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The healthcare gap is the cost of health insurance coverage between leaving an employer-sponsored plan and becoming eligible for your next source of coverage (a new job's plan, a spouse's plan, or in the US, Medicare at age 65). For US-based workers this is frequently the single most underestimated cost of quitting, retiring early, or taking a career break, because employers typically subsidize a large share of premium costs that disappear the moment employment ends.

The main coverage options (US context)

COBRA lets you keep your exact former employer plan for up to 18 months (longer in some qualifying situations), but you pay the full premium yourself — both the employee and the employer share, often plus a 2% administrative fee — which can mean paying several times what was deducted from your paycheck. ACA marketplace plans (healthcare.gov or state exchanges) are usually cheaper than COBRA and offer income-based premium tax credits that can substantially lower the cost if your income drops after leaving a job, though plan networks and deductibles differ from an employer plan.

Why it matters for early retirement/exit planning

Anyone retiring or taking an extended break before Medicare eligibility (age 65 in the US) needs to budget for potentially decades of self-funded premiums, not months — this is one of the biggest reasons "lean FIRE" numbers calculated on bare-bones spending often understate real costs. Premium tax credits under the ACA are based on estimated household income for the year, so someone with no earned income but investment withdrawals can sometimes qualify for significant subsidies if the withdrawal strategy is structured with this in mind.

Common pitfalls

People often compare only the sticker premium between COBRA and ACA plans without factoring in different deductibles, out-of-pocket maximums, and whether current doctors are in-network. Timing also matters: COBRA election windows and ACA special enrollment periods have strict deadlines (typically 60 days after a qualifying life event like job loss) — miss them and you may be locked out until the next open enrollment period.