Divorce and Health Insurance in Massachusetts: Understanding Your Options

It’s hardly controversial to say that healthcare in America is complicated and expensive. For many divorcing couples, continued health insurance coverage is a critical concern. This article explores the legal framework governing health insurance during and after divorce, the options available to divorcing spouses, and strategies for maintaining coverage through this transition.

Health Insurance Considerations During Divorce Proceedings

During the pendency of a action in Massachusetts, the court automatically issues a restraining order under Supplemental Rule 411 of the Probate and Family Court. This order prohibits either party from removing the spouse or minor children from existing health insurance policies. This protection remains in effect throughout the divorce proceedings unless modified by agreement of the parties or court order.

The restraining order serves a critical purpose: it ensures continuity of healthcare coverage during what is often a financially and emotionally turbulent time. This protection is particularly important for a dependent spouse who relies on the other spouse’s employer-sponsored health insurance.

When addressing temporary support during divorce proceedings, Massachusetts courts must specifically consider health insurance. Under G.L. c. 208, § 17, which governs orders for alimony during the pendency of divorce actions, the court must determine whether the obligor spouse has health insurance available through an employer or organization that could cover the dependent spouse.

Health Insurance Options After Divorce

Once a divorce becomes final, several options exist for maintaining health insurance coverage, depending on the type of plan involved and the specific circumstances of the divorce.

Massachusetts Insurance Continuation Laws

Massachusetts has enacted robust protections for divorced spouses through a series of insurance statutes. These laws apply to different types of health insurance carriers and plans:

• G.L. c. 175, § 110I applies to commercial health insurance carriers (such as United Healthcare or Aetna)
• G.L. c. 176A, § 8F and G.L. c. 176B, § 6B apply to Massachusetts-licensed nonprofit hospital and medical service corporations (Blue Cross and Blue Shield of Massachusetts)
• G.L. c. 176G, § 5A governs health maintenance organizations (HMOs)
• G.L. c. 176I, § 9 applies to preferred provider arrangements
• G.L. c. 32A, § 11A and G.L. c. 32B, § 9H govern group health plans for state, county, and municipal employees

Under these statutes, the spouse of a group health plan member who is a party to a judgment of divorce or separate support “shall be and remain eligible” for coverage without medical examination or additional premium, “as if said judgment had not been entered.” This means that if your spouse has health insurance through a fully insured plan governed by Massachusetts law, you may be entitled to continue that coverage after divorce without paying an additional premium.

This eligibility continues until the remarriage of either the insured spouse or the dependent spouse, unless the divorce judgment specifies otherwise. The court has discretion to order continued coverage even after the remarriage of the insured spouse, though in such cases, an additional premium may be charged.

Self-Insured Employer Plans and COBRA

It’s important to note that Massachusetts insurance continuation laws do not apply to self-insured employer plans, which are governed by the federal Employee Retirement Income Security Act (ERISA). Self-insured plans are those where the employer assumes the financial risk for providing health care benefits rather than purchasing insurance from a carrier.

For individuals covered by self-insured plans, the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) provides the primary means of continuing health coverage after divorce. COBRA allows a divorced spouse to maintain coverage under the ex-spouse’s employer plan for up to 36 months, though the divorced spouse must pay the full premium plus an administrative fee.

To qualify for COBRA continuation coverage, the plan administrator must be notified of the divorce within 60 days. This notification responsibility typically falls on either the employee or the divorced spouse. Failure to provide timely notification can result in loss of COBRA eligibility.

Government and Church-Sponsored Plans

Government employer plans and self-insured church-sponsored plans are exempt from both Massachusetts insurance laws and COBRA. However, these plans may offer their own continuation coverage options. For example, federal employees have continuation rights under the Federal Employees Health Benefits Program, while military personnel and dependents may have options under TRICARE.

Health Insurance Provisions in Divorce Judgments

In a divorce, Massachusetts courts must address health insurance for the parties. Under G.L. c. 208, § 34, if the court finds that the obligor spouse has health coverage available at reasonable cost, it can order either:

• The obligor to maintain health insurance for the former spouse, or
• The obligor to reimburse the former spouse for the cost of maintaining separate health insurance

The court’s findings and orders concerning health insurance should expressly reflect compliance with the applicable statute and make provisions for the requisite coverage or reimbursement. The Massachusetts Appeals Court has emphasized this requirement, noting in Zeh v. Zeh that judges must make specific findings regarding health insurance availability and cost.

