Lost your job and your health insurance? What to do this week

You have more time than you think

Losing a job is stressful, and losing your health insurance at the same time can feel scary. Some rules give you time to decide. You do not have to fix everything today.

Below is a short list of steps for the week ahead, and you can start at the top and work down. If you have a health problem right now that feels serious, please do not wait. Chest pain, trouble breathing, heavy bleeding and signs of a stroke are all emergencies. If you think you are having one, call 911 or go to the nearest emergency room right away.

Step 1. Find out when your coverage ends

Call your old employer's human resources office, or look at your last paperwork, and ask for the date your health coverage ends. Many plans end on the last day of the month you worked, but not all do. You should write the date down, because every deadline below starts from it.

Also ask whether your employer will send you a COBRA notice, which we explain below. Keep every letter and email you get about your coverage.

Step 2. Check for a special enrollment period

Most people can only sign up for a Marketplace plan during a yearly window called open enrollment. Losing job-based coverage opens a second window called a Special Enrollment Period. HealthCare.gov says you may qualify if you lost health coverage in the past 60 days. You may also qualify if you expect to lose it in the next 60 days.

A Marketplace plan is a health plan sold on HealthCare.gov or your state's own site. Many people qualify for help paying the monthly cost, and how much help you get depends on your income. You may be asked to show a document that proves you lost coverage, such as a letter from your employer.

Do not let the 60 days slip by. If you miss the window, you may have to wait until the next open enrollment unless another special situation applies. If you need a plan that fits a smaller budget, our guide on high-deductible plans explains how they work.

Step 3. Find out if you qualify for Medicaid

Medicaid is a government health program for people with low incomes. Unlike a Marketplace plan, you can apply for Medicaid any time of year, so there is no deadline to wait for.

Whether you qualify depends on your state, your income and the size of your household. If your income dropped because you lost your job, you may qualify now even if you did not before. Each state has its own rules. In some states, including Kansas, most adults without children do not qualify even with very low income. You can start at HealthCare.gov or call your state's Medicaid office.

Step 4. Learn how COBRA works

COBRA is a federal law. It lets many workers keep the same group health plan they had at work for a limited time after they lose their job. The U.S. Department of Labor says it generally applies to employers with 20 or more employees.

• You usually have 60 days to choose COBRA after you get your notice, and then 45 days to make your first payment.
• You usually pay the full premium, which is the whole monthly price. That includes the part your employer used to pay, plus up to 2 percent more, so it is often a big jump in cost.
• COBRA is temporary, and for job loss it can last up to 18 months.
• If you choose COBRA, it starts the day your old coverage ended, so you do not have a gap.

COBRA is a good fit if you are in the middle of treatment and need to keep your same doctors. For many people it is expensive, so compare it with a Marketplace plan or Medicaid before you decide. HealthCare.gov also says that dropping COBRA on your own does not open a new Special Enrollment Period. If COBRA costs too much, read our guide on COBRA alternatives.

Step 5. Keep taking your medicines

Do not stop a medicine just because your insurance ended. Before you run low, call your doctor's office or your pharmacy and tell them what happened. Then ask what your options are, including the cash price and whether a lower-cost option exists. Never change or skip a dose without talking to your doctor first.

Step 6. Find a regular doctor you can afford

You may need care even while you sort out coverage. A community health center charges based on your income and family size and serves everyone, even people who cannot pay. A direct primary care practice charges a flat monthly fee, usually $50 to $200 a month. A direct primary care membership is not insurance, so it does not pay for the emergency room, a hospital stay or surgery. Our direct primary care guide explains how that works.

You can search our directory for cash-pay doctors. You can also read what to do when you have no insurance for the full list of options. Our list of questions to ask can help when you call an office.

What to do in an emergency before new coverage starts

Chest pain, trouble breathing, heavy bleeding and signs of a stroke are all emergencies. If you think you are having one, call 911 or go to the nearest emergency room right away. Under federal law, an emergency room must examine you and stabilize you whether or not you have insurance or can pay. If a bill comes later, ask the hospital about financial assistance. Nonprofit hospitals must have a written policy for it.