What to Do When You Lose Health Insurance at 26

Scripps Health.
2024-09-20T16:05:39-07:00

If you're on your parents' health plan, coverage usually ends at 26, so you'll need your own plan. Explore HMOs, PPOs and other options.

Your coverage options after leaving your parents’ health plan

If you’re a young adult on your parents’ health insurance, your coverage usually ends when you turn 26. This means you will need to find your own plan.

“Choosing a health insurance provider and plan can be complex, so take time to understand what’s available and how well it meets your needs,” says Anil Keswani, MD, corporate senior vice president and chief medical and operations officer, ambulatory care at Scripps Health. “As you begin to research coverage options, make sure you understand the different types of plans and what they do and don’t cover.”

The good news is that you have several options to stay covered, including low-cost plans and coverage through your job.

Here are the most common types of plans:

Health Maintenance Organization (HMO)

HMO plans charge a monthly fee called a premium and give you access to care from specific doctors, hospitals and other medical providers within each plan (called in-network providers). As long as you receive care within the network, your costs will typically be lower.

As an HMO member, you’re required to choose a primary care doctor. This doctor will help coordinate your care. If you need to see a specialist, your primary care doctor must give you a referral; otherwise, the cost may not be covered.

Your deductible, which is the amount you have to pay for medical services before your insurance begins to pay, may be low or even zero. However, if you choose to use a provider outside of your HMO network, you may have to pay the full cost yourself.
Preferred Provider Organization (PPO)

PPO plans typically charge a higher monthly premium but give you more options when you need care. They tend to have significantly larger networks and you can see a specialist without a referral. You will pay less if you see an in-network provider, but you can go outside of the network and pay the difference. Usually, the lower your PPO premium, the higher your deductible.
High Deductible Health Plans (HDHP)

HDHPs often have lower monthly premiums. However, they have much higher deductibles than other insurance plans. This means you pay more health care costs yourself before the insurance starts to cover care.
Where to get health insurance options after 26

Where can you find health insurance when you’re no longer eligible for your parents’ plan? Here are the most common options:
1. Health insurance through your employer

If you’re employed, your employer may offer health insurance as part of your benefits package. These employer-sponsored plans can be one of the most affordable options because group rates tend to be lower than individually purchased plans and your employer usually pays part of the cost.

You may not have to be working full-time to be eligible for employer-sponsored health insurance. If you work part-time, you may be eligible for employer-sponsored health insurance.

Many companies offer this benefit to employees who work 20-30 hours per week.

Employers have an open enrollment period in the fall that typically lasts several weeks. During this time, you can sign up for health insurance, or make changes to your plan, that will take effect the following year.

“If your parents’ coverage ends before the open enrollment period begins, you may still be able to get on a plan since loss of coverage is considered a qualifying event,” says Dr. Keswani. “Talk to your benefits representative about your options and review each plan carefully before you decide.”
2. Individual health insurance plans

You can purchase an individual health plan directly through a health insurance company or agent, or through the health insurance marketplace. In California, the marketplace is Covered California.

During the open enrollment period, which usually begins in November, you can research and compare a variety of plans on your state’s marketplace at Healthcare.gov.

Depending on your income, you might qualify for financial help. This help can lower your monthly premiums and out-of-pocket costs.

Covered California has different levels of coverage. You can choose a plan that fits your needs and budget.
3. Group insurance plans through associations

Some college alumni groups, professional associations or membership organizations offer health insurance to their members. They’re not as common or as comprehensive as employer or marketplace plans. Check with your group’s administration to see if they offer health insurance but compare carefully with Covered California or employer-coverage before deciding.
4. Medicaid (Medi-Cal in California)

Medicaid provides health insurance to individuals whose income is below a certain amount. Eligibility varies by state. Check with your state’s Medicaid program to see if you may qualify.

Medi-Cal is California’s version of Medicaid, offering free or low-cost health insurance to individuals and families with limited income.

You can apply for Medicaid at any time of the year.
5. Catastrophic health insurance

Catastrophic health insurance plans are considered the “bare minimum” of health insurance coverage. They are intended for young, healthy individuals. These plans help protect against major medical expenses that may result from an accident or serious illness.

Catastrophic health plans are generally available to people under 30. They have low monthly premiums but high deductibles.
6. Short-term health insurance

Short-term health insurance plans provide temporary and limited coverage. They act as a bridge between other coverage options. For example, you might be leaving your parents’ plan but will be starting a job with employer-sponsored coverage in six weeks.
How to choose the right plan

With so many options available, it’s important to weigh your health needs and financial situation before choosing a plan.

“Each option has its own benefits and limitations, so it’s important to understand what kind of care you need, where you want to access care, and how much you are comfortable paying in premiums and copays,” says Dr. Keswani. “You’re ultimately in charge of your health, so make an informed decision about your health insurance.”

Here’s a quick checklist to help you evaluate your options and choose the plan that’s right for you:

1. Know when your coverage ends

Most plans end on the last day of the month you turn 26 for employer-sponsored plans or at the end of the year you turn 26 for Covered California plans. You usually have 60 days before and 60 days after your coverage ends to enroll in a new plan.

2. Consider your health needs

Do you take prescriptions, need regular care, or use mental health services?

3. Set your budget

Think about premiums, deductibles, copays, and potential emergency costs.

4. Compare plan types

HMO: Lower cost, in-network only, referrals required

PPO: More flexible, higher cost

HDHP: Low premium, high deductible — good if you're healthy

Catastrophic: For those under 30, covers major medical events

5. Check provider networks

Make sure your doctors and hospitals are in-network for the plan you choose.
Stay covered, stay protected

Losing coverage at age 26 doesn’t mean you have to go uninsured. Whether you get a plan through your job, Covered California, Medi-Cal or another option, staying covered helps protect your health — and your finances.