Turning 26 and Other Life Events
Turning 26 is a milestone birthday when it comes to health insurance. It’s called a Qualifying Life Event which impacts your eligibility to enroll in a health plan. Choosing health insurance for the first time can be confusing, but with the right information, you can make a confident choice.
What’s a Qualifying Life Event?
A Qualifying Life Event is an event that makes you eligible (qualifies you) to buy health insurance outside of the regular annual open enrollment period.
Since you won’t be eligible to stay on your parents’ plan after you turn 26, this Special Enrollment Period lets you choose coverage right away. You do not have to wait until open enrollment to buy your own health plan.
What is the Health Insurance Grace Period When You Turn 26?
Your Special Enrollment Period begins 60 days before your 26th birthday and lasts for 60 days afterward. If your coverage ends in the middle of the year, for example at the end of your birth month, you should buy health insurance during the Special Enrollment Period to avoid a gap in coverage. A coverage gap means you are not covered by any health insurance plan and you would have to pay full price out-of-pocket for any health care services including medical emergencies.
If your parents have private health insurance through their employer, that employer decides when your coverage under their plan ends. For example, this could be the last day of your birth month, or at the end of the calendar year. Ask your parents to check their employee handbooks or ask their HR department when your coverage will end.
If you have been covered by your parents’ ACA plan, sometimes called an Obamacare plan, your coverage will not end until the last day of the calendar year, and you have until the end of that year’s Open Enrollment period to purchase your own health insurance. Most likely your coverage will end during the Open Enrollment Period, which is between November and the end of January. This allows you to possibly have more time after turning 26 to decide because you can wait until Open Enrollment at the end of the year.
What Are the Best Health Insurance Plans for Young Adults?
ACA Marketplace Plans
You can apply for a Marketplace insurance plan in Northern Virginia, in Washington, D.C. and in Maryland. Depending on your income, you may be eligible for financial assistance. The Marketplace offers a variety of plans with many levels of coverage and many price points. Applying for a Marketplace plan will also tell you if you qualify for Medicaid. All health plans are required to offer you coverage regardless of pre-existing condition such as diabetes, depression or pregnancy.
Employer Sponsored Plans
If you have a job that offers a health insurance plan, your turning 26 may trigger a Special Enrollment Period that will allow you to purchase health insurance outside of your company’s Annual Enrollment Period. Before you turn 26, ask your HR department how to enroll in health insurance through your job.
Like ACA plans, employer-sponsored plans are required to cover pre-existing conditions and will not deny you coverage.
In you are in college, graduate school, or professional school, your educational institution may offer a student health plan. Student health plans offer low payments, and in many cases lower deductibles than alternative plans, but will cover you only until you graduate or un-enroll from school. These plans often offer excellent coverage for school-sponsored health clinics, including on-site clinics at the campus, and school-sponsored telehealth services, as well as local or national networks of doctors and mental health services.
Check with your school’s admissions and enrollment office, or campus health services, to find out if you are eligible for a student health plan.
High Deductible Health Plans
High Deductible Health Plans are designed for young, relatively healthy adults who don’t need a lot of coverage but want to protect themselves against the high out-of-pocket costs of a medical emergency. These plans generally have the lowest monthly payments, in exchange for the highest out-of-pocket costs when used.
The definition of a High Deductible Health Plan is set by the IRS. As of 2023, it is defined as any plan with a deductible of at least $1,500 for just you, or $3,000 for a family. Your total annual out-of-pocket expenses, including your deductible, copays, and coinsurance percentage, are limited by law, and cannot be greater than $7,500 for you individually, or $15,000 for a family. These limits apply only to health care received in-network.
Selecting Your Coverage
If you are ready to enroll in an individual or student health insurance plan in Maryland, Washington D.C., or Northern Virginia, check out CareFirst's Health Insurance Plan options to find out which plan will work best for you!