Losing employer coverage opens a special enrollment period. It is short, it is not advertised, and it arrives in a week when you have other things on your mind.
This guide is what to do in the first fortnight.
The clock
Losing coverage through a job — being laid off, resigning, having hours reduced below the threshold, or the employer dropping the plan — opens a window of sixty days.
Two things about it that matter more than the number.
It runs from the loss of coverage, not from the loss of the job. Those are frequently different dates. Coverage often runs to the end of the month.
You can act before it happens. If you know coverage is ending, you can apply in advance, which is how you avoid a gap altogether rather than backfilling one. This is the single most useful sentence here.
Voluntarily dropping coverage you could have kept generally does not open a window. Losing it does.
In the first fortnight
Write down the date coverage actually ends. Not the last day of work — the last day of cover. Everything is counted from it and you will be asked.
Get the letter. The employer or the plan administrator issues a notice confirming the coverage and the termination date. Request it before you leave, while you still know who to ask. Retrieving it from a former employer two months later is a chore people put off, and the deadline does not wait.
Estimate your income for the rest of the year, and for next year. This is where people get it wrong: they use their old salary. If you have stopped working, your expected income has changed, and the credit is based on what you expect — not what you earned. Households that assumed they earned too much frequently qualify for substantial help the moment the salary stops.
Apply. HealthCare.gov, the Marketplace Call Center, a Navigator, or us. Coverage start dates depend on when you apply, which is the other reason not to leave it to day fifty-nine.
Do not assume COBRA is the answer
COBRA continues your existing plan, which is comfortable and often expensive, because you are usually paying the full cost that your employer was partly covering.
A Marketplace plan with a premium tax credit is frequently much cheaper for the same household. Sometimes COBRA is still right — if you are mid-treatment with a specialist you cannot replace, or your deductible is nearly met for the year.
The comparison is worth doing properly and there is a separate guide on it. The important warning: choosing COBRA and changing your mind later is not straightforward. Dropping COBRA voluntarily does not generally open a Marketplace window; running out of it does. Compare before you elect, not after.
What to check before you choose a plan
Your doctors, by name, with the practice’s billing office. Your medications, by name and strength, on the formulary. Whether you qualify for cost-sharing reductions, which apply only to Silver plans.
If you are part-way through a course of treatment, that goes at the top of the list.
If you have already gone past sixty days
Look for another qualifying event — a move, a marriage, a birth, a change in income that affects eligibility for other programmes. Any of them may open a window.
Check whether anyone in the household qualifies for Medicaid or CHIP, which have no enrollment window and can be applied for at any time of year. In a household that has just lost its income, this is a real possibility and is frequently overlooked.
Otherwise the next Open Enrollment is the route, and it is worth diarising the date now.
Where to get help
HealthCare.gov handles the whole application, free, and shows every plan available where you live. The Marketplace Call Center is on 1-800-318-2596, TTY 1-855-889-4325, open 24 hours — useful in a week when your days are full.
Navigators and certified application counselors give free in-person help and are not paid by insurance companies: localhelp.healthcare.gov.
We do it at no cost to you, and we would much rather hear from you in the first week with an unformed question than in week nine with a gap to explain.
General information, not advice
This guide describes how Marketplace coverage generally works. It is not advice about your situation, and rules and figures change — verify anything that matters to a decision against HealthCare.gov or the Marketplace Call Center on 1-800-318-2596 (TTY 1-855-889-4325), both free.
Heartland Coverage Partners LLC is not the Health Insurance Marketplace, not HealthCare.gov, and not connected with or endorsed by the United States government. We do not offer every plan available in your area.
