How do I get health insurance if I retire before 65?

Medicare generally starts at 65, so retiring earlier means finding coverage for the gap. The main routes are COBRA, the ACA Marketplace, a working spouse's plan, or retiree coverage from your employer if it offers it.

COBRA lets you keep your employer's group plan, usually for up to 18 months after you leave a job. It applies to employers with 20 or more employees. The catch is cost: the plan can charge up to 102% of the full premium, meaning your share, the share your employer used to pay, and a 2% fee. You get at least 60 days to elect it.

The Marketplace is the other main door. Losing job-based coverage gives you a Special Enrollment Period from 60 days before to 60 days after your separation date. Depending on household income and size, you may qualify for premium tax credits. If you are enrolled in an employer's retiree plan you cannot get those credits, though being eligible but not enrolled does not block you.

Timing matters. Being offered COBRA does not stop you from choosing a Marketplace plan instead. But once on COBRA, you generally cannot drop it mid-year to switch to the Marketplace; you wait for Open Enrollment (November 1 to January 15 in most states) or for COBRA to run out.

Worked example: retire at 62 and the gap to Medicare is 36 months. COBRA could cover the first 18, leaving 18 more months to fill. Price both options for every month of the gap, because the premium tax credit depends on the income you report, including retirement account withdrawals.