Under the Affordable Care Act (ACA or Obamacare), individuals can stay on their parent's health insurance plan until they turn 26 years old. This includes individuals who:
- Are married.
- Go away for school.
- They are no longer claimed as a tax dependent.
- Have adopted a child.
- Decline an employer-sponsored health insurance plan.
If you do not meet the requirements listed above and are interested in accessing affordable healthcare, Mira is here to help. With coverage for doctor's visits, lab work (STD, COVID-19, and blood tests), as well as prescriptions with affordable copays, signing up for Mira allows you to spend 2x less on healthcare — even with insurance.
When to Choose Another Health Insurance Policy After Turning 26
Depending on your parent's health insurance, you will either have to enroll in a new policy by the end of the month or by the end of the year of turning 26. If your parents have a marketplace health insurance policy, then you will be allowed until the end of the year to enroll in a policy even if you turn 26 midyear. This would require you to submit your own marketplace health insurance application and be aware of the open enrollment dates in your state.
If you were previously covered by your parent's employer policy, you would have until the end of the month you turn 26 years old to choose a new health insurance plan. Losing your parent's employer-sponsored health insurance coverage will open a special enrollment period (SEP).
SEP allows you to buy your own health insurance outside of the open enrollment period. You should be aware that your SEP begins 60 days before and continues 60 days after you lose coverage. During this time, you are allowed special access to your state health insurance marketplace and can decide what coverage you would like to purchase.
Health Insurance Options After You Turn 26
For most individuals, turning 26 means no longer being covered under their parent’s health insurance plan. However, just because you are 26 and older does not mean you should live without health coverage. There are several options to access healthcare once you have “aged out” of your parent’s plan.
Employer Health Insurance
Employer-sponsored coverage is how most Americans receive their health insurance. Under these types of plans, your employer will share the costs of premiums with you and provide you with your health insurance benefit. These plans can cover your dependents and oftentimes may cover your spouses as well. Businesses with over 50 employees must offer health insurance to full-time employees. In addition, some small businesses offer employer-sponsored coverage as well.
School Health Insurance
Full-time students can access health insurance through their universities. In most circumstances, student health insurance plans count as qualifying coverage to help you access the healthcare you need.
Group Insurance vs. Individual Health Insurance
Group health insurance covers individuals who belong to the same group (e.g., job or organization). On the other hand, individual health insurance is bought by an individual and can cover only one person or a family. Group health insurance depends on your current employment status at a job, while individual health insurance covers you if you switch jobs.
Depending on your situation, there might be a better option than the three listed above. Mira is a great option for aging out of their parent's health insurance because it’s affordable and convenient. At just $45 per month with no deductible, you will have access to doctor visits, prescriptions, and lab tests. Sign up for Mira today.
Other Health Insurance Options
There are less common health insurance options that have more specific requirements. COBRA is a government act requiring employers who meet certain criteria to provide similar coverage after employees lose coverage. The other one we’ll look at is Medicaid, which is a government health insurance program for low-income brackets.
The Consolidated Omnibus Budget Reconciliation Act (COBRA)
COBRA requires employers with greater than 20 employees to continue providing coverage for employees for limited periods of time when these employees would otherwise lose coverage due to certain events.
Qualifying events under COBRA include:
- Voluntary or involuntary job loss
- Reduction in hours
- Transition between jobs
Therefore, this law can extend health insurance coverage to young adults who do not have access to employer-sponsored health insurance through the age of 29.
You may have heard this law be referred to as the Age 29 Law because it permits young adults to continue or obtain health coverage under their parent’s plan until age 29. The law provides two distinct ways to extend coverage: a “young adult option” and a “make available” option.
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Young Adult Option
Under the Young Adult Option, eligible young adults can continue their coverage through a parent’s health insurance coverage, even after they have turned 26 and have reached the maximum age of dependency. Young adults may also elect the Young Adult Option when they newly meet the eligibility criteria, such as if they lose eligibility for group health insurance coverage.
Make Available Option
Under the Make Available Option, insurers are required to make coverage available at the request of the group or individual policyholder/contract holder. In insurance through an employer or group, the employer or group decides whether to offer this benefit to employees — young adults do not get to make this choice.
Medicaid & Child Health Insurance Program
Medicaid is a federal insurance program that offers coverage to eligible individuals. If you make less than $20,000 a year (lower in certain states), you may qualify for Medicaid. Medicaid is a free or low-cost State-sponsored insurance program. While provider selection can be limited, it exists among the best options to access healthcare if you qualify. If you meet the criteria, you can enroll immediately.
Enrollment & Other Health Insurance Terms To Know
You typically can’t enroll in health insurance whenever you want. Instead, you must meet the requirements and be within the right period of time to enroll in most plans. An exception to this would be if you qualified for government health insurance like Medicaid.
Open Enrollment is a period of time at the end of each calendar year where you can sign up for health insurance, make changes to your current plan, or cancel your plan. This period typically runs from early November to mid-December. Plans purchased during this period become effective on January 1st. Some employer open enrollment periods, will occur in the late spring/early summer timeframe, typically a July 1st effective date.
Special Enrollment Period
If you experienced a specific life event, you might be eligible for a Special Enrollment Period. By qualifying for a Special Enrollment Period, you may enroll in a health insurance plan outside the open enrollment dates. Some of the events that may deem you eligible for the Special Enrollment Period are marriage, childbirth, a divorce that leads to a loss of coverage, moving to a new state, or loss of coverage. Read the full list of eligible events for more information.
You should check out our article to learn about more health insurance terms that might be helpful to your situation.
What To Look For In A Health Coverage Plan
When looking for health insurance or an overall coverage plan, it’s important to understand how your personal situation might be impacted by the coverage you’re getting. There are several questions to consider when picking a health insurance plan, including:
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Do you know your terminology?
It’s essential to know your terminology to understand what the insurance plan is offering fully. Is there a high co-pay? Low deductible? Understanding these is key to finding the right plan for you.
How much is your insurance going to cost monthly and annually?
The average insurance plan will have monthly and annual costs. Be sure to assess these costs with your budget and ensure that you can truly afford them.
How much will you pay out of pocket when seeing a doctor?
Out of pocket costs is the amount of money you're paying upfront (deductibles, co-pays, co-insurance, etc.). Therefore, it's necessary to understand how much you will need to pay each time you see the doctor.
Does your insurance plan limit which doctors you can see?
Some insurance plans do not cover a broad range of doctors in their network. You should check if there is a limitation on this and evaluate your needs before choosing a plan.
How often do you typically go to the doctor?
This largely plays a role in your out-of-pocket costs. If you're going to the doctor often and have many high costs, you may want to consider this if it doesn't align with your budget.
While you’ll only be able to stay on your parent’s health insurance until the age of 26, there are plenty of other options available to you at that point. The key is finding the right one that is affordable and meets your personal needs.
Mira is a great option because it isn’t like other traditional health plans. For just $45 per month, we make it easy to access healthcare. From doctor's visits, lab tests, and discounted prescription medication if you are underinsured or uninsured. Become a Mira member today.