Millions of Young Adults Face Health Insurance Transition as ACA Age-Out Looms
As millions of young adults approach their 26th birthday, the question of health insurance coverage is becoming increasingly urgent, with potential affordability challenges on the horizon.
Alexis Zizzo, a Commack resident who will turn 23 this weekend, is already researching options for when she ages out of her parent’s insurance. The recent college graduate, currently seeking employment, explained she frequently visits doctors due to “a few pre-existing conditions” and maintaining those appointments would be financially unsustainable without coverage. “I know what it costs for me to maintain my health,” Zizzo said. “I need to know what I’m expecting when the day comes. I don’t want it to show up, and then I’m 26 and two days old and something happens.” The 2010 Affordable Care Act mandates insurance issuers no longer offer dependent coverage past age 26, a milestone that impacts a significant portion of the population.
Approximately 15% of 26-year-olds opt to go without insurance, the highest rate of any age group in the United States, according to KFF, a nonprofit health policy organization. Affordability is a primary driver, and this issue could be exacerbated by the potential expiration of pandemic-era health insurance tax breaks currently being debated in Congress. A recent analysis by The Washington Post predicts average premium increases of 30% on the federal Healthcare.gov marketplace next year. Navigating these changes is crucial, as a lack of insurance can lead to difficulty accessing care and potentially lower economic productivity.
Experts offer several tips for young adults preparing for this transition. Employer-sponsored plans may offer coverage beyond age 26 through riders, and COBRA provides a temporary extension – up to 36 months in New York State – though at a cost up to 102% of the premium. For those without employer-sponsored plans, exploring state exchanges like New York State of Health is recommended, with potential eligibility for Medicaid or the Essential Plan based on income. “Understand your options, the benefits that exist and what you’re looking to get out of it,” advised Kirat Kharode, CEO and managing partner at Pinewood Family Care Co. Resources like Young Invincibles can also assist with navigating the marketplace and understanding key terms like deductibles and co-pays.
Health navigators are available to help individuals understand their options and avoid gaps in coverage, and officials encourage those leaving a parent’s plan to explore the marketplace immediately to initiate a special enrollment period.
