You Lost Your Job and Your Health Insurance. COBRA, Marketplace, or Medicaid?

The insurance threads we studied are full of one specific ambush: the job ends, life is chaos, the COBRA packet sits unopened, and week seven delivers either a four-figure premium bill or an uncovered urgent care visit. The system actually gives you decent options here, but all of them run on 60-day clocks that start whether or not you're paying attention. Here's the whole decision, with the deadlines in bold.

Option 1: COBRA, your old plan at full freight

COBRA lets you keep the exact plan you had, same network, same deductible progress, for up to 18 months (longer in some situations) after leaving most employers with 20 or more employees. The catch is arithmetic: you now pay the entire premium, the share your employer was quietly covering included, plus up to a 2% administration fee, up to 102% of the total cost. Employers typically covered most of that premium, so the sticker shock is real: family coverage routinely lands north of $2,000 a month.

• Election window: 60 days from the COBRA election notice (or the coverage loss, if later).
• Election is retroactive to the day your coverage ended, so there's no gap once you elect and pay.
• First payment: within 45 days of electing, covering all premiums back to the loss date.
• When COBRA genuinely wins: you're mid-treatment with providers you can't lose, you've already met a big deductible this year, or a specific drug or specialist exists only in that network.

Option 2: the marketplace, usually the cheaper lane

Losing job-based coverage is a qualifying event that opens a [60-day special enrollment period](https://www.healthcare.gov/have-job-based-coverage/if-you-lose-job-based-coverage/) on HealthCare.gov or your state's exchange (you can even enroll up to 60 days *before* a known end date, and should). Subsidies are computed from your expected annual income, and a year with months of unemployment in it often qualifies for substantial premium tax credits, sometimes plans with premiums near zero. Compare the actual plan you'd get, not the category: check that your doctors and drugs are in-network (verify by phone, not directory), and note your deductible restarts at $0 on the new plan.

Option 3: Medicaid, if the income math says so

Medicaid enrolls year-round and, in most states, looks at current monthly income. A household that made good money through May but has near-zero income in June can qualify in June. In expansion states, adults qualify under roughly 138% of the federal poverty level; children often qualify for Medicaid or CHIP at much higher household incomes even when parents don't. The marketplace application checks this automatically and routes you, so applying there answers both questions at once.

How to actually decide, in one afternoon

1. Find your COBRA price (it's in the election notice) and your coverage end date.
2. Run the [marketplace application](https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/) with your honest income estimate for the year. It quotes subsidized prices and screens for Medicaid in the same pass.
3. Compare on four axes: monthly premium, whether your doctors and medications are covered, deductible already met this year (COBRA keeps it; new plans reset), and how long until your next coverage (a new job's insurance, Medicare). The full plan-choosing framework applies to the marketplace side of this decision.
4. Mind the two traps: dropping COBRA voluntarily mid-stream does NOT open a new special enrollment period (you'd wait for open enrollment, or for COBRA to fully run out), and if you're 65+, COBRA is not a substitute for enrolling in Medicare (the penalty trap is permanent).
5. Whatever you choose, decide inside the first 60 days. Both clocks end around the same time, and after them the options are COBRA-only or nothing until open enrollment.