The Young Adult’s Guide to Turning 26
At PDX Insurance & Associates, we are your partner when you turn 26, and beyond.
What You Need to Know About Turning 26
Turning 26 is a significant milestone, especially when it comes to your health insurance. For many young adults, it marks the end of eligibility for coverage under a parent’s health plan. This change can feel overwhelming, but understanding your options ahead of time can make the transition smooth and stress-free.
At age 26, you typically lose access to your parents’ health insurance coverage at the end of your birth month or policy year, depending on the plan. That means it’s time to explore other ways to stay covered — whether through your employer, the Health Insurance Marketplace, Medicaid, or other private insurance options.
Insurance Changes at Age 26
Under the Affordable Care Act (ACA), young adults can remain on their parent’s health insurance plan until age 26. Once you reach this age, your coverage typically ends. This coverage can end on one of three dates:
Your birthday
The last day of your birth month
The last day of your plan year
It’s essential to understand when your coverage will end so you can prepare to enroll in a new plan before you lose your current one.
Important Dates & Deadlines
There are multiple opportunities when you turn 26 to enroll in new coverage:
Special Enrollment Period (SEP): Starts when your coverage under your parents’ plan ends and lasts for 60 days
Open Enrollment Period: Typically runs from November 1st to December 15th, depending on your state
Employer Enrollment Periods: Check with your employer for specific dates if you’re eligible for workplace coverage
Insurance Options After Turning 26
Employer-Sponsored Health Insurance
If you’re employed, check if your job offers health insurance benefits. Employer-sponsored plans are often more affordable than individual plans because employers typically share the cost of premiums.
ACA Marketplace Plans
The ACA Marketplace offers a variety of health insurance plans tailored to different needs and budgets. Losing coverage under your parents’ plan qualifies you for a Special Enrollment Period (SEP), allowing you to enroll in a plan outside the regular Open Enrollment Period.
Medicaid
If your income falls below a certain threshold, you may qualify for Medicaid, a free or low-cost health insurance program.
Catastrophic Health Plans
If you’re under 30 or qualify for a hardship exemption, you may be eligible for a catastrophic health plan.
COBRA Continuation Coverage
COBRA allows you to temporarily continue coverage under your parents’ employer-sponsored plan for up to 36 months.
Tips for Choosing the Right Plan
One of the most important steps before finding the right plan is to assess your health insurance needs. Review the following:
Health Status: Do you visit the doctor frequently or take prescription medications?
Budget: How much can you afford in monthly premiums, deductibles, and copays?
Provider Preferences: Who are your preferred doctors and providers?
Then, compare and contrast:
Premiums vs. Deductibles: Lower premiums often mean higher deductibles and vice versa. Choose a balance that works for your financial situation.
Benefits: Look for additional perks like telehealth services, wellness programs, or mental health coverage.
Networks: Ensure the plan’s provider network includes your preferred healthcare providers.
There are also many subsidies available to lessen the burden of healthcare costs for you and your family. Consider those in your comparison planning. If you’re unsure which subsidies you qualify for, contact our team!