When a job ends, the health plan that came with it usually ends too. You typically have three ways to replace it: COBRA, a Marketplace plan, or a private PPO plan. Each has different costs, deadlines, and rules about who can say no.
The deadlines matter most, so we'll start with those.
The two 60-day windows
Two clocks start when your coverage ends:
- COBRA election. You generally have at least 60 days from the later of your coverage ending or the date you get the COBRA notice to decide whether to elect it.
- Marketplace special enrollment. Losing job-based coverage gives you a special enrollment period of 60 days. You can also apply up to 60 days before your coverage ends if you know the date.
Don't let either window pass while you decide. Missing both can leave you without a way to get a Marketplace plan until the next open enrollment.
COBRA: keeping the plan you had
COBRA lets you stay on your former employer's plan, with the same doctors and the same network. The catch is the price. You pay the full premium, including the share your employer used to cover, plus up to 2% for administration. For many people that's a big jump from what came out of their paycheck.
- It usually lasts up to 18 months, and longer in some situations.
- If you elect it, you generally have 45 days after electing to make the first payment, and coverage goes back to the day your old coverage ended.
- COBRA generally applies to employers with 20 or more employees. Some states have similar rules for smaller employers, so ask your former employer's HR.
COBRA can make sense if you're in the middle of treatment, you're close to meeting this year's deductible, or you need to keep a specific doctor. It's often the most expensive option for someone who's healthy.
Marketplace: special enrollment
A Marketplace plan can't turn you down or charge you more because of your health. Premium help depends on your household income for the coming year, so a job loss can change what you qualify for.
One thing to know before you sign up for COBRA and plan to switch later: dropping COBRA on your own, outside open enrollment, generally doesn't open a new special enrollment period. If a Marketplace plan might be the better choice, compare it before you elect COBRA, not after.
Private PPO: sold through carriers and agents
Private PPO plans aren't tied to the Marketplace calendar, so you don't need a special enrollment period to apply. Many have broad doctor networks, and some come with no deductible. The tradeoff is underwriting. The carrier reviews your health history, and it can approve, charge more, exclude a condition, or decline. They also aren't required to cover everything a Marketplace plan must, so conditions you already have, maternity, and mental health can be limited or excluded.
Side by side
| COBRA | Marketplace | Private PPO | |
|---|---|---|---|
| Cost | Full premium plus up to 2% | Depends on income; help may lower it | Depends on age, health and plan |
| Doctors | Same network as before | Varies by plan | Often broad PPO networks |
| Can you be turned down? | No | No | Yes, based on health history |
| Deadline | 60 days to elect | 60-day special enrollment | Not tied to a window |
Mistakes we see after a job loss
- Assuming COBRA is the only option. It's the one your HR department mentions, but it's often not the cheapest.
- Waiting for the notice. Your Marketplace window starts when coverage ends, not when the COBRA paperwork arrives.
- Guessing next year's income. Premium help depends on it, so work through the number.
- Not checking doctors. A cheaper plan doesn't help if your doctor isn't in it.
We have a longer page on health insurance after COBRA ends if that's where you are.
This article is general information, not a guarantee of coverage or pricing. Plan availability, benefits, and eligibility vary by state and individual. Some private plans are medically underwritten and do not include all ACA essential health benefits.