health Insurance Program (CHIP): If you qualify, these programs offer free or low-cost health coverage, and you can enroll at any time. Learn more or apply for Medicaid through HealthCare.gov or call (800) 318-2596 TTY (855) 889-4325. You can also contact your state Medicaid office. Learn more or apply for CHIP at insurekidsnow.gov or call (877) KIDS-NOW (877) 543-7669.

You’re eligible for COBRA if:

• Your group health plan is subject to COBRA,
• A qualifying event has occurred, and
• You’re a qualified beneficiary—meaning you were covered by the health plan on the day before the qualifying event.

Qualified beneficiaries are individuals who were covered by a job-based group health plan on the day before a qualifying event. They include:

• The employee.
• The employee’s spouse or former spouse.
• The employee’s dependent children.

In certain cases, other individuals may be considered qualified beneficiaries, including:

• Retired employees on a retiree health plan, their spouses, and dependent children if their employer sponsoring their group health plan declares bankruptcy.
• Any child born to or placed for adoption with a covered employee during the COBRA coverage period.
• Employers, agents, independent contractors, and directors who were covered under the employer’s group health plan, assuming their coverage is similar to other employees.

Qualifying events are certain events that cause an individual to lose health coverage under a group health plan. The type of qualifying event determines who the qualified beneficiaries are and how long they will be entitled to COBRA coverage. 

Qualifying events for the employee include:

• Job loss (except for gross misconduct).
• Reduction in work hours.

Qualifying events for the employee’s spouse and dependents include:

• Job loss (except for gross misconduct) or reduction in work hours of the covered employee.
• Divorce or legal separation from the covered employee.
• Death of the covered employee.
• Loss of dependent child status.
• In limited situations, the covered employee becomes entitled to Medicare.

The responsibility for notifying the plan depends on the type of qualifying event.

Your employer must notify the plan if the qualifying event is:

• Termination or reduction in work hours.
• Death of the covered employee.
• The covered employee becoming entitled to Medicare.
• Employer bankruptcy.

You or a qualified beneficiary must notify the plan within 60 days⁽²⁾ if the qualifying event is:

• Divorce or legal separation.
• A dependent child losing eligibility under the plan.

Your plan must have clear procedures for reporting a qualifying event, which should be outlined in the COBRA General Notice.

If your plan does not provide clear instructions on how to report a qualifying event, you should contact:

• The person or department handling employee benefits at your employer.
• The joint board of trustees (for multiemployer plans).
• The insurance company (if benefits are provided through insurance).

COBRA is temporary. The following chart shows the maximum period for which continuation coverage must be offered for the specific qualifying events and the qualified beneficiaries who are entitled to elect continuation coverage when the specific event occurs. Note that an event is a qualifying event only if it causes the qualified beneficiary to lose coverage under the plan.

Your group health plan must provide you with two types of notices.

• General Notice: Sent within 90 days after you enroll in the health plan and provides an overview of your COBRA rights and eligibility.
• Election Notice: Sent within 44 days after a qualifying event or 14 days after you notify the plan of a qualifying event such as divorce or loss of dependent child status. It includes details on enrolling in COBRA. If a plan extends coverage beyond the qualifying event date, such as until the end of the month, the 44-day period to provide the COBRA notice begins on the date coverage ends.

You have 60 days to enroll in COBRA, starting from when your coverage ends or when your COBRA election notice is provided to you or mailed—whichever is later. If you elect COBRA, you then have 45 days to make your first payment.

Yes. If you first waive COBRA coverage, you can still elect COBRA later—as long as it’s within the 60-day election period. Your coverage may begin on the date you revoke the waiver or be retroactive to the date your coverage originally ended, depending on the terms of the plan.

If you elect COBRA coverage, you will receive the same health benefits as active employees and their families. This typically includes:

• The same coverage you had before the qualifying event.
• The same co-pays, deductibles, and coverage limits.
• The same rights to switch plans during open enrollment, if active employees are allowed to do so.
• The same claims and appeal process.

