Health Insurance for Young Adults

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.

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.

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.

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.

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.