Health Insurance After 26: How to Stay Covered
Learn how to stay insured after aging out of a parent’s plan
Learn how to stay insured after aging out of a parent’s plan
Key Takeaways
- Check when your parent’s coverage ends.
- Turning 26 may qualify you for special enrollment.
- Compare employer, Marketplace and other coverage options.
- Review total costs, networks and prescription benefits.
- Start shopping early to avoid a coverage gap.
If you’re covered by your parents’ health insurance, you can generally stay on their plan until you turn 26. After that, you’ll need coverage of your own.
Since the exact end date depends on the plan, it’s a good idea to check when your coverage ends and start looking at your options early.
“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,” he says.
The good news is that losing coverage when you turn 26 is generally considered a qualifying life event. That means you may be able to enroll in a new plan without waiting for the annual open enrollment period.
When does health insurance end at 26?
The exact date your coverage ends depends on the type of plan:
- If you’re covered through a parent’s employer, coverage may end when you turn 26 or at the end of that month.
- If you’re covered through a parent’s Marketplace plan, coverage generally continues through the end of the year you turn 26.
Check with the insurance company or your parent’s benefits department to confirm your end date.
If you’re getting new coverage through the Health Insurance Marketplace, losing coverage at age 26 generally qualifies you for a Special Enrollment Period. You can enroll in a new plan starting 60 days before your current coverage ends and up to 60 days afterward.
If you’re enrolling through your own employer, you may have less time to sign up. Contact your benefits department early to confirm your enrollment deadline.
Health insurance options after you turn 26
Several options may help you stay covered after leaving your parents’ health plan.
1. Health insurance through your employer
If you’re employed, your employer may offer health insurance and pay part of the monthly premium. Eligibility varies and some employers offer coverage to part-time employees. Check with your human resources or benefits department to learn what’s available.
Losing coverage under your parent’s plan may allow you to enroll outside your employer’s annual open enrollment period.
“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. Covered California or another health insurance marketplace
If you live in California, you can shop for an individual health plan through Covered California. If you live in another state, use your state’s insurance marketplace or HealthCare.gov. Compare premiums, deductibles and other out-of-pocket costs to find a plan that fits your needs and budget.
Depending on your household income and other eligibility requirements, you may qualify for financial help to lower your costs. Turning 26 and losing coverage through a parent’s plan generally qualifies you to enroll outside the regular open enrollment period.
3. Medi-Cal
If you meet income and other eligibility requirements, you may qualify for Medi-Cal, California’s Medicaid program.
Medi-Cal provides free or low-cost coverage, and you can apply at any time of the year.
4. COBRA or continuation coverage
If you age out of a parent’s employer-sponsored plan, COBRA, or in California, Cal-COBRA, may let you temporarily keep the same coverage. However, you may have to pay the full cost of the plan yourself, so compare the price with employer coverage, Covered California and other options.
5. Student health insurance
If you’re in college, your school may offer a student health plan. Compare the costs, provider network and coverage when you're away from campus with your other insurance options
6. Catastrophic health insurance
Catastrophic plans generally have lower monthly premiums but very high deductibles. They’re available to people under 30 and cover essential health benefits, including preventive care. However, you’ll pay more yourself for many services before meeting the deductible.
You can’t use financial assistance to lower the cost of a catastrophic plan, so compare it with Bronze and Silver Marketplace plans, especially if you qualify for financial help with those plans.
Understanding HMO, PPO and high-deductible plans
As you compare your health insurance options, you may encounter several types of plans.
HMO and PPO describe how a plan’s provider network works. A high-deductible health plan (HDHP) refers mainly to its deductible and cost structure. An HDHP may have an HMO, PPO or another type of provider network.
Health Maintenance Organization (HMO)
HMO plans generally use a specific network of doctors and hospitals. You may need to choose a primary care doctor and get referrals to see certain specialists, depending on the plan. Most nonemergency care outside the network isn’t covered.
Preferred Provider Organization (PPO)
PPO plans generally give you more flexibility in choosing doctors and don’t require referrals to see specialists. You can also receive care outside the plan’s network, but you'll usually pay more.
High-Deductible Health Plans (HDHP)
High-deductible health plans generally have lower monthly premiums, but you’ll pay more of your healthcare costs yourself before your plan starts paying its share.
Consider whether you could afford the deductible and other out-of-pocket costs if you needed unexpected medical care.
How to choose health insurance after 26
With several options available, look beyond the monthly premium when comparing plans.
“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.”
Consider these factors before choosing a plan:
- Consider your health needs
- Think about how often you need care, including prescriptions and mental health services.
- Compare total costs
- Look beyond the premiums to deductibles, copays, coinsurance and the annual out-of-pocket maximum.
- Check the provider network
- Confirm that doctors and hospitals you want to use participate in the plan.
- Review prescription coverage
- Check whether your medications are covered and what you’ll pay for them.
Stay covered, stay protected
Aging out of a parent’s health plan doesn’t mean you have to go without coverage. Explore your options early so you have time to compare costs, benefits and provider networks and choose a plan that fits your needs and budget.
Having health insurance can help you get the care you need while protecting you from unexpected medical costs.