For example, if the covered employee has a child by birth or adoption while on COBRA and elect coverage for the new dependent, the child is covered as a qualified beneficiary once the premium is paid.

Use caution: Choosing COBRA coverage without also enrolling in Medicare may create unexpected financial obligations. If you are eligible for, but not enrolled in Medicare, the plan may contain a coordination of benefit rule that applies Medicare as primary coverage, even if you have not enrolled in Medicare. See Q27.

You can lose COBRA coverage for the following reasons:

• You don’t pay your premiums on time.
• Your employer stops offering a group health plan.
• You or a qualified beneficiary become covered by another group health plan after electing COBRA.
• You become entitled to Medicare after electing COBRA.
• You or a qualified beneficiary engage in misconduct, such as fraud, that would result in termination of coverage for an active employee.

If your COBRA coverage is terminated early, your plan must provide you with an early termination notice as soon as possible. This notice will explain:

• The date your coverage will end.
• The reason for termination.
• Any rights you may have to enroll in other coverage.

Yes, COBRA coverage can be extended if a qualified beneficiary is disabled, or a second qualifying event occurs.

If any qualified beneficiary in your family is disabled and meets certain requirements, all qualified beneficiaries may receive an 11-month extension of COBRA coverage—for a total of up to 29 months. 
To qualify for this extension:

• The Social Security Administration (SSA) must determine that the qualified beneficiary is disabled before the 60th day of COBRA coverage, and
• The disability continues throughout the initial 18-month COBRA coverage period.

The disabled beneficiary or their representative must notify the plan of the SSA determination. The plan can set a deadline for providing this notice, but it cannot be shorter than 60 days, starting from the latest of:

• The date the SSA issues the disability determination,
• The date the qualifying event occurs,
• The date the qualified beneficiary loses (or would lose) coverage under the plan due to the qualifying event, or
• The date the qualified beneficiary is informed, through the COBRA general notice or Summary Plan Description, about the responsibility and procedures for notifying the plan.

During this disability extension:

• The plan may charge the disabled beneficiary up to 150 percent of the premium.
• The plan may charge up to 102 percent if only non-disabled beneficiaries choose to continue the coverage.

If SSA later determines the qualified beneficiary is no longer disabled, the qualified beneficiary or their representative must notify the plan within 30 days, and the disability extension will end.

The disabled qualified beneficiary does not need to enroll in COBRA or extend their coverage for the remaining qualified beneficiaries to receive the additional 11 months of extended COBRA coverage.

A second qualifying event occurs when another COBRA qualifying event affects a qualified beneficiary during the initial 18-month COBRA period. This may extend COBRA coverage by another 18 months, for a total of up to 36 months.

The second qualifying event only extends COBRA coverage if it would have caused the qualified beneficiary to lose health plan coverage had the first qualifying event not occurred.
Second qualifying events are:

• Death of a covered employee.
• Divorce or legal separation of a covered employee and spouse.
• Medicare entitlement, in certain circumstances.
• A dependent child loses eligibility under the plan.

Just as with a first qualifying event, the qualified beneficiary must notify the plan within 60 days if the second qualifying event is a divorce, legal separation, or dependent child losing eligibility under the plan.

Yes, a divorced or legally separated spouse of a covered employee may continue health coverage under COBRA. 

A court decree of legal separation or divorce is required—simply filing paperwork or starting the divorce process does not qualify a plan participant for COBRA. The plan administrator must be notified within 60 days of the divorce or legal separation.

You may lose coverage at the start of the new plan year. However, once the divorce or legal separation becomes final, it’s considered a qualifying event. At that point, if you provide timely notice of your divorce or legal separation, the plan is required to provide you with an election notice for COBRA coverage.

To keep your COBRA coverage active, you must follow specific payment rules.

