Your special enrollment window after losing coverage, losing Medicaid, a move, marriage, a baby, or turning 26.
How fast a short-term bridge can start if you only need to cover a gap.
COBRA is your old plan at 102% of the full cost for up to 18 months. With the average employer family plan near $27,000 a year, that’s over $2,200 a month. It’s the right answer for some people, mid-treatment for example. It is rarely the cheapest. And if you elect it, you can’t switch to a marketplace plan until it runs out or open enrollment comes around.
Bring your planned retirement date, your projected income for the first full year (pension, withdrawals, any part-time work), the COBRA quote, and your health picture. We’ll map the years to 65 on one page.
I’m Nathan Baughman with BIG Benefits in Doylestown. Bridging to Medicare is a planning problem more than an insurance problem. Get the structure right and the five years are manageable. Get it wrong and you’ll pay for it twice: once in premiums and once at tax time.
Pennie marketplace plan with income planning, if you can keep MAGI under the cliff. Silver if you’re under about 250% of poverty, bronze with an HSA if higher.
Private, underwritten plan if you’re healthy and over the cliff: priced on your health, PPO network, guaranteed renewable to 65.
COBRA short-term, if you’re in the middle of treatment or need to keep a specific doctor for a few months, with a planned exit at open enrollment.
Retiree coverage from your employer if it exists, compared honestly against the above.
COBRA is rarely cheapest. Manage MAGI around the cliff. Underwriting works at 60. Plan the Medicare hand-off a year out.
“Nathan was such a saving grace to my husband and I in our time of need! We feel so incredibly grateful for his help and guidance as we navigate finding insurance for our situation.” — Breene C., Google review
Ignoring the subsidy cliff in retirement. Your marketplace credit is based on household MAGI, and in retirement you have a lot of control over that: Roth conversions, capital gains, IRA withdrawals and pensions count; Roth withdrawals and return of principal don’t. A couple under about $86,000 for 2027 coverage may qualify for a meaningful credit. One dollar over and it’s gone, with full repayment of any advance. This is a conversation with me and your financial advisor together.
Skipping underwriting because you’re “older.
” Plenty of 60-year-olds qualify for a private underwritten plan, and it’s guaranteed renewable to 65, which is exactly the finish line you need. If you’re healthy and your retirement income is over the cliff, this is often the answer.
Missing the Medicare hand-off. Marketplace coverage should end the month Medicare starts. Enroll in Part B during your seven-month window, and remember that a big final-year income (severance, bonus, stock) can raise your Medicare premiums two years later. There’s a form for that (SSA-44) when your income drops.
1. Is there a maximum out-of-pocket? 2. Is it an unlimited contract? 3. Is it guaranteed renewable? If a plan uses words like “deductible” and “PPO network,” that doesn’t automatically make it actual health insurance. These three questions do.
Send me an age and a zip code and I’ll send back a general idea of what’s available in your area. Twenty minutes, no charge, no pressure. Happy to answer any and all questions so you can make the most informed decision for you, your family, or your business.
