Health Plans for Young Adults

You know your kids have a lot on their minds. They may need to finish school and look for their first real job.

One thing that might not be on their radar yet is getting health insurance. But it's a big deal. Especially when you consider that the average emergency room visit can cost more than $1,200.

The health reform law makes it easier for people ages 19 to 26 to get insurance -- whether they have a job or you're still supporting them.

What's Covered

In the past, your child was kicked off your health plan at age 19 or once he or she graduated from college. Under the new health care law, most insurance plans must cover children up to age 26.

If your health plan offers coverage for dependents, your child can stay on your plan even if he or she moves out of the house or gets married.

Under the new law, if your child gets a job with health benefits, he or she will have a choice to make. Your child will be able to either sign up for the plan that's offered through the job or stay on your plan.

Certain plans, called "grandfathered" plans, do not have to extend enrollment to adult children. Grandfathered plans are those that existed before March 23, 2010 -- the day the health reform bill became law and that have not substantially changed since then..

Under the new law, your child who is age 19 to 26 will also have access to free preventive services, such as:

Dental and vision plans work differently than your other health insurance. Whether your child aged 19 to 26 is covered depends on the type of dental or vision insurance plan you have.

How to Choose a Plan

If your 19- to 26-year-old is trying to decide which insurance plan to go with -- yours or one offered by your child's job -- take a close look at the type of plan being offered. If your child chooses to stay on your employer plan, he or she will be enrolled in the same plan you have.

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Here are some options you might have to think about: if yur child chooses not to stay on your plan and buy his or her own plan:

  • HMO. These letters stand for health maintenance organization. If your child picks an HMO, he or she will need to see a doctor in the HMO's network. If your child needs to see a specialist, your child will need a referral from a primary care doctor. On the other hand, medical bills with an HMO are usually lower than with other types of plans.
  • PPO. These letters stand for preferred provider organization. In this type of plan, your child can see a doctor that's in or out of the plan's network. But your child will pay more if the doctor is out of network.
  • POS. This stands for point of service. These plans will usually require that your child choose a doctor who is in network. But the plans may also offer the option of seeing specialists who are out of network for a higher cost.

You and your child should also think about some of these issues:

  • What types of services the plans cover and your need for these services (prescriptions, dental, and vision care, for example)
  • How much each plan will cost, including deductibles
  • Whether your child's doctors are in the plan's network
  • Whether your child is pregnant or planning a pregnancy

If your child is pregnant and remains on your plan, the plan must cover prenatal and pregnancy-related care but does not have to provide coverage for your grandchildren.

Other Insurance Options

If your child works but his or her employer doesn't offer health benefits, your child can buy a health plan on an insurance Marketplace. The Marketplace is a website set up in each state.

Your child can use the Marketplace website to find out if he or she qualifies for tax credits to help pay for insurance premiums. Your child can also learn if he or she is eligible for low-cost care through Medicaid.

WebMD Medical Reference Reviewed by Sarah Goodell on February 08, 2016

Sources

SOURCES:

Caldwell, N. PLoS One, February 2013.

National Conference of State Legislatures: "Covering Young Adults Through Their Parents' or Guardians' Health Policy."

U.S. Department of Health and Human Services: "Young Adult Coverage," "Young Adults and the Affordable Care Act."

American Dental Association: "Potential Effects of the Affordable Care Act."

U.S. Department of Labor: "FAQs About the Affordable Care Act Implementation Part II."

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