As an adult, you are responsible for making decisions about your own health. This includes being sure you have insurance and being aware of medical issues that may affect you. If you’re young and healthy, you may think you don’t need health insurance. Many people get health insurance through their job, but there are other ways for a young adult to get health care coverage.
Health Insurance Marketplace
How to navigate the Marketplace. When you apply for insurance using the Health Insurance Marketplace, you will be able to find out whether you qualify. There is more information on this process at www.healthcare.gov. The plans in the Marketplace are offered by private insurance companies that compete for your business based on features and price. You may be able to save on out-of-pocket costs, too, meaning lower deductibles and lower payments (co-pays) each time you get care. All Marketplace insurance plans cover ER services, doctor and hospital charges, pregnancy, treatment for pre-existing conditions, mental health and substance abuse services, lab work, and other essential health benefits. Some include dental coverage.
What is a deductible? A deductible is the amount of money you will be required to pay before an insurance plan will begin paying for specific treatments. For example, if your plan provides for a $500 deductible, you will pay the first $500 of your medical bill before your insurance company will cover the rest. Keep in mind that your deductible drops back to zero once per year, and you will need to find out the specific date that happens.
What is Open Enrollment? This is the yearly period when people can enroll in a health insurance plan. You may be able to enroll in a Marketplace health insurance plan outside of the Open Enrollment period if you qualify for Special Enrollment for life events such as getting married, having a baby, or losing other health coverage (such as if you lose a job that was providing health care benefits to you). Open enrollment occurs in October of every year.
How do I know if I will save money using the Marketplace? There are a number of online tools at www.healthcare.gov to tell you whether your income is in the range to save by using the Marketplace.
How Do I Get Health Insurance Coverage?
Getting or staying on a parent’s plan. If your parent’s health insurance plan covers dependents, you can usually be added to their plan and stay on it until you turn 26. Your parent should check with their plan or their employer’s benefits department to find out. If your parent is applying for a plan in the Health Insurance Marketplace, they can include you on their application or add you during the yearly Open Enrollment period. In general, you can join a parent’s plan and stay on until you turn 26 even if you get married, have or adopt a child, start or leave school, live in or out of your parent’s home, are not claimed as a tax dependent, or turn down an offer of coverage from your employer.
Buying your own health insurance plan. You can get your own health plan through the Health Insurance Marketplace. If you work part time or are self-employed, you may qualify for low-cost insurance or free coverage through Medicaid. If you leave your job and lose job-based insurance, you can buy an insurance plan any time of year, even if it’s outside the Open Enrollment time period, as long as you enroll within 60 days from when the insurance ends. When choosing the appropriate plan for you, you will want to find out the plan’s premiums (the monthly amount you pay to the insurance company), co-pays (the amount you are responsible for paying directly to your doctor or hospital), and deductibles (the maximum amount you pay before the health plan kicks in). You should also look at the network of doctors and hospitals you will have access to, and what services are covered (such as vision or dental).
Using a student health plan. If you plan to attend a school that offers a student health plan, it can be an easy and affordable way to get basic insurance coverage. Be aware that even if you have access to a student health plan, you may apply for coverage through the Health Insurance Marketplace instead. If you are claimed as a dependent on anyone’s tax returns (for example, by your parents), you may be included on that person’s application for a Marketplace plan. If you live in a different state, you may be able to apply yourself in the state you go to school. If you are not claimed as a dependent you should fill out your own application and do not include your parents’ income.
Medicaid and CHIP. Medicaid is a program that provides health coverage to millions of individuals based, in part, on low income. The Children’s Health Insurance Program (“CHIP”) provides health coverage to people, up to age 19, in families with incomes too high to qualify for Medicaid. You may apply for Medicaid any time of year, as Medicaid and CHIP do not have Open Enrollment periods. You may either apply through the Health Insurance Marketplace or through your local Medicaid agency. To find out if you qualify for Medicaid based on your income, you may go to www.healthcare.gov/lower-costs and enter your household size and income. Even if you don’t qualify for Medicaid based on income, you should apply, because you may qualify for Kentucky’s program, especially if you have children, are pregnant, or have a disability.
