Who Qualifies for COBRA? A Plain-English Guide

COBRA is a federal right, but it's not universal. Whether you qualify for continuation coverage depends on three things: your former employer's size, your previous status under the group health plan, and the nature of the event that caused you to lose coverage.

Here's exactly how it works.

The Three Eligibility Tests

To be eligible for COBRA, you generally have to pass all three:

• Employer size. The employer must have had 20 or more employees on more than 50% of typical business days in the previous calendar year.
• Plan coverage. You (or your covered family member) must have been enrolled in the employer's group health plan on the day before the qualifying event.
• Qualifying event. A specific event under federal law must have caused the loss of coverage.

Missing any one of these means federal COBRA rights don't apply. But — and this matters — many states have their own mini-COBRA laws that fill some of the gaps, especially for employees of smaller companies.

Employer Size: The 20-Employee Threshold

Federal COBRA applies only to group health plans sponsored by private-sector employers with 20 or more employees. State and local government plans are also covered. The count includes full-time and part-time employees, with part-time employees counted as fractions of full-time.

If you worked for a company with fewer than 20 employees, federal COBRA does not apply. But:

• Many states (e.g., California, New York, Illinois, Texas, Florida, and many more) have state continuation laws — often called "mini-COBRA" — that extend similar rights to employees of smaller employers.
• The details of state mini-COBRA vary significantly. Some offer the full 18 months. Some offer only 3-6 months. Some charge the same premium structure. Some don't.
• Check your state's department of insurance website, or ask your former employer's HR whether state continuation applies.

Who Counts as a Qualified Beneficiary

COBRA rights extend to qualified beneficiaries — not just the employee. The full list:

• The covered employee
• The covered employee's spouse
• The covered employee's dependent children (including newborns and adopted children during the coverage period)

Domestic partners generally are not considered qualified beneficiaries under federal COBRA unless the employer's plan specifically extends eligibility to them. Many plans do. Your COBRA notice will tell you whether your domestic partner is covered.

Each qualified beneficiary has independent COBRA rights. This means a spouse can elect COBRA even if the employee declines. A dependent child aging out can elect COBRA even if other family members don't.

The Qualifying Events That Trigger COBRA

Federal law specifies a closed list of qualifying events. If your loss of coverage was caused by one of these events, COBRA rights are triggered.

Events Affecting the Employee

• Voluntary or involuntary termination of employment (except for gross misconduct)
• Reduction in hours that causes loss of coverage (moving to part-time status, furlough, etc.)

These trigger 18 months of continuation coverage.

Events Affecting Spouses and Dependents

• Death of the covered employee
• Divorce or legal separation from the covered employee
• The covered employee becoming entitled to Medicare (this can terminate the spouse and dependents' coverage)
• A dependent child aging out of coverage (typically at age 26 under ACA rules)

These events generally trigger 36 months of continuation coverage for the affected spouses and dependents.

Extensions Beyond 18 Months

Two specific extensions can push an 18-month period further:

• Disability extension to 29 months. If a qualified beneficiary is determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage, all qualified beneficiaries in the family may extend coverage to 29 months. The premium may increase to 150% of the group rate for months 19-29.
• Second qualifying event extension to 36 months. If a second qualifying event (like divorce or death) occurs during an 18-month COBRA period, coverage for the affected spouse and dependents can be extended to 36 months total.

Exceptions: When COBRA Doesn't Apply

A few circumstances where federal COBRA rights don't apply:

• Gross misconduct termination. If the employer terminates the employee for gross misconduct, no COBRA is offered. "Gross misconduct" is narrower than most employers assume — poor performance, insubordination, or routine policy violations usually don't qualify.
• Employer goes out of business. If the employer ceases to maintain a group health plan entirely (not just for the terminated employee), COBRA rights may end. This is a narrow exception.
• Federal government employees. The federal government has its own continuation program (the Temporary Continuation of Coverage under FEHB), which works similarly to COBRA but has different rules.
• Small employers below the 20-employee threshold. Federal COBRA doesn't apply, though state mini-COBRA may.
• Church plans. Certain church-sponsored health plans are exempt from COBRA requirements.

What If You're Not Sure?

Three ways to confirm your eligibility:

• Look at your notice. If you received one, you're almost certainly eligible. Employers don't send COBRA notices to people who aren't eligible.
• Ask your former HR. If no notice has arrived and you think you qualify, email HR directly. Legally, the notice should arrive within 44 days of the qualifying event.
• Contact the plan administrator. Your summary plan description (SPD) names the plan administrator. They're responsible for administering COBRA and can confirm your eligibility.

The Bottom Line

• COBRA applies to employers with 20+ employees in the previous calendar year
• You must have been enrolled in the group health plan at the time of the qualifying event
• The qualifying event must be one of the specific events named in federal law
• Family members have independent COBRA rights
• Coverage typically runs 18 months, with extensions available for disability or second qualifying events
• Smaller employers may be covered by state mini-COBRA, with different rules
• Gross misconduct termination can forfeit COBRA rights, but the bar is high

If you received an election notice, you're eligible. If you didn't and you think you should be, contact your former HR in writing before you assume anything.