“Assistance Eligible Individuals” (AEIs) are eligible for COBRA premium assistance under ARPA. An AEI is someone who, during the period from April 1, 2021, through September 30, 2021, is eligible for COBRA (COBRA qualifying event must be involuntary termination of employment [other than for gross misconduct] or involuntary reduction in hours), and 2) elects COBRA.
There are four categories of AEIs. If the individual falls into one of the first two categories outlined below, then the COBRA effective date would follow existing COBRA rules (i.e., retroactively to the date the individual lost coverage due to involuntary termination or reduction in hours):
- Individual elected COBRA prior to April 1, 2021, and remains on COBRA past April 1, 2021
- Individual becomes eligible and elects COBRA in a timely manner between April 1, 2021, and September 30, 2021
The following two categories, numbers 3 and 4 below, only apply to those eligible for federal COBRA, not mini-COBRA, unless a State law or program provides for a similar extended election right and an individual otherwise satisfies the requirements. If an individual falls into the remaining two categories, they will receive an additional/extended COBRA election opportunity and can begin their coverage retroactively to the date the individual lost coverage due to involuntary termination or reduction in hours, retroactively to April 1, 2021 or prospectively (premium assistance is only provided between April 1, 2021 and September 30, 2021). Coverage would end on the date COBRA would have exhausted if elected in a timely manner or if it was never discontinued:
- Individual was eligible to elect COBRA prior to April 1, 2021, but waived it or missed the election period, but if they had previously elected it, they would still be receiving COBRA continuation past April 1, 2021
- Individual elected COBRA but discontinued it prior to April 1, 2021, but if they didn’t discontinue, they would still be receiving COBRA continuation past April 1, 2021
For numbers 1, 3 and 4 above: If the initial COBRA qualifying event was November 1, 2019, and the COBRA coverage had an 18-month maximum coverage period, COBRA would run until May 1, 2021 (past the April 1, 2021, COBRA premium assistance start date). The individual may be eligible for COBRA premium assistance for the month of April.
ARPA does not extend the maximum COBRA coverage period. Additionally, an individual is not eligible for COBRA premium assistance if they are eligible for other group health coverage, such as through a new employer’s plan or a spouse’s plan (not including excepted benefits, a qualified small employer health reimbursement arrangement [QSEHRA] or a health flexible spending arrangement [FSA]), or if the individual is eligible for Medicare.