Turning 26 Health Insurance: Everything You Need to Know

Turning 26 is an important milestone in many ways. Besides being able to rent a car or vote, it also means you’re no longer eligible to be on your parents’ health insurance plan. Without insurance, a single medical emergency can leave you with staggering debt.

If you’re about to turn 26, don’t worry – this guide will provide you with all the information you need to find affordable health insurance coverage.

What Happens When You Turn 26?

When you turn 26, you can no longer be covered by your parents’ health insurance. Even if you’re still in college, married or living at home, you’re no longer considered a dependent, and you’ll need to find alternative health insurance coverage.

However, some states have expanded their Medicaid programs, which may make you eligible for coverage. You should also look into your employer’s health insurance options.

What Is Medicaid?

Medicaid is a state-run, federally funded health insurance program that provides coverage to low-income individuals and families, pregnant women, children, and people with disabilities.

Eligibility for Medicaid varies by state, but in general, if you earn less than 138% of the federal poverty level, you may qualify for Medicaid. Some states have higher income limits or offer coverage to other groups of people, such as those with certain medical conditions.

What Options Do I Have if I Don’t Qualify for Medicaid?

If you don’t qualify for Medicaid, you still have a variety of options:

How Do I Enroll in Health Insurance?

To enroll in health insurance, you’ll need to:

1. Determine Your Eligibility

Make sure you know whether you’re eligible for Medicaid, employer-sponsored insurance, or other options.

2. Shop for Plans

Visit your state’s health insurance marketplace or use a healthcare insurance comparison tool to compare plans and prices.

3. Apply for Coverage

You’ll need to fill out an application for the plan you’ve chosen and provide information about your income, household size, and other factors that may affect your eligibility or costs.

4. Pay Your Premiums

Once you’ve been approved for coverage, you’ll need to pay your premiums every month to maintain your insurance. Be sure to set up automatic payments if possible.

What Should I Look for in a Health Insurance Plan?

When shopping for health insurance, consider the following factors:

1. Premiums

The premium is the amount you pay each month for your insurance. Compare premiums to make sure you’re getting the best value.

2. Deductibles and Out-of-Pocket Maximums

A deductible is the amount you must pay each year before your insurance kicks in. An out-of-pocket maximum is the most you’ll have to pay in a year for covered services. Look for a plan with a deductible and out-of-pocket maximum you can afford.

3. Network

Make sure your preferred doctors and hospitals are in the plan’s network, or be prepared to pay more for out-of-network care.

4. Coverage

Look at what’s covered by the plan, such as prescription drugs, preventive care, and mental health services.

5. Subsidies

If you qualify for subsidies, make sure to factor that into your decision-making process.

FAQ

Do I Have to Buy Health Insurance?

Under the Affordable Care Act, most Americans are required to have health insurance or pay a penalty. There are some exceptions, such as for certain religious groups or people who can’t afford insurance.

What Happens if I Don’t Have Health Insurance?

If you don’t have health insurance, you may have to pay a penalty on your taxes. More importantly, you’ll be responsible for paying for all of your medical expenses out of pocket, which can be prohibitively expensive.

What if I Missed the Open Enrollment Period?

If you missed the open enrollment period for the health insurance marketplace, you may still be able to enroll if you have a qualifying life event, such as losing your job or getting married.

How Do I Compare Marketplace Plans?

You can compare marketplace plans by visiting your state’s health insurance marketplace or by using a healthcare insurance comparison tool.

Can I Keep My Doctor?

If you have a preferred doctor, make sure to check whether they’re in the plan’s network before enrolling. If you want to keep seeing that doctor, you may need to choose a plan that includes them in the network.

Can I Change Plans?

You can change plans during the open enrollment period or if you have a qualifying life event. However, be sure to carefully consider any plan changes to avoid disruptions in your care or coverage.

Conclusion

Turning 26 may be a milestone, but it doesn’t have to be a stressful transition when it comes to health insurance. By being informed about your options and carefully evaluating plans, you can find a plan that meets your healthcare needs and budget.