According to the Social Security Administration, 1 in 4 of today’s 20-year-olds will become disabled before they retire. If you have a disability that interferes with your ability to work, you may apply for either Social Security Disability (SSD) if you have a work record, or Supplemental Security Income (SSI) if you do not have a sufficient work record. You may meet the definition of a person with a disability under the SSD rules if: (1) you cannot do work that you have done before; (2) you cannot do other work because of your age, education, and medical condition; and (3) your medical condition has lasted or will last for at least one year (or will result in death). SSI provides financial aid to people with limited resources and who are older than 65, blind, or disabled. Applications for Social Security may be filed at your local Social Security Administration Office, by phone at 1-800-772-1213 from 7:00 a.m. to 7:00 p.m. Monday through Friday, or may be completed online at www.ssa.gov/benefits/disability.
You have rights. If you have been diagnosed with a disability, your rights may fall under the protections of the Americans with Disabilities Act (“ADA”). The ADA prohibits discrimination against people with disabilities to make sure that they have the same opportunities as everyone else to enjoy job opportunities, purchase goods and services, and participate in government programs and services (including public transportation, such as city buses and subways). In addition, people with HIV/AIDS are protected by the ADA. For example, the ADA would protect a person denied a job or admission into school because of a rumor that he or she has HIV/AIDS, even if he or she does not have it.
Federal law protects the privacy of your health information. Because your health information is unique and valuable, it is protected by law, including under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”). We live in an age of virtual record-keeping and electronic data, which makes sharing and storing information faster and easier. However, this also means that sensitive personal information is easier to fraudulently access, including demographic data, physical or mental health conditions, health care history, and healthcare payment history. It is also important that you take steps to protect your own health information. Be mindful of when and to whom you give this information, including your Social Security number, especially over the phone or online.
Protecting your information on shared plans. If your healthcare is covered on someone else’s plan – for example, a parent – your insurer may allow you to keep your healthcare information confidential. You may ask a medical provider and your insurance company whether there will be information regarding your health care sent to a parent’s address, and whether there is a way to have it sent to your own address instead. (An insurer is not required to accommodate these requests in Kentucky, but many insurers have such a process in place even if not required by law.)
What kinds of documents and information should I protect? Important documents include your health insurance card, birth certificate or other proof of birth, and social security card or other proof of US citizenship or lawful alien status if you were not born in the United States. Keep these documents in a safe place, but do not carry them with you. You should also learn how to access your medical history and immunization records, keep a contact list of your doctors and dentist, and know the names and doses of any medication you take.
Substance Abuse and Mental Health
As a young adult, this may be the first time you will be responsible for your own healthcare decisions, including dealing with mental health issues such as addiction, anxiety, ADHD, or depression. One in five adolescents has had a serious mental health disorder at some point in their life. Depression, mental health disorders, and substance abuse disorders are major risk factors for suicide. If you or someone you know is in crisis, contact a mental health professional or call the National Suicide Prevention Lifeline at 1-800-273-TALK. Many colleges also offer free counseling or referral services to enrolled students free of charge.
Alcohol. While drinking alcohol under the age of 21 is prohibited in Kentucky (and all 50 states), it is likely that your exposure to alcohol will increase now that you are an adult. In addition to criminal consequences, young adults who drink put themselves at risk of injury or death from alcohol poisoning or alcohol-related accidents. One in seven drivers ages 16-20 involved in fatal car crashes in 2016 had alcohol in their systems.
Tobacco. As with alcohol, the age to buy tobacco products has recently been raised from 18 to 21. There are multiple characteristics and risks associated with tobacco use, according to the US Department of Health and Human Services. Smoking damages nearly every organ of the body, and nicotine is a highly addictive drug that affects users on a cellular level, making the addiction difficult to overcome, regardless of age. www.betobaccofree.gov has more information from the HSS regarding tobacco use.
Issues with prescription medications. This may also be the first time you are responsible for filling and monitoring your own prescriptions. Some prescriptions, particularly for pain treatment, may be highly addictive. The non-medical use of certain painkillers, such as Vicodin and OxyContin, is illegal. It is also against the law to possess certain prescription drugs that are prescribed for someone else. The non-medical use of someone else’s prescription drugs can be just as dangerous and illegal as using street drugs, and both can lead to overdose or death. If you are concerned about substance misuse or abuse, you may call the Substance Abuse and Mental Health Service’s National Helpful at 1-800-662-HELP.Steroids. The use of steroids to increase strength or growth can cause serious health problems. All non-medical use of anabolic steroids is illegal. Steroids can keep teenagers from growing to their full height; they can also cause heart disease, stroke, and damaged liver function. People using steroids and other dietary supplements may develop fertility problems, personality changes, and acne. Men can also experience balding and development of breast tissue. These health hazards are in addition to the civil and criminal penalties for the sale, use, or exchange of anabolic steroids.