If you only do four things

  1. Find the date your coverage ends. It is often later than your last day of work, and both 60-day clocks run from it. The deadlines are here.
  2. Price a marketplace plan before you elect COBRA. Enter your expected income on healthcare.gov or your state marketplace and see the subsidy first. Cost comparison.
  3. Add up the deductible you have already met this year. COBRA keeps it. A new marketplace plan resets it to zero.
  4. Do not send COBRA money on day one. COBRA is retroactive, so the election window itself works as cover while you decide. How that works.

What are the deadlines?

Three clocks start when your employer coverage ends. Miss one and you can be uninsured for months.

60 days to elect COBRA, from your coverage loss date or the date you receive the election notice, whichever is later
60 days Special Enrollment Period on the marketplace, from the date you lose coverage
45 days to make your first COBRA premium payment after electing

Losing employer coverage is what qualifies you for the Special Enrollment Period, so you do not have to wait for open enrollment. The marketplace window runs from the date you lose coverage, not the date you were notified. Pay the first COBRA premium late and you lose the coverage permanently.

What does COBRA cost, and what do you get?

The same plan, network, doctors and deductible progress you have now, at the full premium plus up to a 2 percent administrative fee.

$703 average monthly COBRA premium, individual coverage, 2025
$2,010 average monthly COBRA premium, family coverage, 2025
18 months standard length of COBRA continuation coverage
2% administrative fee allowed on top of the full premium

Those averages come from KFF Employer Health Benefits Survey data and are full premiums with no employer contribution. Employers typically cover 70 percent to 83 percent of the premium while you are employed, which is why the number jumps so much on the way out.

Continuity is the point of COBRA. Same plan, same network, same formulary, and any deductible you have already met this year carries over. That matters most if you are mid-treatment or have a provider you cannot switch away from.

Who qualifies for COBRA, and when it runs longer than 18 months

COBRA is the Consolidated Omnibus Budget Reconciliation Act. It applies if your former employer had 20 or more employees. You, your spouse, and dependent children who were enrolled in the plan can each elect COBRA independently, so one person can take it while others go elsewhere.

Standard coverage lasts 18 months. In some cases, such as disability or a second qualifying event, it can extend to 29 or 36 months.

How does the ACA marketplace work?

You buy an individual or family plan on healthcare.gov or your state marketplace, and if your income dropped after the layoff, premium tax credits can cut the monthly cost sharply.

400% of the federal poverty level, the household income ceiling for premium tax credits
$62,000 roughly, that ceiling for an individual in 2026
$128,000 roughly, that ceiling for a family of four in 2026

After a layoff your projected annual income often drops substantially, which can mean significant subsidies. Coverage does not start the day you enroll:

  • Enroll between the 1st and the 15th. Coverage starts the 1st of the following month.
  • Enroll between the 16th and the end of the month. Coverage starts the 1st of the month after that.
  • Expect a gap of 2 to 6 weeks between losing employer coverage and marketplace coverage starting.
Metal tiers, cost-sharing reductions, and checking your doctors are in network

Marketplace plans come in metal tiers: Bronze has the lowest premiums and the highest out-of-pocket costs, then Silver, then Gold, then Platinum with the highest premiums and lowest out-of-pocket costs. If you qualify for cost-sharing reductions, they only apply to Silver plans.

Marketplace plans have their own provider networks, which may not include your current doctors. Check whether your providers are in-network before enrolling.

Which one is cheaper?

If you qualify for subsidies, the marketplace is almost always cheaper. If you do not, the two are often close and your unmet deductible decides it.

  • With subsidies. A worker earning $40,000 annually might pay $50 to $200 a month for a Silver plan after tax credits, against $700 or more a month for COBRA.
  • Without subsidies. Full-price marketplace plans and COBRA are often in a similar cost range. The difference is in how the plans are structured, not the premium.

COBRA keeps your deductible progress. A new marketplace plan resets it to zero. If you have already spent $3,000 toward a $5,000 deductible between January and March, switching means starting over at $0, and COBRA may cost you less overall even at the higher premium.

How to estimate your income for subsidies, and why severance counts

When estimating your income for marketplace subsidies, include severance pay, unemployment benefits, and any other expected income for the year. The figure is your projected annual household income, not what you are earning this week.

Underestimating income can result in owing money back at tax time, because the tax credits are reconciled against your actual income when you file.

Which should you pick?

COBRA if you are mid-treatment, close to your deductible, or expect a short gap. The marketplace if your income now qualifies you for tax credits or the gap will run past two or three months.

