How to afford healthcare with Coast FIRE before Medicare comes down to one choice: where your insurance comes from during the gap years. The portfolio keeps compounding while you work part-time, but part-time jobs rarely come with benefits. The four real options are the ACA marketplace, COBRA, a spouse's employer plan, and a part-time job chosen specifically for its benefits. Each one fits a different situation, and the wrong pick can cost $10,000 a year for a decade.
Option 1: The ACA marketplace, with the subsidy lever
This is the default for most early retirees, and it is the one where you have the most control. Premium tax credits are based on household modified adjusted gross income, and a Coast FIRE household drawing modest part-time wages plus Roth distributions often lands in subsidy territory. The lever is MAGI management: Roth draws do not count, HSA withdrawals for medical costs do not count, and timing capital gains into low years keeps the premium down.
The catch is that the subsidy math got worse in 2026. The enhanced premium tax credits expired at the end of 2025 and were not renewed, and average net premiums for subsidized shoppers rose about 58%, from $113 to $178 a month, with enrollment falling by over a million people. A 40-year-old who paid $316 a month in 2025 faces a projected $546 for 2027. At 55 or 60, near the top of the age rating band where insurers can charge 3 times the 21-year-old rate, unsubsidized premiums commonly run $700 to $1,100 a month. The subsidy still absorbs most of that for low-MAGI households. Every year the unsubsidized price climbs, the gap between managing MAGI and not managing it gets wider.
Option 2: COBRA as an 18-month bridge
COBRA continues your employer's plan for 18 months at full cost plus a 2% administrative fee. It is expensive, often $700 to $900 a month for single coverage, because you now pay the employer's share too. Its real use is continuity: mid-treatment, a specialist network you cannot rebuild, a surgery scheduled for next quarter. Price it against a subsidized ACA plan and switch unless continuity of care is genuinely at stake. It is a bridge, not a plan.
Option 3: The spouse's plan, and option 4: the benefits job
If a spouse keeps working with employer coverage, take it. Employer plans remain the cheapest coverage per dollar for most households, and one FIRE forum poster reported $8,000 a year in premiums on a spouse's plan, which beats the marketplace for most families. If there is no spouse plan, the fourth option is to pick the coast job for its benefits: 20 hours a week at an employer with health coverage. School districts, large retailers, and universities are the classic sources. This is Barista FIRE in practice, and for some households it is the most stable answer of the four.
The decision rules
If your household MAGI stays in subsidy range, the ACA marketplace wins on price and flexibility. If you need under 18 months of bridge coverage and your doctors matter, take COBRA and set a calendar reminder for month 17. If a spouse works with benefits, join their plan and stop optimizing. If none of those fit, make benefits a hiring criterion for the coast job. If your MAGI will be high, price unsubsidized ACA against a benefits job, because at $1,000 a month the job's insurance is worth $12,000 a year of salary.
Here is the part I will not resolve for you. The subsidy landscape changed once in 2026 and a bill to extend the credits is stalled, not dead. The numbers in this article are October 2026 numbers, and they could move in either direction during any open enrollment. Budget healthcare as its own line item, inflated separately from everything else, and recheck the marketplace every fall. The portfolio math of Coast FIRE assumes the world holds still for 20 years. Health insurance is the line item that refuses to.
Frequently asked questions
How much does health insurance cost for early retirees before Medicare?
Unsubsidized marketplace premiums at ages 55 to 64 commonly run $700 to $1,100 a month. With premium tax credits, many early retirees pay $200 to $400. Federal rules let insurers charge older adults up to 3 times what they charge a 21-year-old for the same plan.
Can I get ACA subsidies while Coast FIRE?
Yes. Premium tax credits are based on household MAGI, and Coast FIRE earners with modest part-time income often qualify. Managing MAGI, through Roth draws, HSA use, and timing capital gains, is the main lever that controls the premium.
Is COBRA worth it during Coast FIRE?
As an 18-month bridge, sometimes. COBRA continues your employer's plan at full cost plus a 2% fee, which is expensive but preserves your doctor network mid-treatment. Most people price it against a subsidized ACA plan and switch unless continuity of care matters.
What happened to ACA subsidies in 2026?
The enhanced premium tax credits from 2021 expired December 31, 2025 and were not renewed. Average net premium payments for subsidized shoppers rose about 58%, from $113 to $178 a month, and enrollment fell by over a million. The landscape may change again, so recheck during open enrollment.
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Related reading: Coast FIRE vs Barista FIRE · Does Coast FIRE Work If You Have a Mortgage? · Is Coast FIRE Real? The Criticism · Your Coast FIRE Number by Age
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