If you will soon be turning 26 or are the parent of a 25-year-old, now is the time to make plans for health insurance coverage starting at age 26.
Dependents may continue health insurance on their parent’s plan until age 26. Coverage will end either at the end of the birthday month or the end of the birthday year (depending on the plan), so if no new plan is in place, you will pay out-of-pocket for future medical expenses.
A 2024 online search for self-pay medical prices found:
- Urgent care visits cost approximately $150 to start. Any x-rays, lab tests, and treatments are additional fees.
- An inpatient knee arthroscopy surgery at Grand View Health is approximately $27,000*.
- An appendectomy at Grand View Health is approximately $35,000*.
The surgical prices mentioned above are only for the procedures and do not include any supplies or medications provided. A surprise injury or illness can result in significant medical debt.
Medical coverage transfers the risk of the expenses to the health insurance company. There are multiple options for health insurance.
TEMPORARY SOLUTIONS
- Federal COBRA:
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- Eligibility: You are eligible for COBRA if your parent’s employer has 20 or more employees nationwide in the previous year.
- Coverage: COBRA allows you to continue your parent’s employer-sponsored health insurance for 18 months, with the option to extend it in certain situations.
- Cost: You will be responsible for paying the full premium for your coverage plus an administrative fee. This can be significantly more expensive than other options.
- Pennsylvania Mini-COBRA:
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- Eligibility: You are eligible for Mini-COBRA if your parent’s employer has one (1) to 19 employees in Pennsylvania and offers group health insurance.
- Coverage: Mini-COBRA provides similar continuation coverage as COBRA but for a shorter duration – nine (9) months with no extensions available.
- Cost: The cost structure is like COBRA, but the fees might differ.
Remember, COBRA and Mini-COBRA are temporary solutions. It is crucial to research all your options and choose the one that best fits your needs and budget.
LONG-TERM SOLUTIONS
- Employer-Provided Health Insurance
Likely the most cost-effective coverage option, these plans vary from employer to employer, so you may want to weigh the health coverage packages when selecting an employer.
2. Marketplace
- Pennsylvanians can purchase health coverage for themselves and/or their family. If you are a small business owner, self-employed, a student, or your employer does not provide health insurance, you can choose from plans in the Marketplace.
- With the loss of coverage at age 26, you do not have to wait for ACA Marketplace Open Enrollment. Generally, you have 60 days before and after loss of coverage to apply and enroll in a new Marketplace Individual coverage. Be aware that coverage begins the first day of the following month when enrollment is completed.
These are important factors to consider regarding COBRA and Mini-COBRA:
- Cost: COBRA and Mini-COBRA can be expensive compared to other health insurance options, especially since you will pay the full premium. Consider your budget and explore alternative options like the Marketplace or employer-sponsored plans, if available.
- Health needs: Health insurance is crucial if you have pre-existing conditions or require ongoing medical care. Weigh the cost of COBRA/Mini-COBRA against the potential financial burden of medical expenses if you remain uninsured.
- A gap in coverage: If you switch to another plan, there might be a gap in coverage between plans. Consider the potential implications for pre-existing conditions or ongoing treatment.
Since there are so many options and plans, selecting the best for you may be confusing. At FIFS, we have licensed health insurance agents who will guide you through the selection process and provide advice. Getting a quote from FIFS does not oblige you to purchase a plan, and we do not charge any fees for the services in the quoting or purchasing process.
To begin exploring your options, contact FIFS today at 267.384.5300 or complete the form below.
*discounted cash price