In the US, health insurance is usually tied to your job. When the job ends, coverage often ends at the end of that month. A medical emergency without insurance can cost thousands of dollars, so avoiding a gap matters, even for a few weeks.
This guide covers the main options. It’s general information, not insurance or legal advice.
When does coverage end?
Check with HR or your benefits portal. Common patterns:
- Coverage ends on your last day of work
- Coverage ends at the end of the month you leave (most common)
- If you’re starting a new job, coverage may not begin until the first of the following month, or after a waiting period
Write down your end date and your new plan’s start date. The gap between them is what you need to cover.
Option 1: COBRA
COBRA is a federal law that lets many people keep their employer’s health plan after leaving a job, usually for up to 18 months.
- Same plan, same doctors, same deductible progress
- You pay the full premium, including the part your employer used to pay, plus up to a 2% admin fee. This often costs several hundred dollars a month for one person, and more for families
- You have 60 days to elect COBRA after you receive the notice or lose coverage, whichever is later
- Coverage can be retroactive: if you elect and pay within the deadlines, coverage goes back to the day your old coverage ended
COBRA applies to employers with 20 or more employees. Many states have “mini-COBRA” laws for smaller employers.
Tip: Because COBRA can be retroactive, some people wait to see whether they need medical care before electing. It’s legal, but risky if you miss a deadline or can’t pay the premium later.
Option 2: ACA Marketplace plans
Losing job-based coverage is a qualifying life event. You get a special enrollment period, usually 60 days before or after losing coverage, to buy a plan on HealthCare.gov or your state’s marketplace.
- Plans are grouped as Bronze, Silver, Gold and Platinum, from lower premiums and higher out-of-pocket costs to the reverse
- Depending on income and status, you may qualify for premium tax credits
- Coverage usually starts the first of the month after you enroll
The 2027 change for immigrants
Starting with 2027 coverage, premium tax credits for non-citizens are limited mainly to lawful permanent residents, certain Cuban and Haitian entrants, and people from Compact of Free Association nations. Many people on work or student visas, as well as refugees, asylees and TPS holders, can still buy Marketplace plans, but at full price. If you’re in that group, compare Marketplace prices with COBRA carefully.
Option 3: Join a spouse’s or partner’s plan
Losing coverage is also a qualifying event for joining a spouse’s employer plan, usually within 30 days. This is often the cheapest option.
Option 4: Medicaid
Medicaid covers people with low income, and your income after a job loss may qualify. Eligibility for immigrants depends on status and time in the US, and rules vary by state. Children and pregnant people often have broader eligibility. Check with your state Medicaid office.
Option 5: Short-term health plans
Short-term plans can be cheaper, but they’re not ACA-compliant. They can exclude pre-existing conditions, cap benefits and skip essential services like maternity or mental health. Federal rules limit their length, and some states ban them. Read the fine print closely.
Comparing your options
| Option | Cost | Keeps same doctors | Covers pre-existing conditions | Best for |
|---|---|---|---|---|
| COBRA | High | Yes | Yes | Ongoing treatment, short gaps |
| Marketplace | Varies; subsidies depend on status | Maybe | Yes | Longer gaps, eligible for credits |
| Spouse’s plan | Usually lower | Maybe | Yes | Married or partnered |
| Medicaid | Low or free | Maybe | Yes | Low income, eligible status |
| Short-term plan | Low | Maybe | Often no | Healthy people, very short gaps |
For visa holders after a layoff
If you’re on an H-1B or another work visa and in the 60-day grace period, keep coverage in mind. A hospital bill can drain the savings you need to find a new job. COBRA or a Marketplace plan for one or two months can be worth it. International students on OPT should also check if their school plan continues after graduation; many end on a set date.
Checklist when your job ends
- Get your coverage end date in writing
- Look for the COBRA notice, which should arrive within weeks
- Get Marketplace quotes within 60 days
- Check a spouse’s plan
- Refill prescriptions before your coverage ends
- Use any remaining FSA money before it expires
- Keep your HSA; it’s yours even after you leave
Avoiding surprise bills
- Stay in network when possible
- Use urgent care for non-emergencies instead of the ER
- Ask for cost estimates before planned procedures
- Review every bill and ask for an itemized statement
The No Surprises Act protects you from many unexpected out-of-network bills for emergency care.
Cost example: COBRA vs. Marketplace
Here’s an illustration for one person between jobs for two months. Your numbers will differ.
| COBRA | Marketplace Silver plan (no subsidy) | Marketplace Bronze plan (no subsidy) | |
|---|---|---|---|
| Monthly premium | $650 | $480 | $360 |
| Deductible | Already partly met this year | New deductible, e.g. $4,000 | New deductible, e.g. $7,000 |
| Same doctors | Yes | Maybe | Maybe |
| Total premiums for 2 months | $1,300 | $960 | $720 |
If you’ve already met much of your deductible this year, or you’re in the middle of treatment, COBRA may be worth the higher premium. If you’re healthy and eligible for subsidies, a Marketplace plan may cost far less.
Timing tricks that help
- Start the new job on the first of a month if possible, so employer coverage starts sooner
- Ask your new employer whether coverage starts on day one or after a waiting period
- Elect COBRA only if needed: because it’s retroactive within the deadlines, some people keep it as a backup during a short gap, then pay if they need care. Understand the risk and never miss the deadlines
Students after graduation
Many school health plans end on a fixed date after your last semester. If you’re starting OPT, check:
- When your student plan ends
- Whether your OPT employer offers coverage, and when it starts
- Whether you can buy a Marketplace plan (lawfully present students can usually enroll, though subsidies depend on status)
- Whether a short-term international student plan is available as a bridge
Families
If you cover a spouse or children, include them in your comparison. COBRA can cover dependents who were on your plan. A spouse’s employer plan may be the cheapest option for the whole family. Children may qualify for CHIP depending on income and state rules.
Mental health and prescriptions
Before your coverage ends, schedule any therapy sessions or refill ongoing prescriptions. Ask your doctor for a 90-day supply if possible. Some medications have manufacturer assistance programs that lower costs if you’re temporarily uninsured.
Questions to ask HR before your last day
- What is the exact date my health, dental and vision coverage ends?
- When will I receive the COBRA notice, and what will it cost per month?
- Does the company subsidize COBRA as part of severance?
- What happens to my FSA and HSA balances?
- Can I get a certificate or letter showing my coverage end date for a Marketplace application?
Getting clear answers in writing makes the next steps much easier.
Key terms at a glance
- COBRA: keeping your employer plan after leaving, at full cost
- Special enrollment period: a window to buy coverage after a life event like job loss
- Premium tax credit: a Marketplace subsidy based on income and eligibility
