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Losing Employer Coverage

Losing employer coverage: your real options

Losing a group plan starts two clocks at once: a 60-day COBRA election window, and a 60-day special enrollment period for the ACA marketplace. Miss both and your options narrow considerably until the next open enrollment.

There is no single right answer here. There are four roads, and which one is yours depends on your health, your income, and how long you expect to need the coverage.

COBRA or the marketplace

The two paths opened by the loss of coverage itself, both with a 60-day clock attached.

  • COBRA keeps your exact plan, doctors and deductible progress
  • COBRA costs the full unsubsidised group premium plus an admin fee
  • Losing coverage is a qualifying event for a marketplace special enrollment
  • A drop in income often means a subsidy you did not qualify for last year
  • Both clocks run 60 days from the loss of coverage

Private PPO

The path with no clock attached, available on any day of the year.

  • No enrollment window — apply whenever you are ready
  • Commonly well below the unsubsidised COBRA premium
  • Nationwide PPO network, not your old employer's regional one
  • Underwritten, so approval depends on health history
  • Renewable, so it works whether the gap is three months or three years
Line by line

Where each one actually wins.

  • Deadline to actCOBRA or the marketplace60 days for bothPrivate PPONoneAdvantage: private PPO
  • Keeps your current doctorsCOBRA or the marketplaceCOBRA: yes. Marketplace: variesPrivate PPOUsually, on a broad PPOAdvantage: the alternative
  • Cost if your income droppedCOBRA or the marketplaceMarketplace subsidy can be substantialPrivate PPONo subsidy availableAdvantage: the alternative
  • Cost if your income did not dropCOBRA or the marketplaceCOBRA and unsubsidised plans are expensivePrivate PPOOften half or lessAdvantage: private PPO
  • Health questionsCOBRA or the marketplaceNonePrivate PPOYes — underwrittenAdvantage: the alternative
  • How fast coverage startsCOBRA or the marketplaceCOBRA backdates to the gapPrivate PPONext available effective dateAdvantage: the alternative
  • If you are mid-treatmentCOBRA or the marketplaceCOBRA preserves everythingPrivate PPODeductible resetsAdvantage: the alternative
  • If the gap lasts yearsCOBRA or the marketplaceCOBRA expires at 18 monthsPrivate PPORenewable indefinitelyAdvantage: private PPO
The questions behind the table

What people ask us before deciding.

People weighing up COBRA or the marketplace against Private PPO

  • What should I do in the first week?

    Three things. Find the exact COBRA premium on your HR notice — not the guess, the number. Check healthcare.gov for a subsidy estimate at your new income, which is often much lower than last year's. Then put a real underwritten alternative next to both. That is what the advisor call is for.

  • My income dropped a lot. Does that change anything?

    Substantially. Marketplace subsidies are based on the income you expect this year, not what you earned last year, so a household that was far above the subsidy line in December can be well inside it by February. If that is you, the marketplace is very likely your cheapest road and we will tell you so.

  • What if I do not decide in 60 days?

    Both special windows close. You can still apply for underwritten private coverage on any day of the year, which is the practical reason it exists as an option — but you will have lost the guaranteed-issue routes until the next open enrollment or another qualifying event.

  • Can I be covered from the day my old plan ends?

    COBRA backdates, which is its quiet advantage — you can decline it for now and elect retroactively if something happens inside the window. Underwritten plans start on a set effective date instead. Say your last covered day on the call and your advisor will build around it.

  • What if I am starting a new job soon?

    Then you are bridging a known gap, and the answer is usually the cheapest thing that covers a catastrophe — often COBRA for one month, or a short-term plan. Do not buy a long-term solution for an eight-week problem.

Best for COBRA or the marketplace

  • Anyone whose income dropped enough to qualify for a subsidy
  • Households mid-treatment or mid-deductible
  • People with health history that makes underwriting uncertain
  • Short, known gaps before a new employer plan begins

Best for Private PPO

  • Healthy households whose income did not drop
  • Anyone who has already passed the 60-day windows
  • Self-employment that is now the plan rather than a stopgap
  • Gaps expected to run longer than COBRA's 18 months

The plain-language verdict

Get three numbers in front of you — the COBRA premium from your notice, the subsidised marketplace premium at your new income, and a real underwritten number from a licensed advisor — before either 60-day clock runs out. One call gets you the third number and an honest read on the other two.

Your turn

Find out which column you actually belong in.

Five questions, about thirty seconds. One licensed advisor reviews your details and calls you once, including to say that the alternative is the better one for you.

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