The Tool Desk
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Start with your coverage end date and enrollment deadlines
Write down the date your employer plan ends and the dates by which you must elect or pay for any replacement coverage. Losing job-based insurance generally qualifies you for a Marketplace Special Enrollment Period. HealthCare.gov says the application window is 60 days after the loss; the application may ask for proof. Check the dates and any documentation request in your eligibility notice. HealthCare.gov explains enrollment after losing job-based insurance.
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A Marketplace plan can generally begin on the first day of the month after your job-based plan ends, so it may not start the same day your employer coverage stops. Confirm the actual effective date before letting existing coverage end.
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Compare the coverage routes
| Route | What to check | Timing and trade-offs |
|---|---|---|
| Marketplace plan | Premium after any estimated savings, deductible, copayments, coinsurance, provider network, and drug coverage. | Loss of job-based coverage generally opens a 60-day application window. Coverage can generally start the first day of the month after the employer plan ends; verify the date in your eligibility results. |
| COBRA | Actual full premium, administrative fee, election and payment deadlines, covered family members, and continuation period. | HealthCare.gov describes the typical continuation period as 18 months. You generally pay the full premium, including the former employer’s share, plus a small fee. See HealthCare.gov’s COBRA guidance. |
| Medicaid or CHIP | Eligibility for each household member under your state’s rules. | Applications are available year-round. Eligibility and program details vary by state and household; apply through the Marketplace or your state agency. |
Marketplace savings depend on your household circumstances
A Marketplace application can assess eligibility for premium tax credits, extra cost-sharing savings, Medicaid, or CHIP. For Marketplace savings, report estimated income for the full calendar year, including earnings before your job ended, and use the applicable tax household. Update the Marketplace if your circumstances change. An offer of coverage through a spouse’s job or another employer can affect premium tax-credit eligibility: if the offer is considered affordable and meets minimum standards, credits may be unavailable even if you decline the coverage. Let the Marketplace make the eligibility determination rather than assuming unemployment automatically qualifies you for savings. HealthCare.gov explains how to find out whether you can save.
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COBRA can preserve continuity, but check the exit rules
Keeping COBRA may preserve a familiar plan and its network, but the price can rise when the employer contribution ends. During Marketplace Open Enrollment, a person can generally switch from COBRA to a Marketplace plan. Outside Open Enrollment, a Special Enrollment Period can apply when COBRA runs out or is no longer available, including when an employer stops contributing or a subsidy ends. Voluntarily ending COBRA early or simply stopping premium payments generally does not create a new Special Enrollment Period. Check eligibility and replacement-plan effective dates before ending COBRA.
Estimate what each option could cost over the year
Compare the premium for the months you need coverage with the cost-sharing you might pay for care. Build low-, medium-, and high-use scenarios if you do not know how much care you will need. The Marketplace’s total-cost estimate is not a guarantee: actual spending depends on the services you use and how the plan covers them.
Rank #2
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- Include monthly premiums, the deductible, copayments, and coinsurance.
- Check the plan’s out-of-pocket maximum and which costs count toward it. It caps covered in-network care after applicable deductibles and cost sharing; premiums, uncovered services, out-of-network care, and amounts above the allowed charge are excluded.
- For the 2026 plan year, the Centers for Medicare & Medicaid Services’ federal Marketplace ceiling is $10,600 for an individual or $21,200 for a family. That is a ceiling, not a promise that every plan sets its maximum at those amounts. Check the actual plan limit and coverage year. HealthCare.gov describes out-of-pocket limits.
Check whether the plan works for your care
Confirm providers and prescription coverage
Look up the doctors, hospitals, specialists, and pharmacies you rely on in the plan’s current directory. Check each important medication on the plan’s drug list, including its formulary tier and any prescription deductible or cost sharing. Networks and formularies are plan-specific, so a provider or drug covered by one option may not be covered the same way by another. HMO and EPO plans generally restrict non-emergency care to network providers; PPO and POS plans have different out-of-network and referral rules.
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Read the plan’s Summary of Benefits and Coverage (SBC) to compare benefits, cost-sharing rules, and standardized examples that include diabetes care and childbirth. SBCs are available for individual and job-based plans. HealthCare.gov explains how to use the SBC.
Rank #3
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Do not treat metal level as a quality score
Bronze, Silver, Gold, and Platinum describe how costs are shared between a plan and its members; they do not rate the quality of care. Plans within the same metal category can differ in networks, plan type, and benefits. Compare those details directly. HealthCare.gov explains Marketplace plan categories.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Use a side-by-side checklist before enrolling
- Eligibility and timing: Is the option available to your household, what is the deadline, when does coverage begin, and is proof required?
- Total household cost: What are the premiums and likely out-of-pocket costs, and what is the maximum for covered in-network care?
- Care continuity: Are your doctors, hospitals, specialists, and pharmacies in network?
- Medicines: Are your prescriptions covered, and what tier, deductible, or cost sharing applies?
- Benefits and rules: What does the SBC say about the services you expect to use, referrals, and network restrictions?
- Flexibility: How long can COBRA continue, and what would qualify you to switch later? What service area and network limits apply to a Marketplace plan?
Compare current Marketplace results and the actual COBRA notice before acting. Plan availability, premiums, networks, drug lists, and state Medicaid or CHIP rules vary and can change. General federal guidance cannot determine which option is best for a particular household.
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