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

This page is for people in cancer treatment who are losing, or have just lost, health insurance through a job. It explains the Marketplace sign-up window and how to avoid a gap in 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. 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. Ask the Marketplace when your new coverage would begin, so you can plan around any gap.

For most people two weeks without coverage 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. Ask when the new plan would start, so you know whether any days are uncovered.
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. (HealthCare.gov describes COBRA as a federal law that lets you and your family keep your employer's group health plan for a limited time.)

The rule covers more than job loss. HealthCare.gov says you may qualify if you lose qualifying health coverage, including coverage you had through a parent, spouse or other family member. Medicaid and CHIP (the Children's Health Insurance Program) are also covered by the rule. If your hours were cut and you lost coverage, ask the Marketplace whether you qualify.

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

Some people continue their employer plan through COBRA. Choosing COBRA does not close the Marketplace off to you afterward. When COBRA ends, you have 60 days to enroll in a Marketplace plan.

HealthCare.gov says voluntarily dropping coverage generally does not qualify you for this window. If cost is the issue, look at the numbers before you choose COBRA, and ask the Marketplace or a financial counselor to help you compare 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.

HealthCare.gov says 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 counselor what is happening, so nobody schedules an expensive week into the middle of a coverage change.

• HealthCare.gov: Special Enrollment Period