Losing job-based coverage

Minimum essential coverage (MEC) is any plan that meets the Affordable Care Act (ACA) requirements for having health coverage.

Plans that qualify as MEC include:

Employer-sponsored plans

• Current employees
• Retiree coverage
• COBRA

Government plans

• Medicaid
• Medicare
• Tricare
• Children's Health Insurance Program (CHIP)

Individual plans

• An Individual health plan you enrolled in through the Marketplace (or had before the ACA went into effect and were allowed to keep it)

Plans that are not considered MEC include:

• Dental and vision plans
• Accident supplement insurance
• Worker's compensation
• Health discount plans
• Heath care sharing ministries

Documents must show that you lost qualifying health coverage in the past 60 days or will lose coverage in the next 60 days. These documents must include your name and the date of coverage loss.

Documents you can submit for job loss:

A letter from an employer, on official letterhead or stationery, that confirms one of these:

• That your employer dropped or will drop your coverage or benefits
• That your employer stopped or will stop contributing to your cost of coverage
• That your employer changed or will change coverage or benefits, and your coverage will no longer be considered qualifying health coverage

If your COBRA is ending:

A letter about COBRA coverage, like a letter from an employer or health insurance company that confirms these:

• Your employer's offer of COBRA coverage along with the date this coverage would start
• Your COBRA coverage ended or will end, or your employer stopped or will stop contributing to the cost of coverage and when

Learn about submitting documents at healthcare.gov.

Yes, but only if your spouse and dependents also lost their job-based coverage when you left your job.

If you're offered coverage through a spouse's plan, you can still enroll in a Marketplace plan but it may affect your eligibility for premium tax credits and cost-sharing reductions. 

COBRA stands for the Consolidated Omnibus Budget Administration Act. COBRA allows you to keep your group health coverage when you lose your employer-based health coverage under certain circumstances. COBRA also covers your spouse and any dependents on your plan.

Here are some things to keep in mind about COBRA as you make a decision about your health coverage:

• If your employer-sponsored health plan is covered under COBRA, you'll get COBRA insurance as an option if you quit or lose your job.
• Being offered COBRA continuation coverage doesn't mean you're ineligible for coverage through an Individual health plan or for a tax credit.
• Typically you have at least 60 days after you lose your employer-sponsored health insurance to decide whether you want to enroll in COBRA.
• If you elect COBRA coverage, employers may require you to pay the full cost of the coverage, plus an administration charge.
• The COBRA coverage premium is often more expensive than you're used to paying, because employers usually pay part of the cost of coverage for active employees.
• COBRA coverage typically ranges from 18 to 36 months, which you have to use without interruption. If you choose to terminate your COBRA coverage, you cannot start it up again.

If you choose to enroll in COBRA, you can switch to a Marketplace plan only if you've used up your COBRA coverage, you have another qualifying event or it's OEP.

There are many options for health plans on the Marketplace, and the task of finding the right one may appear overwhelming at first. Knowing a few things beforehand will help you feel prepared as you shop and enroll in an Individual & family health plan.

Here are some costs that will be referred to in each plan:

Premium: The amount you pay to your insurer each month in exchange for health coverage.
Deductible: The amount you pay each year before the health plan starts to pay for certain services. A lower deductible will have a higher premium.
Copayment: A set amount you pay at the time you receive health care services or prescriptions. An example is paying a $20 copay each time you see your primary care provider.
Coinsurance: A percentage of the cost of health care services or prescriptions. An example is paying 20% of the cost of an X-ray.

Think through these questions as you consider a plan:

• What is your budget? (Keep in mind, if you qualify for a premium tax credit to help subsidize your cost, it can be paid to your insurance plan for you each month.)
• Do you have a chronic condition? Look for a plan that's committed to helping keep your chronic condition under control.
• Is it important that you keep your same provider? If so, you'll want to check that they are in-network for the plan you're looking at.
• Do you take any prescription drugs? If so, you'll want to look for good prescription coverage and make sure the medication you're taking is covered under the plan you're looking at. These can be found in the plan's "formulary."
• Do you frequently visit the doctor or a specialist, or need X-rays or other tests, be sure to add in the cost of copays and coinsurance into your budget. If you qualify for cost-sharing reductions and enroll in a Silver plan, you can save on these out-of-pocket costs. Learn more.
• Are you interested in added benefits to help keep you at your healthiest? Look for a plan that gives you added benefits, discounts and perks to save you even more.