Training ends June 30 and the new job starts whenever credentialing lets it. A fellowship, a move, a waiting period at the new place that federal law lets run 90 days. Somewhere in there is a stretch of calendar where you are a physician without health insurance.
The COBRA notice offers your old plan back at four or five times what came out of your paycheck. That number is real: the plan may charge up to 102 percent of the full premium, because your employer was quietly paying most of it and now nobody is. Looking at that in a month you already cannot afford, you decline and deal with it later.
That is the expensive mistake, and it is expensive in a way nobody explains.
Electing is not a decision you have to make today. You get 60 days from the day your coverage ends. If the notice goes out later than that, the clock starts there instead. Either way, coverage elected inside that window must run from the date it would otherwise have been lost. Not from the day you sign. From the day it ended.
Waiving is what breaks it. Send the form back declining, change your mind, and coverage need not reach back past the day you revoked. If you have already sent it, revoke anyway. You can, up to that same deadline, and the plan may restore more than the floor requires.
Two catches. The window does not hold your other option: the clock to buy your own plan runs from 60 days before coverage ends to 60 days after, not from the notice, and letting COBRA lapse later does not reopen it. And electing means producing every back premium within 45 days, or the election is void and the bill stands whole.
So run the clock only if you are healthy and your new coverage starts before the window closes. If there is a month uncovered on the far side, elect, or price a plan at healthcare.gov first.
Until you elect, you are not enrolled, so a clinic wants payment at the desk. If that happens, have their billing office call the plan. The plan is required to tell them you currently have no coverage but will have it retroactively if you elect, which is the difference between paying cash and having a claim held.
Do not tick the box. Put the day your coverage ends on a calendar, count 60 forward, and put that there too. That date is the healthcare.gov deadline; COBRA's may fall later. Elections, revocations and payments all count on the day you send them, not the day they arrive.