Stepping into adulthood comes with a game-changing moment – hitting the big 26 and waving goodbye to the safety net of your parent's health insurance. It’s like unlocking a new level of independence but navigating the health care landscape can feel like a rollercoaster ride. This transition isn’t just about paperwork and getting the proper coverage; it’s a real-life journey into adulting. Picture this blog as your guide, unraveling the ins and outs of claiming your own health coverage. It’s going to feel like a breeze when you approach the 26th year of your life.
Understanding The Transition
Young adults lose coverage from their parents' plans because of the Affordable Care Act (ACA), which only requires companies to cover dependents on a parent’s plan until they turn 26. Before the ACA, insurance companies dropped young adults from their parent’s policies after they reached a certain age or stopped attending college. This resulted in many young adults losing their insurance earlier in life. Now, with the ACA, adults 26 years and under can stay on their parent’s plan even if they:
- Have started or finished school
- Are no longer a dependent
- Are married
- Adopt or have a child
- Turn down group health insurance through work
What this means is that when you turn 26, you’ll need to find alternative coverage to ensure you’re protected in case of illness or injury. Understanding the options available to you is crucial as you embark on this new phase of your life.
Exploring Your Health Care Options
It’s essential to understand you have various options when choosing health care options. Let’s take a look at your options:
Employer-sponsored plans: If employed, your company may offer health insurance benefits. It’s essential to familiarize yourself with the coverage options and enrollment periods provided by your employer.
Health insurance marketplace: You can explore plans through the Health Insurance Market, where you may be eligible for subsidies based on your income. A subsidy is a benefit given to an individual, business, or institution, usually by the government. It can be direct (cash payments) or indirect (tax breaks). It’s typically given to remove some burden and is often considered in the public’s overall interest, given to promote a social good or an economic policy.
COBRA coverage: You may qualify for the Consolidated Omnibus Budget Reconciliation Act (COBRA) for a temporary extension of your parents' plan, although it can be costly. This coverage gives workers, and their families who lost their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances, such as voluntary or involuntary job loss.
Medicaid: Depending on your income, you may qualify for Medicaid, which provides low-cost or free health care coverage. In all states, Medicaid provides coverage for some low-income individuals, families and children, pregnant women, the elderly, and those with disabilities.
Transitioning off your parents’ health plan can pose several challenges, such as understanding insurance jargon, comparing different plans, and budgeting for health care expenses. It’s normal to feel overwhelmed, but there are resources available to guide you through this process. The following are a few resources available to you:
- healthcare.gov
- Professional consultation
- Local agencies
Financial Considerations
- Budgeting for premiums: Evaluate the cost of premiums for different plans and consider how they fit into your monthly budget. For a healthy 26-year-old, the average cost of a marketplace plan is $372 per month.
- Out-of-pocket expenses: Understand the potential out-of-pocket costs for deductibles, copayments, and coinsurance when comparing plans.
- Health savings accounts (HSAs): If eligible, consider opening an HSA to save for medical expenses with pre-tax dollars. An HSA is a type of savings account that lets individuals set aside money on a pre-tax basis to pay for qualified medical expenses.
In addition, it’s essential to understand the plan coverage:
- Network providers: Check if your preferred doctors and health care facilities are included in the plan’s network to ensure continuity of care.
- Prescription drugs: Assess how different plans cover the cost of prescription medications you may currently use or anticipate needing in the future.
What Next?
If 26 is just around the corner, you must start thinking about this process. Being able to compare your options allows you to get the best coverage for the best price as opposed to waiting until the last minute and rushing this decision. If your employer offers health insurance, you’re in luck. Your colleagues should be able to offer you advice, and if you're lucky, your company might have a designated benefits specialist who can walk you through the entire process. If your employer doesn’t offer health insurance, the process will be longer, and you’ll have to make decisions on your own.
For employers, have you considered partnering with a professional employer organization (PEO) like GMS? As your employees transition to their independent health care coverage, it’s essential you provide them with the tools and resources to make the right choice. When you partner with GMS, we provide access to comprehensive group health plans, leveraging our buying power to offer competitive rates and quality insurance. In addition, our Benefits Account Managers work with you and your employees to guide them through the enrollment process. We will also simplify complex paperwork, ensure compliance with regulations, and get the coverage your employees want and need. Contact our benefits experts today to ensure a seamless process for employees during this transitional period.