Health insurance between travel contracts: COBRA, Marketplace and the 60-day windows

The short version

• Find out exactly when your agency coverage ends after your last shift and when the next one starts. The gap is between those two dates.
• Two federal 60-day windows protect you: COBRA (at least 60 days to elect) and the Marketplace special enrollment period (pick a plan within 60 days before or after losing coverage).
• COBRA keeps the same plan but you pay the whole premium, up to 102% of its cost. Marketplace savings depend on income and household size.
• Don't let a window lapse while you wait to hear about the next contract.

1. Ask your agency these first

• On what date does coverage start on a new contract: your first day or the first of the next month?
• On what date does it end after the last shift: that day, or the end of the month?
• Will I get a COBRA election notice, and from whom?
• If I sign my next contract with you within a few weeks, does coverage continue without a gap?

2. COBRA: same plan, full price

From the U.S. Department of Labor's COBRA guide:

• It applies to group health plans of private employers with at least 20 employees, and to state and local governments.
• You get at least 60 days to elect, from the date of the election notice or the date you'd lose coverage, whichever is later.
• After a job ends (other than for gross misconduct) or hours are cut, coverage can last up to 18 months.
• You can be charged up to 102% of the plan's cost. You have at least 45 days after electing to make the first payment, and a minimum 30-day grace period on later payments.
• Many states have “mini-COBRA” laws for employers with fewer than 20 employees; check with your state insurance office.

For a short gap between contracts, ask the plan administrator what date coverage would start from if you elect, so you know what a mid-gap claim would cost.

3. Marketplace: a new plan, maybe cheaper

• Losing job-based coverage qualifies for a Special Enrollment Period: you must select a plan within 60 days before or after losing it (HealthCare.gov; DOL).
• Savings are based on household size and estimated income for the year, not on whether you're working right now.
• If you're on COBRA, choosing to stop paying it doesn't qualify for a special enrollment period. Using up COBRA does: you then have 60 days to enroll.

4. A spouse's or partner's plan

Under HIPAA special enrollment, if you lose other coverage you can join a spouse's employer plan you were previously eligible for, but you must request it within 30 days of losing your coverage (DOL).

A simple gap plan

1. Write down the coverage end date when you sign, and the next contract's coverage start date.
2. Price both options: the COBRA premium from your notice vs. a Marketplace quote for your income.
3. Put both 60-day deadlines (and the 30-day spouse-plan deadline) on your calendar.
4. Keep the agency's benefits answers with the contract. TravelNurseMap's contract checklist saves notes on each contract.