What health coverage options do I have if I retire early and my spouse is still working?

If your spouse has an employer plan, joining it is usually the simplest and cheapest option, since employer coverage is often subsidized and avoids the ACA income games. Check whether their plan offers family coverage and what the added premium is for adding you. If employer coverage isn't available or is too costly, you can buy an ACA marketplace plan; note that being eligible for 'affordable' employer coverage through a spouse can disqualify you from ACA subsidies, so run both numbers. COBRA can bridge a short gap right after leaving a job but is typically expensive because you pay the full premium. A working spouse also lets the household earn income that can fund Roth conversions or a taxable buffer while still covering healthcare, which eases the whole early-retirement plan considerably.