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Is COBRA Worth It? What Price Alone Does Not Show

COBRA continues the same network, formulary and deductible progress; a new plan can reset all three. Medicaid, cost-sharing and HSA rules also count.

published 2026-09-07 · figures checked 2026-09-07

Price is not the whole comparison. COBRA continues the same plan, so the network, the drug list and the deductible you have already met stay. A new Marketplace plan can reset all three.

The COBRA vs Marketplace calculator compares premiums over the months you need cover. It does not price anything on this page, and that is a deliberate limit rather than an omission.

What a premium comparison leaves out

A premium is one number a month. The rest of the cost of a plan year sits in the deductible, the copayments, the coinsurance and the out-of-pocket maximum, and none of those appears in a monthly figure.

The gap matters most in the middle of a plan year, and most of all in the middle of a course of treatment. That is the position in which the cheaper monthly premium and the cheaper year are least likely to be the same plan.

What resets when the plan changes

CMS described the mechanic in a 2021 fact sheet on mid-year plan changes: when a consumer changes plans, “the amount they’ve already paid towards meeting their prior plan’s deductible and annual limit on cost sharing may be reset to zero”.

So a household that has already met most of a deductible by September is not comparing two premiums. It is comparing one premium against another premium plus a deductible it has already paid once this year.

What continues when the plan does not change

COBRA is a continuation of the same group health plan, not a replacement for it. The Department of Labor describes it as “a temporary extension of health coverage” under the plan the employer sponsors.

Two things follow from that. The provider network is the one already in use. The formulary — the plan’s list of covered drugs and their tiers — is the same list, because it belongs to the same plan.

The cost of that continuity is 102% of the plan's cost¹ for up to 18 months² after a job loss.

Three income tests on the Marketplace side

HealthCare.gov states the Medicaid test as “Income below 138% federal poverty level: If your state has expanded Medicaid, you may qualify for Medicaid”. Cost-sharing reductions carry their own condition: “you must enroll in a plan in the Silver category to get the extra savings.”

The Medicaid line is state-dependent. Ten states have not adopted the expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming, per KFF’s tracker as of August 21, 2026. KFF also records that Georgia and Wisconsin cover adults to 100% of the poverty line under 1115 waivers, so no coverage gap exists in those two.

Bronze and catastrophic plans changed in 2026

Bronze and catastrophic plans count as HSA-compatible⁶. The IRS stated it in IR-2025-119: “As of Jan. 1, 2026, bronze and catastrophic plans available through an Exchange are considered HSA-compatible, regardless of whether the plans satisfy the general definition of an HDHP.”

For a household that contributes to a health savings account, that widens the Marketplace side of the comparison: the cheapest metal levels are no longer automatically incompatible with continuing HSA contributions. The HSA eligibility rules for 2026 set out the conditions.

Does my deductible reset if I switch plans mid-year?

It can. CMS states that on a plan change “the amount they’ve already paid towards meeting their prior plan’s deductible and annual limit on cost sharing may be reset to zero”. The new insurer’s terms decide whether any credit is given, so the insurer is the authority for a specific case.

Will my doctors and prescriptions carry over?

Under COBRA, yes, because it is the same plan with the same network and formulary. Under a new Marketplace plan the network and drug list are the new plan’s, and both are worth checking provider by provider and drug by drug before enrolling.

Can a Marketplace plan work with an HSA?

Yes, and more of them can since 2026. Bronze and catastrophic plans count as HSA-compatible⁶, so bronze and catastrophic Exchange plans now sit alongside other qualifying high-deductible plans for HSA purposes.

What if my income is low enough for Medicaid?

In a state that expanded Medicaid, income at or below 138% of the federal poverty level³ points to Medicaid rather than a subsidized Marketplace plan, and the premium tax credit is not available in that situation. In the ten non-expansion states the same income is treated differently.

What are cost-sharing reductions?

They are extra savings that lower a Silver plan’s deductible, copayments, coinsurance and out-of-pocket maximum for households at or below 250% of the federal poverty level⁴. They apply only to Silver plans, so a Bronze plan at the same income carries the full cost sharing.

Does the calculator answer this question?

No. It answers the premium half and labels its own scope. The factors on this page — continuity of care, cost sharing already met, and the metal level that fits an HSA — are the ones that decide the rest, and they are checked against the plan documents rather than computed.

Information, not advice. This is the reading version; the interactive calculator and the full page are at https://thresholds.pages.dev/health-insurance/is-cobra-worth-it/.