How long you have to enroll after losing job-based coverage

Losing coverage through a job is one of the life events that lets you buy a Marketplace plan outside the normal sign-up season. HealthCare.gov describes the window in two directions: the loss counts if it happened in the past 60 days, or if you expect to lose coverage in the next 60 days.

That second half is the useful part, and most people never hear about it. You do not have to wait until you are uninsured to act.

If you already know the date your coverage ends, you can start now and avoid a gap entirely.

For most people an uncovered fortnight is a nuisance. For someone in active cancer treatment it can mean a postponed infusion, an unfilled prescription, or a scan that slips by weeks — and a bill for anything that goes ahead anyway.

So the sequence is worth planning rather than improvising:

1. Find out the exact last day of your job-based coverage, in writing.
2. Apply during the 60 days before that date, so new coverage can pick up when the old ends.
3. Check the new plan against your actual treatment — the providers you see and the drugs you take.
4. Keep the termination notice and any COBRA paperwork.

The rule is not limited to being laid off. HealthCare.gov's coverage-loss category includes losing job-based coverage, individual coverage, Medicaid, CHIP, or coverage you had as someone's dependent. A reduction in hours that drops you below your employer's eligibility threshold counts as losing job-based coverage, even though you still have the job.

For Medicaid and CHIP, the backward-looking window is longer: 90 days past the loss rather than 60.

Many people continue their employer plan through COBRA to avoid disrupting treatment. That is a reasonable choice, and it does not close the Marketplace off to you afterwards — when COBRA ends, you have 60 days to enroll in a Marketplace plan.

Note what is not being promised: this is about COBRA ending, not about dropping it because it turned out to be expensive. If cost is the issue, look at the numbers before you elect COBRA rather than after, and ask a Marketplace assister to compare the options against the treatment you have scheduled.

Premium is the easiest number to compare and rarely the decisive one. During cancer treatment, three other questions usually matter more:

• Network. Are your oncologist, your surgeon, and your treating facility all in the new plan's network?
• Formulary. Is every drug you take on the new plan's covered list, and at what cost level?
• Out-of-pocket maximum. If you are heading for the cap either way, the cap is your real budget.

A plan that is cheaper monthly and forces you to change cancer centers mid-treatment is not cheaper.

When you apply you must attest that the information you provide is true, and documentation may be required to confirm your qualifying event. Collect it now: the employer letter with the end date, the COBRA election notice, and any Medicaid termination notice.

If your circumstances are unusual — an employer offering an HRA, for instance — some situations cannot be completed online and need a call to the Marketplace Call Center. Make that call early in the 60 days, not late. And tell your cancer center's financial counsellor what is happening, so nobody schedules an expensive week into the middle of a coverage change.