Managing Health Care and Insurance After Graduation

By Kelly Burch

Until now, your parents or caregivers have likely been involved in your health care decisions. But once you turn 18, your health care becomes entirely yours. Whether you are living with a mental health condition or other chronic illness, or only go to the doctor for checkups or when you’re sick, it’s important to learn how to manage your medical care now, before you leave home. That way, when you need to see a doctor, you know exactly where to turn and what to do. 

Here are the steps you need to take to get insurance and health care after high school:

Figure Out Whether You Need to Change Providers

As you approach 18, consider whether you need to change care providers. There are two main reasons that college-age students switch care providers:

You’re outgrowing pediatric providers. Although there’s no official age limit on who can see a pediatrician or pediatric mental health provider, these doctors specialize in treating children and teens. Now that you’re becoming an adult, you’ll have different health care needs that a doctor serving adults is better able to address. 

You’re moving. Many young people move after graduation, whether they’re going to college, traveling for work, or joining the military. If you’re moving, you might want to connect with a care team closer to where you’ll be living. 

You may decide to continue care with your current team using telehealth and other remote options. In that case, make sure you know where to turn if you need an in-person appointment for a sudden illness, like strep throat, or a mental health concern.

Consider Your Insurance

Health care can be expensive, and insurance helps you handle the cost. Once you’re 18, you’ll likely be responsible for your own medical bills, so it’s important to understand how health insurance works. Here are a few things to keep in mind:

• You may be able to stay on your caregivers’ plan. If your parent or caregiver has commercial health insurance (through work or the healthcare marketplace), you can stay on their plan until you’re 26 or 27. Still, if you’re moving, check to see what providers in your new location accept the insurance plan you have. Finding providers that take your plan can be challenging, especially if you’re moving out of state. 
• Your state plan might not cover you. If you’re on Medicaid (state-sponsored insurance that has different names in different states) things are trickier. Many states require people 18 or older to apply for their own Medicaid coverage. And many Medicaid plans are only accepted in the state they’re issued, so Medicaid might not cover you if you go to school or work out of state. You may need to apply for Medicaid coverage in the state where you’ll be living. 
• Your campus might offer a health insurance plan. Since most colleges require their students to have health insurance, it’s common for them to offer a student health insurance plan. These plans will cover medical and mental health care in the state where you’ll be attending college and are usually more affordable than plans you might purchase elsewhere.
• You’ll have to learn the lingo. Even if you have health insurance, you’ll still likely pay some money when you see a doctor. Learning health insurance terms like “copay” and “deductible” can help you understand how much your appointments will cost.

Learn more about insurance in this guide for young adults from Boston Children’s Hospital and our article on health insurance after high school

Decide Who Should Be Involved with Your Care

Once you’re 18, you get to decide whether a parent or caregiver (or anyone else) gets information about your health, and what info they can receive. 

Learn more about privacy and health care

If you want your new health provider to talk to a parent or caregiver about your health, you’ll need to sign a health care release (also called a consent) that allows the doctor to share information (here’s an example). You’ll get this form from the doctor’s office, hospital, or clinic that’s caring for you, and you’ll want to consider this every time you see a new doctor. 

Note that you can sign a release that only allows them access to some of your health care information. For example, if you don’t want them to know you’re on birth control, have been tested for STDs, or have been treated for substance use disorder, you can exclude that information from the release. 

You can also decide not to sign a release or tell a parent or caregiver where you’re seeking care. In that case, consider having a conversation with them about your decision. Talking about it openly ahead of time can help establish healthy boundaries and avoid misunderstandings or hurt feelings. 

Set a Health Care Proxy

As an adult, you make all the decisions about your health care. But if you’re injured or unable to make decisions, someone else needs to be able to tell health care providers what kind of treatment you would or would not want in certain circumstances. This person is called a health care proxy, or surrogate—a person who makes health decisions for you when you can’t. 

It’s tough to think about worst-case scenarios, like an accident that leaves you unable to make medical decisions. But setting a health care proxy and talking to them about your wishes in certain medical situations can help make sure you get the type of care you want, even when you can’t advocate for yourself. 

Learn more about setting a health care proxy and talking about your wishes 

Managing your physical and mental health care is an important part of being an adult. But taking responsibility for your medical care can feel overwhelming. These resources can help:

• Got Transition: Resources and research for young people and families
• “What Happens When I Turn 18?”
• “Transfer of Care to Adult Providers: A Guide for Young Adults”
• Questions to ask your doctor about transitioning to adult health care

Taking more control of your health care is a process. Giving yourself lots of time and starting the process well before graduation or your 18th birthday can help make the transition smoother.