Health Insurance Options After Age 26

HMO plans charge a monthly fee called a premium and give you access to care from specific doctors, hospitals, and other medical providers within each plan (called in-network providers). As long as you receive care within the network, your costs will typically be lower. However, if you choose to use a provider outside of your HMO network, you may have to pay the full cost yourself. Your deductible, which is the amount you have to pay for medical services before your insurance begins to pay, may be low or even zero.

As an HMO member, you’re required to choose a primary care doctor to coordinate your care. If you need to see a specialist, your primary care doctor must give you a referral; otherwise, the cost may not be covered.

 PPO plans typically charge a higher monthly premium but give you more options when you need care. They tend to have significantly larger networks and you can see a specialist without a referral. You will pay less if you see an in-network provider, but you can go outside of the network and pay the difference. Usually, the lower your PPO premium, the higher your deductible.      

HDHPs usually have lower monthly premiums but much higher deductibles than other insurance plans, so you pay more health care costs yourself before the insurance starts to cover care.

Where can you find health insurance when you’re no longer eligible for your parents’ plan? Here are the most common options:

If you’re employed, your employer may offer health insurance as part of your benefits package. These employer-sponsored plans can be one of the most affordable options, because group rates tend to be lower than individually purchased plans and your employer usually pays part of the cost.

You may not have to be working full-time to be eligible for employer-sponsored health insurance. Many companies offer this benefit to employees who work 30 or even 20 hours per week.

Employers have an open enrollment period that usually lasts several weeks. During this time, you can sign up for health insurance, or make changes to your plan, that take effect the following year.

“If your parents’ coverage ends before the open enrollment period begins, you may still be able to get on a plan since loss of coverage is considered a qualifying event,” says Dr. Keswani. “Talk to your benefits representative about your options and review each plan carefully before you decide.”

You can purchase an individual health plan directly through a health insurance company or agent, or through the Health Insurance Marketplace. In California, the marketplace is Covered California.

During the open enrollment period which usually beings in November, you can research and compare a variety of plans on your state’s marketplace at Healthcare.gov. Depending on your income, you might qualify for subsidies that can lower your monthly premiums and out-of-pocket costs. Again, if your parents’ coverage ends outside of the open enrollment period, you may be able to sign up with a qualifying event.

If you belong to a group or organization If you meet the low income that offers health insurance, such as a college alumni association, you may be able to obtain coverage through the group plan. Check with your organization’s administration to see if they offer health insurance.

Medicaid provides health insurance to individuals whose income is below a certain amount. Eligibility varies by state; check with your state’s Medicaid program to see if you may qualify. You can apply for Medicaid at any time during the year.

Considered the “bare minimum” of health insurance coverage, catastrophic health insurance plans are intended for young, healthy individuals who want to protect themselves against major medical expenses that may result from an accident or serious illness. Generally available to people under 30, catastrophic health plans have low monthly premiums and very high deductibles.

Short-term health insurance plans offer temporary, limited coverage. Think of them as a bridge between other coverage options; for example, you are leaving your parents’ plan but will be starting a job with employer-sponsored coverage in six weeks.

“Each option has its own benefits and limitations, so it’s important to understand what kind of care you need, where you want to access care, and how much you are comfortable paying in premiums and copays,” says Dr. Keswani. “You’re ultimately in charge of your health, so make an informed decision about your health insurance.”