You lost your job and your health plan with it: the options and deadlines, in order

What happens to your coverage, and your main options

When a job ends, the employer's health plan usually ends with it, on a date your employer or the plan sets. Your main options are to continue the same plan through COBRA or Texas state continuation, join a spouse's employer plan, buy a Marketplace plan through a Special Enrollment Period, or, if you are healthy and need a bridge, consider short-term medical. HealthCare.gov says losing coverage generally gives you 60 days to enroll in a Marketplace plan, so that is the deadline to plan around. Which option is best depends on cost, your doctors, your health and how soon you expect new coverage.

I am Rex Slover, and at Slover Agency in Murphy I help people between jobs, early retirees and newly self-employed people across the Dallas area find coverage that fits the gap. This is general information to help you think clearly during a hectic week; the specific dates in your situation come from your employer, your plan documents and HealthCare.gov.

First week: find out exactly when your coverage ends

Before you compare anything, get three facts in writing from your former employer or its benefits administrator. Many people assume coverage ends on their last day of work, when it may run to the end of the month, or the reverse. Every other deadline is measured from that end date, so it is worth a phone call to be sure.

While you are asking, find out whether you will receive a COBRA or continuation notice and when. That notice explains how to keep the plan, what it costs and the deadline to elect it. Watch the mail and your email for it, and do not throw it away even if you think you will not use it.

Make a short list of anything health-related that is scheduled in the next two months, such as a surgery, a specialist visit or a refill of an expensive prescription. If something important is coming up, it may make sense to schedule it before your current coverage ends, and it will certainly shape which option you pick next.

• The exact date your medical, dental and vision coverage ends
• Whether you will be offered COBRA or state continuation, and when the notice will arrive
• Whether any severance arrangement includes help with premiums

COBRA: same plan, full price

COBRA lets you keep the same group plan for a limited time after you leave. The U.S. Department of Labor explains that it generally applies to group health plans sponsored by employers with 20 or more employees in the prior year, and that you may be required to pay the entire premium, up to 102% of the cost to the plan. That last part surprises people, because they were used to seeing only their share of the premium on a paycheck.

COBRA's strength is continuity. Your doctors, your deductible progress for the year and your prescriptions stay exactly as they were. That can be worth the cost if you are mid-treatment, have met much of your deductible, or expect to start a new job with benefits soon. HealthCare.gov's advice is simple: compare the cost of COBRA with plans available through the Marketplace before you decide.

When I run the comparison for someone, I look at the full monthly COBRA cost, how much of this year's deductible and out-of-pocket maximum they have already met, and how many months they realistically expect to need coverage. A person three months from a new job who has nearly met the deductible often keeps COBRA. A person starting a business with no fixed timeline usually comes out ahead on a Marketplace plan.

Texas state continuation for smaller employers

If your employer is too small for COBRA, Texas law may still let you keep the group plan. The Texas Department of Insurance explains that if you are not eligible for COBRA, state continuation can last up to nine months after your job ends, as long as you had coverage for the three months before you left. Texas law also requires some group plans to continue coverage for six months after COBRA ends.

There are limits. TDI notes that state continuation usually is not available if you were fired, and it does not apply to self-funded plans, which the state does not regulate. Your plan administrator can tell you whether your plan is fully insured or self-funded, and whether state continuation applies to you.

A spouse's plan or a Marketplace plan

If your spouse has coverage through work, losing your coverage may let you join their plan outside its normal enrollment period. Employer plans have their own deadlines for this, often short ones, so your spouse should contact their HR department as soon as you know your coverage end date. Compare the added cost of joining their plan with the alternatives before you assume it is cheapest.

The Marketplace is the other main route. HealthCare.gov says you may qualify for a Special Enrollment Period if you lost qualifying coverage in the past 60 days or expect to lose it in the next 60, and you may be asked for documents confirming the loss. Depending on your expected income for the year, you may qualify for savings that lower the premium, which can make a Marketplace plan considerably cheaper than full-price COBRA. I explain how to shop it in buying your own plan on HealthCare.gov.

The 60-day rule that trips people up

Here is the detail that causes the most trouble. HealthCare.gov explains that if you choose COBRA and later want to switch to a Marketplace plan outside Open Enrollment, you generally have to make the switch within 60 days of losing your job-based coverage, unless your COBRA is running out or you lose your employer's contribution. If you voluntarily drop COBRA later, that does not open a Special Enrollment Period, and you may have to wait for the next Open Enrollment.

In practice, the first 60 days are your decision window. Use them to compare COBRA, a spouse's plan and Marketplace options side by side with real numbers. Do not elect COBRA by default and plan to sort it out later, because later may be too late to change.

Short-term medical: a bridge, not a replacement

Short-term medical is designed for people between jobs or waiting for new employer coverage to start. As I explain on my agency's individual benefits page, these plans are not regulated by the Affordable Care Act, can be bought outside open enrollment, and do not cover preexisting conditions. TDI adds that such plans may not cover chronic conditions and do not qualify for federal subsidies.

For a healthy person with a new job starting soon, short-term medical can be a sensible, inexpensive bridge. For anyone with ongoing treatment, regular prescriptions or a condition that needs care, it can leave you exposed exactly when you need coverage. I talk people out of short-term plans about as often as I sell them. Read the health plan mistakes I see every enrollment season before you choose one.

If you are 65 or older

Losing a job at 65 or older raises a separate set of deadlines. Medicare gives you a Special Enrollment Period to sign up for Part B after your employment or group coverage ends, and COBRA does not extend it. Waiting until COBRA runs out to sign up for Medicare can leave you with a lifetime penalty. I cover this in whether you need Medicare at 65 if you are still working, and it is worth reading before you elect COBRA.

The same goes for a spouse. If you are under 65 and were covered through a spouse who is retiring or losing a job at 65 or older, you will need your own coverage, because Medicare covers individuals, not households. That usually means COBRA, state continuation or a Marketplace plan for the younger spouse while the older one moves to Medicare, and the two decisions should be made together.

A simple timeline for the next two months

Put these on a calendar the day you learn your coverage is ending. The goal is to make one deliberate decision within the window, not three rushed ones after it closes. If a new job with benefits is already lined up, ask the new employer when its coverage begins, because the length of the gap shapes which option makes sense.

• Day 1 to 7: confirm your coverage end date and whether COBRA or state continuation applies
• Week 2: gather your doctors, prescriptions and income estimate, and ask your spouse's HR about adding you
• Weeks 2 to 4: compare COBRA, a spouse's plan, Marketplace plans and, if you are healthy, short-term options
• Before day 60 after coverage ends: enroll in your chosen plan, and keep proof of the coverage loss
• Throughout: watch for the COBRA notice and its election deadline

Where I can help this week

Losing a job is stressful enough without decoding plan documents. If you send me your coverage end date, your COBRA cost if you have it, your doctors and prescriptions and a rough income estimate, I will lay out COBRA, Marketplace and short-term options side by side and tell you what I would do in your position.

If you are starting your own business rather than looking for a new job, we can also talk about individual coverage for the long term, along with dental, vision, life and disability. Wherever you are in the Dallas area or beyond, the service costs you nothing, because carriers pay the broker.

Questions people ask me