Turning 26?  The Ultimate Health Insurance Cheat Sheet

Posted on July 10th 2017 in Health Plans

So, you’re turning 26.  Big deal, right?  You’ve been drinking for six years, you started voting and entering contracts at 18.  If you’re in the software business, you’re an old man.

But 26 means your parents cannot put you on their health insurance anymore.  And buying your first health insurance plan is a big deal.

So, let’s help you cheat the system a little and avoid the pitfalls of buying the wrong plan.

First, find out what you’ve got.  That will help determine what you need and how much coverage.  Chances are you’re healthy and haven’t seen a doctor in the last few years.  But do you need dental?  What about vision?  And how much more do those things cost?

Get a copy of your parent’s plan and bring it in.

Second, if you don’t have a job, are still in the process of higher learning or just not making enough, there is no need to avoid dealing with it.  Medicaid or Medi-Cal is available if you don’t make enough and, in California, includes dental and vision coverage.  Here’s the good part: no premiums, no co-pays.  Yes, you might not be able to keep your doctor but you haven’t seen them since that poison ivy outbreak at camp when you were 17.

And if you do make more than the Medicaid limit, you can take advantage of the subsidies.  The important thing is to get potential costs or “quotes.”  You’re not obligating yourself to anything, you’re just asking us to help.  And that doesn’t cost you anything either.

Most importantly, if you are eligible for a subsidy, make sure to call someone.  Mistakes are easy to make when you enroll yourself.  It doesn’t have to be us but the online enroll portal is not as easy as it seems, and once a mistake is made, it can sometimes take a lot to undo.

Here’s another to call or email an advocate: you do want to keep your doctor or you need help to find someone other than a pediatrician.  Networks change monthly and we keep up.  As medical professionals ourselves, we often know some good referrals.

If you do make too much for a subsidy, start paying your parents back for that summer at camp.  Trust me, they’ll say “No, no,” but they’’ take the money.  Also, don’t necessary go online to an exchange portal like Covered California to enroll.  Using other sources can give you a plethora – using our own college education with that word – of choices not available through the exchanges.

 Finally, it’s time to choose a plan.  If I remember correctly, the only insurance I was interested in was for my car at 26.  Eventually, I got to home and when my kids were born – health and life.  But because you’re under 30, you can qualify for a catastrophic plan.  They satisfy the need to purchase coverage but have high deductibles and cost sharing, meaning you’re going to pay a lot before they cover anything.  You also can’t get any subsidy assistance.  It’s sort of what the Republican led Congress wants to enact and often they are as expensive as a good plan.

If all you want is a catastrophic plan, the penalty for not having insurance is probably less.

But other than that, there are the Bronze, Silver, Gold and Platinum plans in terms of increasing value.  Would you want a Bronze if you’re asthmatic with high medication costs?  Certainly not.  But how are you to know.  Well, that’s why we ask serious questions about the state of your health and your doctor.  And the Silver plan has some interesting twists we should discuss that depend upon your income.

So, we come to when to apply.  You have 60 days before your turn 26 and 60 days after.  If you can’t find the time in that window, you can’t apply. So, keep an eye on the calendar.

All that’s left is to make your first payment because the insurance company will no issue your policy without that. You can even set it up to pay automatically so you won’t be caught short if something does happen.

And open your mail.  It’s almost as if they never heard of the internet.  But they’ll send you a lot of mail, so make sure to open it and call us if you don’t understand.

Don’t worry, we will.


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