To Help With COBRA Denials

Armen Hareyan's picture

CMS has set up a new website and a toll-free line that will help the unemployed workers to appeal denials of COBRA health insurance's premium assistance under Recovery Act. Either by going to or calling the helpline (1-866-400-6689) qualified unemployed workers may request expedited review of a denial by their former employers of eligibility for COBRA premium assistance under the American Recovery and Reinvestment Act of 2009 (ARRA).

CMS has contracted with MAXIMUS Federal Services, Inc., a subsidiary of MAXIMUS, Inc., to review requests for expedited review of denials and make recommendations - subject to CMS's review - on whether individuals are eligible for health insurance premium assistance under the Recovery Act's expansion of COBRA continuation health insurance coverage. Maximus will also answer questions about the premium assistance program and the expedited review process. Contact information for the Web site and helpline is provided below.

To help displaced workers maintain health insurance coverage for themselves and their families, the Recovery Act provides a 65 percent subsidy for health insurance premiums for workers who have elected COBRA after they have been involuntarily terminated from their jobs. "COBRA coverage" generally refers to the continuation of coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), which apply to employers with twenty or more employees. The ARRA-established subsidy is also available to eligible Federal, state, and local government employees, and, if state law requires certain continuation health insurance coverage, to workers for private sector employers with fewer than twenty employees.


The Recovery Act's premium assistance applies to periods of continuation coverage beginning on or after February 17, 2009 (when ARRA became law), and lasts for up to nine months.

To qualify for premium assistance, a worker must be involuntarily terminated between September 1, 2008, and December 31, 2009, and elect continuation coverage. The subsidy ends when the worker is offered any new employer-sponsored health care coverage or becomes eligible for Medicare. Workers who were involuntarily terminated between September 1, 2008, and February 16, 2009, but who failed to elect COBRA coverage at that time, most likely because it was unaffordable, or who elected COBRA after September 1, 2008, but let it drop because it was unaffordable, would be given an additional 60 days after employer notifications are released to elect COBRA and receive the subsidy. Depending on actions taken by their states, individuals with state continuation coverage may also be eligible for this additional election period. To ensure that the premium assistance is targeted at workers who are most in need, the subsidy generally will be available only to people whose income does not exceed $125,000 for individuals ($250,000 for families).

When an individual's former group health insurance plan denies access to ARRA's premium assistance, he or she may request an expedited review of the denial. Under the law, CMS handles requests for review for all Federal government employees, employees of state and local governments, and those individuals covered by certain state continuation coverage laws (sometimes called "mini-COBRA" programs) that apply to employers with fewer than 20 employees. Decisions on appeals will be made within 15 business days after receipt.

For more information, visit For the toll-free helpline, which is available from 8 a.m. to 8 p.m. Eastern time, dial 1-866-400-6689. (TTY: 1-866-631-5610). When appropriate, MAXIMUS Federal Services will direct callers to the Department of Labor (DOL), which handles COBRA cases involving private employers with 20 or more employees. DOL may be reached directly at 1-866-444-3272. DOL's help site may be accessed at

The Internal Revenue Service oversees tax issues for all individuals and group health plans affected by the Recovery Act's premium assistance provisions. For more information, visit,,id=204505,00.html. Or, individuals may call 800-829-1040. The toll-free number for pension plan administrators is 877-829-5500.