• Initial payment: COBRA coverage generally doesn’t start until you make your first premium payment. Since COBRA coverage is retroactive to the day you lost your job-based plan, your initial payment may include premiums for more than one month. You don’t have to pay it all at once—you have 45 days to pay the full amount. You can choose to pay for just the months you want coverage.
• Ongoing payments: Plans must allow monthly payments once the initial payment has been paid. Some plans may offer other options, like weekly or quarterly payments.
• Don’t expect a bill: Your plan doesn’t have to send you a bill. You’re responsible for making timely payments even if you don’t receive a billing statement.
• Grace period for ongoing payments: You have a 30-day grace period after each due date, except for the initial payment, to make your COBRA payment. If you pay within this period, your coverage must be reinstated, even if it was temporarily cancelled for nonpayment.
• Termination for nonpayment: If you don’t pay before the grace period ends, your COBRA coverage can be terminated.
• Short payments: If your payment is slightly less than the required amount, your plan may accept it or provide you at least 30 days to pay the difference.

If your coverage was terminated because you didn’t pay the full premium within the grace period, the plan is not required to reinstate it. 

If you believe your coverage was wrongfully terminated, contact the Employee Benefits Security Administration or call (866) 444-3272 for help.

Follow the claim procedures in your plan’s Summary Plan Description. If you need assistance filing a claim, contact your plan administrator.

For more information, review the Department of Labor’s guide to “Filing a Claim for Your Health Benefits.” 

No. If you’re on FMLA leave, your employer is required to maintain your group health plan coverage under the same terms as if you were still working.

If you don’t return to work following your FMLA leave and lose your health coverage, you may qualify for COBRA. For more information on FMLA, visit the Department of Labor’s FMLA website or call (866) 487-9243.

Sometimes employers include a temporary COBRA subsidy in a severance or separation agreement. While this subsidy can reduce your costs, it might last longer than the time you have to enroll in other coverage.

The end of the subsidy does not trigger a new special enrollment period for group coverage. However, you may still qualify for a special enrollment period through the Marketplace, depending on your state residence.

If you miss the initial special enrollment window, you may need to wait for open enrollment. To better understand your coverage options, contact the plan administrator of the other group health plan or your state’s Marketplace representative. 

Yes, dual coverage is allowed. However, wait to elect COBRA until your other coverage is active. If you elect COBRA before then, your COBRA coverage may end once your other coverage begins.

There are also Medicare-specific rules for dual enrollment. Please see Q27 for more details.

Medicare is the federal health insurance program for people who are 65 or older and certain younger people with disabilities or End-Stage Renal Disease.

If you become eligible for Medicare, such as turning 65, that alone doesn’t trigger COBRA coverage. COBRA only applies if you lose your job-based coverage because of qualifying events like job loss or reduced hours.  

Here’s how Medicare and COBRA work together:

Important: Qualified beneficiaries who are eligible for Medicare but haven’t enrolled may have Medicare treated as their primary insurance. Once COBRA starts, this can affect how medical claims are paid. Always check your plan’s Summary Plan Description or talk to your plan administrator to understand how the plan coordinates payment with Medicare.

For more information on Medicare, visit Medicare.gov or call (800) MEDICARE.

COBRA coverage is typically not available if your company no longer offers a health plan. 

However, if an affiliated company—tied to your employer, such as one within the same corporate group—still provides a group health plan, you may be eligible for COBRA under that plan. 

Union members covered by a collective bargaining agreement that includes a medical plan may still be eligible for continued coverage.

No, COBRA does not apply to federal employees. However, federal employees have similar benefits under a different law. 

If you’re a federal employee who wants to learn more about temporary health coverage options, contact your agency’s personnel office or visit the U.S. Office of Personnel Management website or call at (202) 606-1800.

If you have questions about your COBRA rights under a private-sector group health plan, contact the Employee Benefits Security Administration or call (866) 444-3272. 

If you have questions about your COBRA rights under are a public-sector group health plan (state or local government), contact The Centers for Medicare and Medicaid Services at (877) 267-2323 or visit their website.