Turning 26 and Losing Your Parents' Health Plan: What to Do Next

What happens to my health insurance when I turn 26?

Under the Affordable Care Act you can stay on a parent's health plan until you turn 26. When that coverage ends depends on the plan, so do not assume a date. Employer plans usually end on your birthday or the last day of your birthday month, and Marketplace plans often run to the end of the birthday month, though some carry you to the end of the plan year. Whatever the date is, losing that coverage counts as a qualifying life event, and it opens a Special Enrollment Period, or SEP.

How long is the Special Enrollment Period?

You get 60 days before your coverage ends and 60 days after it ends. Enrolling before the end date is the move, because your new plan can start the day after the old one stops and you never have an uncovered day. If you let all 120 days pass, you are generally waiting for Open Enrollment, which runs November 1 through January 15 in most states.

The most common mistake I see at this age is treating the birthday as the deadline. The birthday is the trigger, not the finish line, and people who wait until it arrives lose the clean handoff between plans.

Do I need the same plan my parents had?

No, and copying their plan is usually the expensive choice. Your premium and your subsidy are calculated on your own household income now, not your parents' income. Early career earnings frequently qualify for premium tax credits, so a plan you assumed you could not afford can turn out to cost less per month than a streaming bundle. Compare on your numbers.

What are my coverage options?

• An employer plan, if your job offers one. It is often the cheapest option because your employer pays part of the premium, but check the deductible and the network before you sign, since a low premium with a narrow network can cost you more at the doctor.

• An ACA Marketplace plan, with subsidies based on your own income. This is where most people turning 26 land, and it is the option that most often surprises people with how affordable it is.

• Medicaid, if your income falls under your state's limit. Virginia, Maryland and DC all expanded Medicaid, so a low or irregular income can qualify you, and there is no enrollment window for it.

• COBRA, which keeps your parent's plan temporarily. You pay the entire premium yourself, including the part the employer used to cover, so it is normally a bridge rather than a plan.

What should I do right now?

1. Confirm your exact coverage end date in writing, from the insurer or from your parent's HR or benefits contact.

1. Check subsidy eligibility using your own expected income for the year.

1. Compare an employer plan, a Marketplace plan and Medicaid side by side on premium, deductible, network and prescriptions.

1. Enroll inside the 60-day window, ideally before the end date.

1. Save your documentation, because you may be asked to prove the coverage loss.

Keep three things in a folder or your email: the termination letter or notice of coverage end, the name of the plan you were on with the member ID, and the exact end date. That is what an exchange asks for when it verifies a Special Enrollment Period.

Where do I enroll in my state?

This part trips people up, because not everyone uses the federal site. Virginia residents enroll through Virginia's Insurance Marketplace, Maryland residents through Maryland Health Connection, and DC residents through DC Health Link. Florida residents use Healthcare.gov. We are licensed in all four, so if you moved for a job you do not have to figure out the switch alone.

Bottom line

Turning 26 is the point where coverage becomes yours to choose. Confirm your end date, enroll inside the Special Enrollment Period, and price it on your own income, and you keep continuous coverage that is usually cheaper than you expect.

If you want a second set of eyes, start with the Turning 26 coverage guide or run the Turning 26 questionnaire and we will tell you what you qualify for. You can also compare on the health insurance questionnaire or read more about Austin.

Need help before your deadline? Scudo Benefits Group works with young adults, self employed people and small teams across DC, Maryland, Michigan, Ohio, Texas, Virginia and Florida. Call (571) 571-1491 or email austinw@scudobenefitsgroup.com. There is never a cost to talk, and we respond within 24 hours.

Related reading: for every deadline, subsidy rule, and plan decision in one place, see Open Enrollment: Every Deadline, Rule, and Decision You Need to Know.