COBRA & Under-65 Health Insurance Guidance
Reviewed by Prodest Insurance Group, a licensed insurance agency (NPN 19515569) · Updated 26 October 2026 against current federal guidance.
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| COBRA | ACA Marketplace | |
|---|---|---|
| What it is | The right to stay on your former employer’s group plan | A new individual or family plan bought through the ACA Marketplace |
| Who can use it | Employees and dependents of employers with 20 or more staff, after a qualifying event | Almost anyone lawfully present who is not eligible for Medicare |
| How long it lasts | 18 months for job loss or reduced hours; up to 36 months for other events | Renews every year with no time limit |
| When you can enroll | 60 days from the later of coverage ending or receiving your election notice | 60 days from the day you lose coverage, or during annual Open Enrollment |
| COBRA | ACA Marketplace | |
|---|---|---|
| What you pay | Up to 102 percent of the full plan premium: the whole cost plus a 2 percent administrative fee | A premium set by the plan you choose, reduced by any subsidy you qualify for |
| Employer contribution | None. Your employer stops paying their share | Not applicable |
| Income-based subsidies | Not available. COBRA does not qualify for premium tax credits | Available below 400 percent of the federal poverty level. Not available above it |
| Cost-sharing reductions | Not available | Available on Silver plans for households under certain income levels |
| Choice of price point | No choice. You keep the plan you had, at its full cost | Multiple metal tiers, from lower premium with higher out-of-pocket to the reverse |
| COBRA | ACA Marketplace | |
|---|---|---|
| Your doctors | Unchanged. Same plan, same network | A new network. Your doctors may or may not be in it, so check before enrolling |
| Your prescriptions | Unchanged. Same formulary and tiers | A different formulary. Coverage and cost for the same drug can change |
| Deductible already met | Carries over. You stay in the same plan year | Resets to zero. A new plan means starting the deductible again |
| Out-of-pocket maximum | Carries over within the same plan year | Resets with the new plan |
| Ongoing treatment | Continues without interruption or new prior authorizations | May require new referrals or prior authorization under the new plan |
| COBRA | ACA Marketplace | |
|---|---|---|
| Covering part of a household | Each qualified beneficiary can elect independently | You choose who is on the policy when you apply |
| Dental and vision | Continues only if you had it through the employer | Bought separately, either as a Marketplace dental plan or a standalone policy |
| If you move | The plan continues, but an out-of-area network may not serve you well | Plans are county specific. Moving generally opens a new enrollment window |
| If you get a new job | You can drop COBRA when new coverage starts | You end the Marketplace plan when new coverage starts |
| Ending it early | Dropping COBRA voluntarily does not open a Marketplace enrollment window. Letting it run out does | You can end it at any time, but re-enrolling may require a qualifying event |
COBRA is the right to stay on your former employer's group plan, paying up to 102 percent of the full premium. A Marketplace plan is a new individual or family plan bought through the ACA Marketplace, with a premium that may be reduced by a subsidy depending on your income. COBRA keeps everything as it was; a Marketplace plan is a fresh start with a new network and a deductible that resets.
Cost is usually the deciding factor. COBRA is the same plan at its full price, with no employer contribution and no subsidies. A Marketplace premium can be reduced by a premium tax credit for households below 400 percent of the federal poverty level, so the gap can be substantial when income has dropped. Above that threshold no credit applies, and the comparison changes.
No. COBRA does not qualify for premium tax credits or cost-sharing reductions. Those are available only on Marketplace plans.
Not necessarily. A Marketplace plan means a new network, so your doctors may or may not be in it, and you should check before enrolling. Your prescription formulary can change too, and any deductible you have already paid resets to zero under the new plan.
Only if you had dental or vision coverage through your employer. COBRA continues the plans you were enrolled in; it does not add new ones. With a Marketplace plan, dental is bought separately, either as a Marketplace dental plan or a standalone policy.
Losing job-based coverage opens a 60-day Marketplace window, and that is the time to compare. If you elect COBRA and voluntarily drop it later, that does not reopen the window; you would generally wait for Open Enrollment. Letting COBRA run out completely does qualify you for a new window.
COBRA lasts 18 months after job loss or reduced hours, and up to 36 months for other qualifying events. A Marketplace plan renews every year with no time limit, which matters if you need coverage for longer than 18 months.
COBRA applies to employees and dependents of employers with 20 or more staff, after a qualifying event. The Marketplace is open to almost anyone lawfully present who is not eligible for Medicare.
It depends on your situation. COBRA keeps everything exactly as it is and you pay the full price for it. An ACA Marketplace plan, often called Obamacare, is a fresh start that may cost far less depending on your income, but the network and deductible reset.
Prefer to talk? Call (888) 918-4516 · Monday to Friday, 10:00 a.m. to 5:30 p.m. Eastern
This website provides educational information about health insurance and is a solicitation for insurance. It is a non-government website operated by Prodest Insurance Group, a health insurance agency that presents health plans, which may include Affordable Care Act (ACA) plans, private health insurance, short-term medical insurance, or supplemental insurance based on the consumer's selection. Qualified ACA plans must meet or exceed the essential benefit requirements of the Affordable Care Act; non-ACA plans are not required to provide all of the essential benefit requirements contained in the Affordable Care Act. Pre-existing condition provisions, benefit availability, limitations and exclusions vary by plan type and state. You should review all plan details and product brochures before purchase. To qualify for ACA health insurance coverage outside of the open enrollment period, you must meet special enrollment requirements.
*Eligibility for Affordable Care Act (ACA) Advance Premium Tax Credit (APTC) and cost-sharing reductions is based on annual federal income thresholds, household size, and plan availability within the applicable service area. Premium rates, plan availability, and subsidy amounts vary by state and marketplace. Final eligibility and premium obligations are determined by the Health Insurance Marketplace under Internal Revenue Code Section 36B and applicable federal regulations.
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