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Coverage for Young Adults

Cancer patients and survivors face special health care needs. In most states, children become legal adults at age 18 and must make decisions regarding health insurance.

Cancer Survivor Rights to Coverage

Federal law, under the Affordable Care Act (ACA), protects cancer patients and survivors by establishing insurance companies cannot:

  • Deny coverage to an individual due to a pre-existing condition, a health condition prior to enrolling in coverage. 
  • Charge an individual with a pre-existing condition more than an individual without a pre-existing condition.
  • Limit coverage benefits for an individual with a pre-existing condition.
  • Refuse to cover treatment for a pre-existing condition.
  • Place a limit on how much they will cover in one year.
  • Place a limit on how much they will cover in an individual’s lifetime.

NOTE: Some grandfathered health plans limit some rights and protections mentioned above.

Coverage Options

At age 18, individuals have one or more of the following options for securing health insurance coverage:

  • Staying on a parent’s health insurance plan until the age of 26
  • Enrolling in a student health insurance plan offered by a college
  • Enrolling in a health plan offered through an employer
  • Purchasing a health insurance plan through the state or federal marketplace, directly through a health insurance company, or through an insurance broker
  • Securing public health insurance coverage through Medicaid

Parent Insurance

On most health plans, a child may receive coverage through a parent’s health insurance may remain on the parent’s plan until he or she turns 26, if the parent agrees to keep them on the plan.

Student Health Insurance

Many colleges and universities offer health insurance coverage options to their students. Some colleges include insurance as part of the tuition package. Many of these health plans offer very basic coverage. 

Employer-Based Insurance

Employers with 50 or more full-time equivalent employees must offer affordable, comprehensive health insurance to employees who work more than 30 hours per week or pay a tax penalty. Each employer sets rules for employee eligibility to enroll in company health insurance plan. The company’s human resources department can provide details on options and their cost.

Purchasing an Individual Health Plan

Individuals who are 18 years and older have the option to buy their own insurance directly through a state marketplace. Those living in a state that does not have a state health insurance marketplace can buy insurance through the federal marketplace.

The state and federal marketplaces have specific times of year during which individuals can purchase insurance. The open enrollment period usually begins in November and continues through the end of December. However, open enrollment periods can change year-to-year and vary by state.

Individuals may enroll in coverage outside the open enrollment period if they:

  • Lose health care coverage
  • Get married or divorced
  • Have a baby or adopt a child
  • Move residences to a different ZIP code

People purchasing insurance through the marketplace may be eligible for financial aid to help with the cost of coverage. The Premium Tax Credit helps individuals pay for health insurance premiums. The marketplace enrollment process will determine eligibility for a tax credit. If eligible, a tax credit is paid in advance directly to the insurance company. These tax credit payments help lower out-of-pocket payments for monthly premiums. 

Public Insurance 

A cancer patient or survivor who receives coverage through public insurance — the Children’s Health Insurance Program (CHIP) or Medicaid — minimally qualifies for coverage up to age 19 with family (of 4) income to $49,200 per year. Some states have different rules regarding family income limits. Insurance benefits include:

  • Annual check-up
  • Scheduled sick visits 
  • Prescriptions
  • Immunizations
  • Diagnostic procedures
  • Emergency medical attention
  • Dental
  • Vision

Individuals who receive health insurance through CHIP or Medicaid should meet with an enrollment specialist in their local Medicaid office to determine the coverage they may qualify for as adults.

An individual’s ability to quality for free or lower-cost care through Medicaid is based on income and family size. Each state has different requirements. To find out whether one qualifies for assistance, survivors can visit the Medicaid and CHIP coverage page on HealthCare.gov.

The Insure Kids Now website has put together a detailed list of questions and answers regarding state CHIP and Medicaid programs.

Questions to Ask to Find the Right Plan

  • Does the plan require approval before visiting specific doctors and specialists?
  • Are the doctors you need in-network or out-of-network? Every insurance company contracts with health care organizations to create a list of in-network providers. For out-of-network care, the cost of care may be significantly higher, not covered, or a lesser percentage of the costs covered.
  • Does the plan cover the necessary medications? Every insurance plan has its own list of covered drugs, which is called a formulary. Within the list, there will be differences for generic drugs and brand-name drugs.


Reviewed: June 2018

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