Losing your job doesn’t have to mean losing your health coverage — but the clock starts the moment your employer plan ends, and the option that looks cheapest on paper isn’t always the one that actually protects you.
By Marc Gilman
Questions? Call (800) 927-9326 or email
Key Takeaways
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You typically have 60 days from the date your job-based coverage ends to enroll in a Marketplace plan, elect COBRA, or apply for Medicaid — miss that window and you may be stuck without coverage until the next open enrollment period.
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COBRA keeps your exact plan and network, but you now pay the full premium yourself, often hundreds of dollars more per month than you were paying as an employee.
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Enhanced ACA subsidies expired at the end of 2025, so Marketplace premium tax credits reverted to pre-2021 rules — that changes the math on whether COBRA or a Marketplace plan is the better deal.
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If your income dropped with your job, you may now qualify for MassHealth or NH Medicaid even if you didn’t before — and there’s no enrollment deadline to apply.
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The right answer is rarely the same for every household. It depends on your income, your state, your prescriptions, and whether you’re mid-treatment for something.
What Happens to My Coverage the Moment My Job Ends?
Most employer plans end either on your last day of work or at the end of that month, depending on your employer’s policy. Either way, you’re not left without options — you have a qualifying life event, which opens a 60-day special enrollment window to sign up for a new plan outside the normal enrollment period.
That 60-day clock is the single most important number in this whole process. It applies whether you’re looking at COBRA, a Marketplace plan, or in some cases enrolling a spouse onto their employer’s plan. Miss it, and in most cases you’re waiting until the next annual open enrollment period to get covered — a gap most people can’t afford to have.
Should I Keep My Employer Plan Through COBRA?
COBRA lets you stay on your exact same plan — same doctors, same prescriptions, same network — for up to 18 months after your job ends. For some people that continuity is worth paying for, especially if you’re in the middle of treatment and switching plans would mean starting over with a new insurer’s prior authorization process.
The catch is cost. Your employer was almost certainly covering a large share of your premium while you worked there. Under COBRA, you pay the full premium yourself, plus up to a 2% administrative fee. For family coverage, that can easily run into four figures a month. COBRA tends to make the most sense when:
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You’re actively mid-treatment for a condition where switching networks or specialists would disrupt care
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You’ve already met your deductible for the year and switching plans would reset it
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You expect a new job with benefits within a few months and just need a short bridge
Should I Look at an ACA Marketplace Plan Instead?
For most people, the Marketplace is worth checking before defaulting to COBRA — losing job-based coverage qualifies you for that same 60-day special enrollment period on the ACA Marketplace (Massachusetts residents use the Health Connector; New Hampshire residents use HealthCare.gov).
Here’s the part that changed recently: the enhanced premium tax credits that made Marketplace coverage unusually affordable from 2021 through 2025 expired at the end of 2025. Premium tax credits still exist, but they’ve reverted to the original ACA rules, which means:
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The income cap returns — households above roughly 400% of the federal poverty level may no longer qualify for a subsidy at all (this is sometimes called the “subsidy cliff”)
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For households that do still qualify, subsidies are generally smaller than they were the past few years
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Out-of-pocket premiums are rising for a meaningful share of Marketplace enrollees in 2026
That doesn’t mean the Marketplace is off the table — it often still beats COBRA on price, especially for lower and middle incomes. But it does mean the “just go on the Marketplace, it’s cheap” advice from a few years ago needs a second look this year. This is exactly the kind of comparison worth running with an agent before you commit either way.
Am I Now Eligible for Medicaid or MassHealth?
If your household income dropped when your job ended, you may qualify for Medicaid now even if you didn’t while employed — and unlike COBRA or the Marketplace, there’s no enrollment deadline. You can apply any time, and approval can happen within days.
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In Massachusetts, MassHealth is generally available to individuals earning up to 138% of the federal poverty level (roughly $21,384 for a single person in 2026). The same application through the Health Connector also checks your eligibility for ConnectorCare and standard Marketplace subsidies, so one form covers all three.
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In New Hampshire, Medicaid expansion covers adults up to the same 138% FPL threshold, and enrollment is also available year-round through the state’s Medicaid program.
If your income is close to that line, it’s worth applying even if you’re not sure — the application itself will route you to whichever program you qualify for.
What About My Spouse’s Employer Plan?
If your spouse has coverage available through their own job, losing your coverage is also a qualifying life event for their plan — most employers give you 30 days (sometimes 60) to add yourself to their plan outside of their normal open enrollment. This is often the simplest and cheapest option if it’s available, since you’d be joining an existing group plan rather than buying individual coverage. Check the deadline with their HR or benefits department right away, since employer-side windows are sometimes shorter than the Marketplace’s 60 days.
Is Short-Term Health Insurance Worth Considering?
Short-term plans are built as a temporary bridge — lower premiums, fast approval, but with real trade-offs: they can deny coverage for pre-existing conditions and often skip essential benefits like maternity or mental health care.
Availability also depends heavily on your state:
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Massachusetts requires any short-term plan sold in the state to meet the same guaranteed-issue and rating rules as ACA-compliant plans — which means the bare-bones, medically underwritten short-term plans common in other states generally aren’t available here in the way people expect.
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New Hampshire allows more traditional short-term plans, which can be a reasonable stopgap for a healthy individual who needs a few weeks or months of coverage while sorting out something more permanent.
If you’re in Massachusetts, this option is more limited than it looks from a national insurance website — worth confirming with an agent licensed in your state before assuming it’s on the table.
So Which Option Actually Costs the Least?
There’s no single answer — it depends on three things: your income relative to the poverty level, your state, and your health needs. As a general pattern:
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Lower income, especially near or below 138% FPL: Medicaid/MassHealth is usually your least expensive, most comprehensive option
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Moderate income, no urgent mid-treatment needs: A Marketplace plan is often cheaper than COBRA, even with the subsidy changes
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Mid-treatment, or you’ve already hit your deductible: COBRA’s continuity may be worth the higher premium
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Spouse has employer coverage available: Usually the simplest and often the cheapest path
What Should I Do About My HSA?
If you were enrolled in a high-deductible health plan with a Health Savings Account, losing that coverage doesn’t touch the money already in the account — it’s still yours, and you can still use it for qualified medical expenses. What it does affect is new contributions: you can only contribute to an HSA while enrolled in an HSA-eligible high-deductible plan. If your next plan (COBRA, Marketplace, or otherwise) isn’t HSA-eligible, your contributions stop until you’re back on one that qualifies. This is worth checking before you assume you can keep funding it the way you were.
What To Do Next
Losing a job is stressful enough without a health insurance decision made under pressure. The right move depends on your income, your state, your current treatment needs, and what’s available through a spouse — and getting it wrong can mean either overpaying for months or having a coverage gap you didn’t intend.
If you’ve recently lost employer coverage, reach out and we’ll walk through your specific numbers — COBRA cost, your actual Marketplace subsidy eligibility under the new 2026 rules, and whether MassHealth or NH Medicaid might apply — so you can make this decision once, with the full picture in front of you.
Questions? Call (800) 927-9326 or email
