Understanding Health Insurance for Young Adults
By Joanna Nesbit
When you turn 18, you are able to sign up for your own health insurance coverage if you need it. Below are a few basics to understand about health insurance for young adults.
Why Health Insurance Is Important
Health insurance helps you pay for your medical bills. Even healthy, young people can get hurt or sick, and paying for medical care without insurance can be very expensive. If you don’t have coverage, you might skip medical care because you can’t afford it, and that can make a problem worse.
Health Insurance Through a Parent or Guardian
If your parent or guardian gets their health insurance from an employer, the ACA health insurance market, or a publicly funded insurance plan like the VA, Medicaid, or Medicare, you can probably be added to—or stay on—their insurance plan.
Even if you have your own job or you’re no longer in school, you can probably continue to be covered by a parent or guardian’s plan until you’re 26. (If your job provides insurance, however, that plan could be a better choice financially). Many plans allow dependents to be covered until they’re 26, but staying on your parent or guardian’s plan may depend on whether you go out of state for college or a job, since some insurance policies won’t cover you out of state. Consider talking to your parent or guardian about your family’s insurance.
If your family uses Medicaid—a free or low-cost option for health care—coverage may be a bit more complicated once you turn 18 (more on this below). If your state requires it, you may need to reapply for your own policy even if you’re counted as a dependent on your parents’ tax forms.
Health Insurance If You Aren’t Covered by a Parent or Guardian
Once you turn 18, you can obtain insurance on your own if you’re not covered by a parent or guardian. The information can be overwhelming though. Check out this young adult’s guide or this Young Invincibles guide to young adult health care.
Other Things to Think About
Many colleges and universities offer a student health insurance plan that also may extend over the summer while you’re home. If you don’t want the campus coverage, usually you must prove you have your own insurance to be able to waive the school’s plan or you will be charged for it. Some schools may have an insurance office with staff to assist students with questions about insurance and navigating the benefits and limitations of their plan. Check with your school.
If you’re not in college or don’t want to use your college’s health insurance plan, you can instead apply for coverage through Medicaid or health insurance marketplaces (you can search by state). The health insurance marketplaces are federal and often state websites that allow you to search for and choose private health-care plans.
Marketplace insurance: When you apply for your state’s marketplace insurance, you’ll find out if you qualify for a subsidy—financial help from a state government to pay for your insurance plan—based on your parent or guardian’s income. If you’re already independent of your family, the state will look at your income and not your parents’ income to determine the subsidy. If you relocate to another state full time, you’ll need to apply through that state’s marketplace or Medicaid plan.
If you’re going to college in another state but not changing residency, however, most state-based marketplace plans don’t travel well across state lines. Check with the college to see if it works. If not, which is likely, you may need to purchase the college insurance plan. You can also check the requirements for that state’s marketplace plan, but many states have residency requirements you won’t meet. Plus that state’s marketplace plan likely won’t cover you when you’re home for the summer. Typically, the college plan provides better coverage between states.
Medicaid: Medicaid is also tricky if you’re going out of state for college. Usually, it can be used only in the state it was issued, but check to see if you can apply for Medicaid in your college’s state. As with the marketplace plans, many states require residency, so you may not qualify if you’re a dependent somewhere else. Every state’s rules are different, and some are more flexible than others. If you’re going out of state, you may not be able to continue to receive your parent or guardian’s Medicaid coverage.
If you’re under 19 and your income is below a certain amount, you may qualify for the Children’s Health Insurance Program (CHIP). If CHIP doesn’t work, then try Medicaid. Both of these options will only work if you’re living or attending college in your state. Check out this resource for information about health insurance for young people.
Using your health insurance: Check your insurance company’s website to learn what services are covered and to search for a professional near you who accepts your plan. Most websites will let you filter by in-network providers, or providers who take your insurance plan. Every plan has different limits on care, though, including how many days you’re covered for inpatient care, how many physical therapy visits are allowed, and what types of mental health programs are covered. Check ahead so you don’t end up with unexpected medical bills.
Privacy Issues When You’re Covered by a Parent or Guardian’s Health Insurance
HIPAA, the federal health-insurance privacy rule, is intended to protect your medical information from being shared with anyone else once you turn 18, but there are ways your mental health, reproductive health, or other health-care information can end up being disclosed to your parents or guardians when you’re covered by their insurance plan. It’s possible they could receive an Explanation of Benefits (EOB) from their insurance provider with details about the care you received, and they could learn about your visit to obtain contraception or something else when you didn’t intend them to.
If you receive care at a college health center that doesn’t require billing your insurance, however, your visit wouldn’t be disclosed to your parents with an EOB statement. College campuses operate a bit differently than regular health-care facilities in other ways too. On campus, your health-care information is usually protected by FERPA or state health-care laws, not HIPAA, although sometimes they overlap. FERPA, the Federal Educational Rights and Privacy Act, requires K-12 schools and colleges receiving certain federal funds to protect your student information by not sharing it with third parties.
When students turn 18, FERPA rights transfer to them (until then, their parents have the rights). The only way your parent or guardian would have access to FERPA information is if you signed a waiver that gives them access to things like grades and college tuition bills. Your medical information may require another form called a medical authorization release. Ask your student health center how your health information is protected if you sign a FERPA waiver.
Even if a college doesn’t share information, there are times it may decide sharing information with a parent is necessary for the safety of the student, such as if they believe the student is at immediate risk of hurting themselves or someone else.
Steps You Can Take to Protect Your Privacy
Once you are 18, you can take these five steps to protect your privacy:
- Consider what you want your parents to know and what you’d like to keep private. It’s part of normal development to have some separation as you become an adult.
- Discuss your decisions about privacy with your parent or guardian so they understand your perspective. But remember, controlling your privacy is ultimately your decision.
- Make sure all paperwork allowing your parents access to your health-care information is discussed openly, reviewed, and signed. Now that you’re 18, doctors won’t give your parents any information unless you sign a health-care release. You may need to sign one for every doctor or clinic you see.
- Talk to your health-care provider about your expectations for privacy and confidentiality so they know how to handle billing and communication about your care. They will default to not sharing anything with your parents now that you’re an adult. If you’re concerned about your parents learning about your health from insurance or office paperwork, you may need to provide an alternate address for your EOB statements. Learn more here about adult health privacy.
Find out your insurance company’s policies and procedures about disclosing sensitive and private information. You may be able to work with them to make sure your privacy is maintained.