You’re 26! What’s Your Health Care Fix?
July 11, 2016 : Teresa Shipley Feldhausen – Guest Contributor
When you turn 16, you can drive. When you turn 18, you can vote. And when you turn 26, you likely have to find your own insurance. If you don’t have other options, navigating the new terrain of the Affordable Care Act can be daunting. Here are some common questions and answers to make it simple for you.
When will I be dropped from my parents’ insurance?
You can keep your parents’ coverage until you turn 26 years old. Once you turn 26 – starting on your actual birthday – it’s generally up to you to get your own health insurance.
What are my options for health insurance?
You have a lot of options. If you will lose coverage through your parents, you qualify for a special enrollment period to buy coverage through a state or Federal marketplace. Your special enrollment period will begin 60 days before your birthday and last for 60 days after you lose your parents’ coverage.
If you’ve enrolled in a plan before your 26th birthday, your coverage can start as soon as the first day of the month you lost coverage. If you sign up for health care after your birthday, during the special enrollment period, coverage can start as early as the first day of the month after you pick a plan.
Of course, you may also be able to obtain health coverage through your employer.
How much is this going to cost?
It depends. On what? Several things: your location, age, desired level of coverage and so on. Click to read more about the various plans available, as well as their associated costs and benefits.
What if I decide not to buy any health coverage?
Getting minimum essential coverage is the law now. If you don’t get insured, you may have to pay the penalty for being uninsured (unless you qualify for an exemption).
Also, not to sound like your mother, but you really should purchase at least catastrophic coverage. Even a short visit to the emergency room can add up to thousands of dollars out-of-pocket.
What about taxes?
If your income is so low that you don’t have to file a federal tax return (roughly $10,000 a year for a single filer), you won’t have to pay the fee, even if you don’t have coverage. But this also means that you are responsible for paying for all your medical costs including routine doctor visits and screenings.
But if you want to qualify for lower costs on an insurance plan based on your income, you must purchase a qualified Marketplace plan and file a tax return for the year of the coverage. Filing a tax return is required, no matter how low your income is.
What if I turn 26 on December 1 and want to wait until January 1 to start my insurance?
You should purchase health coverage as soon as possible after your 26th birthday. Remember, you only have a 60-day special enrollment period to get insurance through a Marketplace after you lose coverage. But, if you are uncovered for fewer than three months of the calendar year, you will not have to pay the penalty for being uninsured when you file your tax return. To illustrate: if you were covered all year prior to your 26th birthday on October 15, 2015 and do not enroll in health insurance, you will not face any penalty for 2015. However, you should enroll in coverage for 2016.
I’m not even close to being 26, but I’m married. Do I have to get my own plan?
Not necessarily! As long as you meet any qualifications through your parents’ insurance provider and are able to enroll properly, you can join or stay on a parent’s plan even if you are:
- Not living with your parents
- Attending school
- Not financially dependent on your parents
- Eligible to enroll in your employer’s plan
These rules apply to both job-based plans and individual plans bought inside or outside the Marketplace.