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Financing Your Youth’s Adult Healthcare

Families of transition-age youth often have years of experience dealing with healthcare coverage issues and co-payments, specialized equipment, home adaptation, and other health-related expenses. However, when youth become adults, there are brand new issues to deal with.

Planning ahead is critical. Young adults are at risk of losing healthcare coverage at 3 critical points in their transition to adulthood:

It is reassuring to know that there is national network of family health advocates and other programs that can help youth with disabilities and their families understand the health insurance options that are available to them.

Co-pay? Co-Insurance? Confused?

Definitions of key health insurance terms .

Recommended Resources for Information on Healthcare Financing:


Meeting the Health Insurance Needs of Your Young Adult with a Disability: Questions to Ask *

* This list is found on the Medical Home Portal website.

This video from Healthcare.gov is a helpful general resource: How to Choose a Plan in the Health Insurance Marketplace


What health insurance options are available?

Your youth’s options for health insurance coverage depend on several factors, including age, state of residence, income level, employment status, and other personal circumstances.
Options include:

Health Insurance Options for Youth Adults Age 18-30
Private Government Funded No Insurance

Job-Based Group Plans
Health insurance offered to an employee (and often his or her family) by an employer. Employers with 50 or more full-time have to offer coverage to full-time employees or get a fine. Generally, employers subsidize the cost of the insurance and workers are responsible for paying part of the premium, co-payments and deductibles.

Young adults who work 30 or more hours per week will qualify for a job-based group plan themselves, if offered by their employer.

COBRA
Short term coverage for employees who have been laid off or terminated or dependents who lose coverage because of a change in parental coverage (i.e. divorce, death, retirement)

College/University Student Health Plans
Students in college or other types of post-secondary schools may have the option to purchase insurance through their school.

Marketplace (ACA)

  • Individual
  • Family

The Kaiser Family Foundation’s easy-to-understand Health Insurance Marketplace Calculator estimates eligibility for subsidies and cost of health insurance based on income, age, and family size.

State Public Insurance
Medicaid
Medicaid is a federal-state partnership. States have different eligibility rules and offer different kinds of benefits. Some states use a different name for this program (e.g. Medical Assistance, MaineCare, MassHealth or MO HealthNet).

  • Low income individuals, with and without disability
  • Young adults who have aged out of foster care
  • Medicaid Waivers
    For individuals who have special needs and meet certain rules

Find more information about Medicaid.

Federal Public Insurance
Medicare
Federal health insurance program for people who are age 65 or older, individuals with end-stage kidney disease, and certain low income persons with disabilities

Indian Health Services
Provides coverage for members of federally recognized tribes.

TRICARE
Managed care program for active duty and retired military and their families.

You Pay All the Bills

  • Every medical visit
  • All prescriptions
  • Any Hospitalizations

You Pay Penalty Tax

  • Unless hardship exemption is approved

Low Cost Options

  • Community Health Centers
  • Discount Prescription Cards
  • Prescription Assistance Programs

Based on this chart from Hackett-Hunter, P., Hess, J., Comeau, M., & Sloyer, P. 3rd ed. Just the Facts: The 411 on Health Care Insurance for Florida Young Adults 18-30.  Tallahassee, FL: Florida Department of Health. 2015.

What costs are covered individuals responsible for?

Youth who qualify for their own health insurance coverage as independent adults will be responsible for:

It is important for individuals to know the number of visits allowed under their insurance in order to plan for certain services, such as physical therapy or home health care. Youth will have to pay for visits above the allowed amount if they have not had the additional visits pre-approved beforehand. Families can help youth understand and follow their insurance plan’s requirements.

Videos


Understanding Your Health Insurance Costs


Health Insurance Explained


How does student health insurance work?


Words to Know – from Coverage to Care

For more videos on this topic, visit our Videos page.

Did you find this helpful?

PACER Resources

The following resources were developed for families in Minnesota but contain general information that is applicable to youth in any state.

Additional Resources