The duration of court-ordered health insurance coverage is within the judge’s discretion but must be supported by the facts of the case. In Mailer v. Mailer, the Supreme Judicial Court upheld a three-year limit on health insurance coverage where the judge made detailed findings based on factors in G.L. c. 208, § 34. Conversely, in Adlakha v. Adlakha, the Appeals Court remanded the case where the trial judge failed to articulate reasons for a two-year limit on coverage.

Practical Considerations for Divorcing Spouses

For the Dependent Spouse

If you are a dependent spouse who relies on your spouse’s health insurance, consider the following steps:

• Determine what type of health plan covers you. Is it a fully insured plan governed by Massachusetts law, a self-insured plan subject to COBRA, or a government/church plan with its own rules?
• If covered by a Massachusetts-regulated plan, ensure that your divorce judgment explicitly addresses continued coverage under the applicable state law (e.g., G.L. c. 175, § 110I).
• If covered by a self-insured plan, make sure the divorce judgment requires your spouse to take necessary steps to ensure you can secure COBRA coverage, including timely notification to the plan administrator.
• Provide your current mailing address to the insurance carrier if different from your ex-spouse’s address, and update this information if it changes.
• Be aware that if your ex-spouse remarries, you may face an additional premium for continued coverage, depending on the type of plan and the terms of your divorce judgment.

For the Insured Spouse

If you are the spouse who carries the health insurance, consider these points:

• Understand your obligations under the divorce judgment regarding maintaining coverage for your ex-spouse.
• Be aware that Massachusetts law prohibits reducing alimony based on the cost of providing health insurance for your ex-spouse.
• Recognize that failure to maintain required health coverage could result in contempt proceedings.
• If you change employers or your employer changes insurance carriers, you may need to take steps to ensure continued coverage for your ex-spouse as required by your divorce judgment.
• Be prepared for potential tax implications, as employer-provided health insurance for an ex-spouse may be treated as taxable income to you.

Health Insurance for Children After Divorce

Federal and state laws require every child support order to include provisions for health care coverage. Under the Massachusetts Child Support Guidelines, the court must enter an order requiring either parent to provide health care coverage if such coverage is available at reasonable cost and accessible to the child.

Health care coverage is considered reasonable if it does not exceed 5% of the gross income of the party. If the court determines that health care coverage is not in the best interest of the child or creates an undue hardship for either parent, it must enter written findings explaining this determination.

If a parent has enrolled a child in MassHealth (Massachusetts’ Medicaid program), the court must order that parent to maintain such coverage as long as the child remains eligible. However, the court may also order the other parent to enroll the child in private health insurance if it is available at reasonable cost, accessible to the child, in the child’s best interest, and would not create an undue hardship.

Life Insurance Considerations

In addition to health insurance, divorce judgments often address life insurance. When there is an order of child support or alimony, or when children are young, parties frequently agree to carry term life insurance naming the other spouse as the beneficiary for the benefit of the children.

The amount of life insurance required typically relates to the financial obligations being secured, such as child support, college expenses, or alimony. The court has the authority to order life insurance as security for support obligations under G.L. c. 208, § 36.

Conclusion

Health insurance considerations are a critical component of divorce proceedings in Massachusetts. The state’s robust insurance continuation laws provide significant protections for dependent spouses, though these protections vary depending on the type of health plan involved.

When navigating a divorce, it’s essential to understand what type of health plan covers you, what continuation options are available, and how to properly document these arrangements in your divorce judgment. Proper planning and clear language in divorce agreements can help ensure continuous health coverage during and after divorce, protecting both parties’ physical and financial well-being.

Given the complexity of health insurance laws, the high cost of insurance and healthcare in this country, how these interact with divorce proceedings, consulting with an experienced family law attorney who understands these nuances is highly recommended. With proper guidance, you can make informed decisions about health insurance that will serve your long-term interests following divorce.