Short answer: COBRA is a federal continuation law that applies mainly to employers with 20 or more employees, while Texas State Continuation is a Texas law that applies only to fully insured group medical plans and operates either instead of COBRA or after COBRA ends.
Both COBRA and Texas State Continuation allow individuals to remain on a former employer’s group medical plan after losing eligibility, but they differ in who they apply to, what coverage they include, and how long continuation lasts.
COBRA is a federal law that generally applies to employers with 20 or more employees and covers both fully insured and self-funded group health plans. COBRA requires continuation of the same coverage the individual had before losing eligibility, which often includes medical, dental, and vision benefits. Continuation typically lasts up to 18 months, though longer periods may apply in certain circumstances. COBRA is administered under federal rules.
Texas State Continuation is a state law regulated by the Texas Department of Insurance and applies only to fully insured group medical plans issued in Texas. It applies regardless of employer size but does not apply to self-funded plans. Texas State Continuation does not include standalone dental or vision coverage.
When COBRA does not apply, generally because the employer has fewer than 20 employees, Texas State Continuation serves as the primary continuation option and allows up to 9 months of continued medical coverage. When COBRA does apply and the plan is fully insured, Texas law may allow an additional 6 months of continuation after the full 18 months of COBRA is exhausted, bringing total continuation to up to 24 months.
In certain situations, such as divorce, retirement, or the death of the employee, certain dependents may qualify for longer continuation under Texas law, potentially up to 36 months, if the coverage is fully insured.
Sources
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Texas Department of Insurance, State Continuation of Coverage
https://www.tdi.texas.gov/pubs/consumer/cb046.html -
Texas Insurance Code §1251.251–1251.257
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U.S. Department of Labor, COBRA Continuation Coverage
https://www.dol.gov/general/topic/health-plans/cobra
Content history
Originally published: June 16, 2025
Last reviewed: January 25, 2026