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:

• when they turn 19
• when they graduate from high school or college, or
• when they change jobs.

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.

Recommended Resources for Information on Healthcare Financing:

• HealthCare.gov Health Insurance Marketplace, also known as the health insurance exchange, helps uninsured people who do not have coverage through a job, Medicaid, or another source find health coverage that meets their needs and budget.
• Family-to-Family Health Information Centers are family-staffed organizations that assist families of children and youth with special health care needs and professionals who serve them. F2Fs provide support, information, resources, and training around healthcare funding, family support, and related issues. There is a F2F center in every state.

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

• Is adult dependent coverage beyond age 26 allowed on a parent’s existing job-based group plan or private insurance plan? Does it meet the criteria below or will your son or daughter need a different plan to meet their needs?
• Does the plan allow you to use the specialists that youth need?
• Which hospitals can you use?
• Does the policy cover the type of medicines youth need?
• Does the plan cover the specific procedures and therapies youth need?
• Does the plan limit the number of times per year that a certain item or procedure will be covered?
• Does the plan cover assistive technology?
• Does the policy cover assessment for mental and physical disorders?

* 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:

• Staying on their parents' existing family plan until youth is 26 years old. Family plans may also offer Dependent Disabled Adult coverage beyond age 26 if an adult child is incapable of self-sustaining employment due to disability and dependent on the policyholder for care and financial support.
• Job-based insurance coverage where employers offer group plans to employees.
• Student health insurance: some postsecondary schools offer health insurance to their full-time students.
• Medicaid coverage for individuals with low incomes and some people with disabilities (eligibility requirements and covered services vary by state). Former foster youth qualify for Medicaid coverage until they are 26 years old.
• Private insurance where an individual purchases their own insurance plan. The deductibles, co-insurance expenses, and maximum limits on coverage can vary a great deal. The best place to compare insurance plans is on state Health Insurance Marketplace websites, where people can compare rates and find out if they are eligible for discounts based on income.
  In general, plans that offer lower monthly premiums have more limited coverage and higher deductibles and co-insurance costs. People who pay low premiums may find themselves responsible for a large portion of their medical costs if they are injured, become sick, or have a chronic medical condition or disability.

Health Insurance Options for Youth Adults Age 18-30

Private	Government Funded	No Insurance
Private 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.	Government Funded 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 for young adults age 18 and older. 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.	No Insurance 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:

• Co-insurance, co-payment, deductible, and premium expenses.
• Co-pay cost for prescription medicine.
• The cost difference between seeing a provider in-network and out-of-network.

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.