COBRA is usually better when:

  • You are mid-treatment with a specific provider who is not in any marketplace plan network.
  • You have already met or nearly met your annual deductible.
  • You have a short expected gap before new employer coverage starts, a month or two.
  • You are pregnant or have a planned surgery in the near term.
  • Your income is too high for marketplace subsidies.

The marketplace is usually better when:

  • Your income after the layoff qualifies you for premium tax credits.
  • You are looking at more than 2 to 3 months without employer coverage.
  • You do not have strong provider-specific needs.
  • You want to minimize monthly cash outflow during the job search.
  • Your former employer's plan was expensive even with the employer contribution.

You can do both, in order. Elect COBRA to hold coverage now, then switch to a marketplace plan during your Special Enrollment Period. The SEP runs 60 days from your coverage loss, not from your COBRA election, so using COBRA for a month or two does not cost you the marketplace option.

How do you avoid a gap in coverage?

Use the COBRA election window. COBRA is retroactive to the day your employer coverage ended, so the 60 days you have to decide are also 60 days you are covered if something happens.

A coverage gap is any period when you have no health insurance. It matters because an unexpected ER visit or accident during an uninsured period can create catastrophic medical debt. Marketplace coverage does not start until the 1st of the following month, or the month after that, so there is almost always a short gap after employer coverage ends. COBRA is what bridges it.

You can wait up to 60 days to elect COBRA and still be covered back to your coverage loss date. If nothing happens, let the window expire without paying anything and enroll in a marketplace plan instead. This is sometimes called the "COBRA bridge" strategy.

The risk in the bridge strategy, and what it costs if you need it

If you get sick or injured during that 60-day window and then elect COBRA, you will owe back premiums from the coverage loss date. Those retroactive premiums can be substantial, since you are paying the full monthly premium for every month since your coverage ended.

The trade is straightforward. You only pay if you need it, but if you do need it, you pay for the whole period at once.

Does your state change the answer?

It can. Your state may extend continuation coverage to employers too small for federal COBRA, and 14 states plus DC run their own marketplace instead of healthcare.gov.

  • Mini-COBRA. If your employer had fewer than 20 employees, federal COBRA does not apply but state continuation coverage may.
  • State marketplaces. If your state runs its own, use that instead of healthcare.gov.
  • Medicaid expansion. In most states, Medicaid now reaches incomes well above the old limits.
Which states have mini-COBRA laws and their own marketplaces

States including California, New York, Texas, Illinois, Connecticut, and many others have laws that extend continuation coverage rights to employees of smaller companies, typically those with 2 to 19 employees. Duration and terms vary by state.

Fourteen states and DC run their own health insurance marketplaces, such as Covered California and NY State of Health. These may have different enrollment periods, plan options, or state-specific subsidies.

In 40 states plus DC, Medicaid has been expanded to cover adults earning up to 138 percent of the federal poverty level, about $21,000 for an individual. If your income after the layoff drops below that threshold, Medicaid may be available with no premiums and minimal cost-sharing.

Could you qualify for Medicaid?

Medicaid uses your current monthly income, not last year's. Even if you earned $80,000 last year, unemployment benefits alone can put you under the threshold.

138% of the federal poverty level, the Medicaid ceiling in expansion states
$21,000 about, what that works out to for an individual
Year-round Medicaid enrollment, no deadline and no enrollment period

Apply through healthcare.gov or your state marketplace. The system automatically checks whether you qualify for Medicaid based on the income you report, so there is no separate application.

How a severance payment affects a Medicaid application

A lump-sum severance payment can push your income above Medicaid thresholds for the month it is received. If you received a large severance, you may not qualify for Medicaid in that month but may qualify in later months, once unemployment benefits are your only income.

Decision checklist

Confirm your last day of employer coverage (not always the same as your last day of employment)
Review your COBRA election notice for premium amounts and the 60-day election deadline
Estimate your projected annual income (severance + unemployment + any other income) for subsidy calculations
Visit healthcare.gov or your state marketplace to preview plans and subsidy estimates before committing to COBRA
Check whether your current doctors and prescriptions are covered by marketplace plan networks
Calculate how much deductible you have already met this year (if switching mid-year)
If income may qualify you for Medicaid, apply through the marketplace to check eligibility
If a spouse has employer coverage available, compare that option against COBRA and marketplace plans
Mark your 60-day COBRA election deadline and 60-day SEP deadline on your calendar

One caveat

This is general information about health insurance options after a layoff, not legal or financial advice. Health insurance regulations vary by state and individual circumstances differ. Premium amounts, subsidy eligibility, and Medicaid thresholds change annually. Visit healthcare.gov or your state marketplace for current plan information and subsidy estimates.

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