What to Know About Your Health Insurance Options When You Turn 26 - GoodRx (2024)

Once you turn 26, you typically don’t have the option to remain on a parent’s health insurance plan. You may still have this option if you continue to qualify as a dependent under your state’s law or if you have a specific disability. Either way, it's important to prepare for insurance alternatives before the big year.

Finding out if you live in a state that allows you to stay on a parent’s plan beyond age 26 is a good place to start. If not, you’ll need to find coverage elsewhere to avoid being uninsured.

If your job offers health insurance, you may be able to join an employer-sponsored plan on your own. If you’re in college, you may be eligible for student health insurance. And if you’re married or have a domestic partner, you may be able to join their plan.

There’s also the Affordable Care Act (ACA) marketplace, where you may be able to find a plan for $10 or less per month if you qualify for premium subsidies.

Do you lose coverage under a parent’s health insurance as soon as you turn 26?

No, unless your birthday is the last day of the year, you don’t lose coverage on a parent’s health insurance plan as soon as you turn 26. In most states, coverage for young adults under a parent’s plan ends on December 31 of the year you turn 26. That gives you the option to apply for coverage during the ACA open enrollment period, which begins November 1.

In some states, coverage under a parent’s plan extends beyond the year you turn 26. We’ll discuss those states in the next section.

State-by-state health insurance age limits after 26

At least 7 states consider young adults as dependents on a parent’s health insurance plan past age 26 if they meet certain eligibility requirements. There’s typically no age limit for dependents with certain disabilities.

The chart below outlines the requirements to stay covered under a parent’s plan in these states.

How do I avoid a gap in health coverage after 26?

Under the ACA, losing your dependent status on your parent’s health insurance plan is a qualifying life event. That means you’re eligible for a special enrollment period (SEP) through the ACA marketplace. The SEP lasts 60 days after the day coverage on your parent’s plan ends.

Since you can find out when your coverage ends in advance, you also can apply for new coverage 60 days before an anticipated qualifying life event. If you take charge, access your options, and make a decision early enough, you can avoid a gap in insurance coverage.

What are my options when I no longer have dependent coverage on my parent’s plan?

You have many options for health insurance after you lose coverage under your parent’s plan. Depending on your individual circ*mstances, these options could include coverage through:

• Job-based insurance: If your job offers health coverage, you may be eligible for employer-sponsored insurance.

• A partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.

• ACA marketplace: Through the ACA exchange, you may be able to find coverage for $10 or less per month if you qualify for a premium subsidy.

• Medicaid: Depending on your income, you may qualify for your state’s Medicaid program.

• A special plan: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.

• Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.

• Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) — you can enroll in Medicare at any age.

• Veterans Affairs: If you are an active-duty service member or a veteran, you may qualify for TRICARE or Veterans Affairs benefits and services.

• COBRA: You may be able to continue coverage with COBRA under your parent’s plan, but this option typically has very high costs.

Choosing a health plan

There are a few factors you should consider when choosing a health plan or weighing the options presented in the previous section. Here are some questions to ask yourself:

• What’s my budget? You may prefer to pay higher premiums and have lower costs when you receive care. Or lower premiums and higher costs when you access care may work better for you.

• What are my healthcare needs? You may be better off choosing a health plan that has your current providers in its network or covers providers of your choice. You should also check that you have coverage for your medications.

• Am I expecting any major life events soon? If you need to have surgery or expect to need prenatal or postnatal services in the next year, you should consider that in your decision.

• Will I have a partner with insurance coverage? If you plan to get married or enter a domestic partnership that will give you access to health insurance, a short-term insurance plan may be the best option for you.

Major types of health plans

Consider the pros and cons of different types of health plans when you’re weighing your options. There are 4 main types of health plans:

1. HDHP (high-deductible health plan)

2. HMO (health maintenance organization)

3. PPO (preferred provider organization)

4. POS (point-of-service)

A 2022 Kaiser Family Foundation survey reported that the distribution of enrollment among employer-provided health plans was:

• 49% PPO

• 29% HDHP with savings option

• 12% HMO

• 9% POS

• 1% conventional (also known as indemnity or fee-for-service plan)

In the chart below, we will briefly discuss the features of HDHP, HMO, PPO, and POS plans.