When you turn 18, you can exercise your right to vote. At 21, you can legally purchase alcohol. And when you reach 26, if you receive healthcare benefits through a parent or guardian’s plan, current federal law states that you have to arrange for your own coverage.
Needless to say, it’s critical that people with bleeding disorders maintain access to affordable, quality healthcare. At first, it may seem daunting to purchase your own plan. But if you know some of the basics about your options you’ll be one step ahead before you blow out those birthday candles. Also, don’t forget that help is available from your social worker and the rest of your healthcare team at your hemophilia treatment center (HTC).
When will I lose eligibility for health insurance?
The answer depends on what plan you’re on before turning 26.
Parent’s employer-based healthcare plan
In most cases, your coverage ceases at the end of the month you turn 26. But depending on the insurer, it could be on the day of your birthday or at the end of the calendar year. (Call the insurance company to find out the exact date you lose eligibility).
Parent’s health insurance marketplace plan
Coverage ends on December 31, regardless of what month you turn 26.
Enroll in a job-based health insurance plan
If you’re employed and your job offers health insurance that meets federal affordability and coverage standards set out in the Affordable Care Act (ACA) of 2010, you can enroll in your employer’s plan.
Depending on the cost of the company plan, it may seem tempting not to accept your employer’s health insurance and buy your own plan. However, by rejecting employer-based insurance, you generally lose all eligibility for income-based savings when purchasing a marketplace plan and will be forced to pay full price for a marketplace plan.
Purchase a plan from the health insurance marketplace
If you’re unemployed or your job doesn’t offer qualifying insurance, you can buy a plan through your state’s marketplace (also referred to as an “exchange”).
If you’re aging off of a parent’s job-based insurance, you can purchase coverage during a special enrollment period that starts 60 days before your 26th birthday and ends 60 days after.
If you’re currently on a parent or guardian’s plan purchased from the health insurance marketplace, no matter when your birthday is you can buy your own marketplace plan during open enrollment, which typically begins November 1.
Note on qualifying for savings when buying a marketplace plan: If your parent doesn’t claim you as a tax dependent when your coverage ends, you’re eligible for potential income-based savings. If your parent claims you as a tax dependent, you will not be eligible for income-based savings. In both cases, you may qualify for Medicaid (see below).
While it’s generally a costly option, you may be able to extend coverage of your parent’s plan for up to 36 more months through the Consolidated Omnibus Budget Reconciliation Act (COBRA). Contact your parent’s employer to learn if using COBRA is a possibility.
Student health plan
If you’re a student and your school offers student healthcare, evaluate whether you’re eligible and whether the plan meets your needs.
Depending on your income, you may qualify for Medicaid, the joint federal-state program that provides free or low-cost healthcare coverage to low-income and needy individuals.
What happens if I don’t arrange health insurance?
If you go more than two consecutive months without health insurance coverage, you may have to pay a penalty when you file your federal tax return. This penalty will no longer be in effect starting in 2019, but for now, unless you qualify for a limited number of exemptions, the fine for individuals is $695 or 2.5% of your household income, whichever is greater.
Visit the NHF website to keep up to date on the latest in the fight to preserve access to healthcare for all people with bleeding disorders.