Yup — almost made this comment in another thread. There are tons of gotchas with COBRA. Sure, if you can afford it, it can be better than the alternative (especially if you have expensive medications or a pre-existing condition that requires lots of ongoing treatment), but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent — and as you say, if you’re late at all with COBRA, you lose it.

The fact that the United States doesn’t have universal, affordable healthcare is a travesty and the fact that our system has persisted for this long is utterly insane.

Late with Cobra is different from most insurance because you can pay the month after you receive services, not before.

This also allows you a little more flexibility than with a traditional plan where you have to prepay. For instance, if you're going to enroll in a new plan as of January, and don't end up using any medical services in December, you can decide in January not to pay for that month and Cobra will terminate coverage.

You don't have that option with a normal plan.

> but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent

Do affordability tests not apply once you are laid off? I would think your premium subsidies would go up and you can get an ACA plan.

At least living in CA, it generally feels like we have universal, affordable (by some definition) healthcare, but I'm sure there are edge cases where the affordability calculation breaks.

Affordability tests are based off what you’re projected to make and if you have any income or savings at all, that can impact that directly. Moreover, depending on your needs, the cheap plans might not work out. If you’re diabetic and require insulin and testing strips and other stuff, a high-deductible plan probably isn’t going to work out. The same is true if you’ve got specific prescriptions you need covered that are only up to a certain amount on a lower-tier plan or aren’t available unless you pay more. So in some cases, the ACA plan could cost the same as COBRA, and you’d be stuck starting from zero with your deductible, which if you had paid into under your employer, could be significant.

But beyond that, let’s say you anticipate you can make $3000 a month freelancing. Now, this isn’t enough for your rent and your insurance, but it’s still too high, perhaps, to qualify you for a lower-rated ACA plan. And it is certainly too high for Medicaid. So if you live in a high-priced city, you’re now stuck having to decide what you pay for — and that’s not always easy. Remember, it’s not like moving is that easy — you may have to break a lease (which costs money you don’t have), and you’re unemployed so signing a new, less-expensive lease is going to be challenging too.

The safety nets we have in place are really only designed for the very, very poor (and even then, they don’t go far enough). If you are anything but that — you’re really fucked, especially if you live in an medium-size or larger city/urban area.

> That means people who quit or are laid off will end up having to pay more for their healthcare at a time when they don't have any income.

(ignoring tax issues) They aren't really "paying more", it's just their salary when they were working was higher than the top-line number.