Who Qualifies for COBRA, and for How Long

Test one: was your employer large enough?

Federal COBRA applies to group health plans maintained by employers that had 20 or more employees on more than half of their typical business days in the previous calendar year. Two details matter and are easy to get wrong.

• Part-time staff count as fractions, not as zero. A firm with 14 full-time and 12 half-time employees can be over the line. Do not assume from headcount in your own office; the test is across the whole employer.
• It is last year's workforce that counts. A company that has shrunk below 20 through the layoffs that cost you your job may still be a COBRA employer this year.

The law covers private-sector employers and state and local government. Federal government employees have a separate but comparable arrangement under the FEHB program, and plans sponsored by churches are outside COBRA entirely.

If your employer is genuinely under the threshold, you have not run out of options. Most states have their own continuation statute covering small employers, often called mini-COBRA, and it is a separate right with separate rules. That is covered in the state continuation guide.

Test two: were you covered the day before?

To be a qualified beneficiary you must have been actually enrolled in the employer's group health plan on the day before the qualifying event. Being eligible but never having signed up does not create a COBRA right.

This catches two groups. People who waived coverage because they were on a spouse's plan have no COBRA right of their own from their own employer. And a new hire still inside a waiting period, who has not yet been enrolled, generally has nothing to continue.

A child born to or adopted by a covered employee during a period of COBRA coverage can be added as a qualified beneficiary, which is a useful exception to know if your family grows mid-continuation.

Test three: what kind of event was it?

The event determines the maximum length. Broadly, events that take away your job give 18 months, and events that change your family relationship to the covered employee give 36.

Note which rows put the notification duty on you rather than your employer. For divorce, legal separation, and a child ageing off the plan, the employer has no way of knowing the event happened, so you have 60 days to tell the plan. Miss it and no offer is made at all. The deadline guide sets out the full chain.

The gross misconduct exception

Termination for gross misconduct is the one firing that removes COBRA rights, and it is narrower than it sounds. It is not the same as being fired for poor performance, for a policy breach, or for cause in the ordinary employment sense. The term is not precisely defined in the statute and has been litigated, so if you are denied COBRA on this basis and disagree, ask for the reason in writing and speak to a Department of Labor benefits adviser before accepting it.

Everyone in the family decides separately

Each qualified beneficiary has an independent right to elect. Your spouse can take COBRA while you go to the Marketplace. One child can be continued and another not. The covered employee turning it down does not remove anyone else's right.

This matters financially more than most people realise, because it lets you cover only the person who actually needs the continuity. A family in the middle of one member's treatment can continue that person on the old plan and put everyone else on a cheaper individual plan, rather than paying a full family COBRA premium to protect one course of care. Ask the administrator for the premium broken down by individual before assuming you must elect as a household.

Two ways 18 months can become longer

The disability extension: 29 months

If the Social Security Administration determines that a qualified beneficiary was disabled at any point during the first 60 days of COBRA coverage, the 18-month period can be extended to 29 months for the whole family unit, not only for the disabled person. The 11 extra months are the bridge to Medicare eligibility, which is why the number is 29.

Two conditions attach. You must notify the plan of the SSA determination within 60 days of receiving it and before the initial 18 months run out. And the plan may charge up to 150% of the plan cost for months 19 to 29 rather than 102%, so budget for the step up. This extension is widely under-claimed because nobody tells you about it at the point the determination arrives.

A second qualifying event: 36 months

If a family is already on an 18-month continuation and a second qualifying event occurs, such as the covered employee dying or the couple divorcing, the spouse and dependent children can extend to 36 months measured from the original event. It does not restart the clock; it lengthens it. The second event must be one that would independently have given 36 months, and you have to notify the plan.

How COBRA can end early

The 18 or 36 months is a maximum, not a guarantee. A plan can cut coverage short if:

• a premium is not paid within the grace period;
• the employer stops offering any group health plan to any employees;
• you become covered under another group health plan after electing;
• you become entitled to Medicare after electing;
• a disability extension applies and SSA determines you are no longer disabled.

The Medicare row is the one that causes lasting damage if you get the sequence wrong, and the harm is not confined to your COBRA coverage. If you are 64 or older, or your spouse is, read COBRA and Medicare before electing anything.

If you are told you do not qualify

Denials are sometimes right and sometimes administrative. Before accepting one:

1. Ask for the reason in writing, naming which test you failed. A vague verbal "you are not eligible" is not an answer you have to accept.
2. Check the employee count yourself against last calendar year, remembering that part-timers count as fractions.
3. Check whether you were enrolled the day before the event, which is the test that most often trips people who had recently changed coverage.
4. Ask about state continuation if the employer is genuinely under 20 employees.
5. Contact a Department of Labor benefits adviser. The service is free and exists for this.

And whichever way it goes, remember the parallel clock: losing job-based coverage opens a 60-day Special Enrollment Period for a Marketplace plan whether or not you are entitled to COBRA. Do not let a dispute about eligibility consume that window.