What turning 26 means for your health

By Lucy Maher | Updated on Sep. 14, 2020 Medically reviewed by Anis Rehman, MD

Key takeaways

Turning 26 triggers loss of parental health insurance coverage under the Affordable Care Act, necessitating early planning for alternative coverage.
A 60-day Special Enrollment Period around the 26th birthday allows for the acquisition of new health insurance, which is crucial to avoid penalties and high out-of-pocket costs in emergencies.
Health insurance options for those turning 26 include employer plans, the Health Insurance Marketplace, COBRA, and Medicaid, each with different eligibility criteria and costs.
Understanding the types of health insurance plans (PPO, HMO, EPO, HDHP) and their costs versus benefits is essential for selecting the most suitable coverage.

If you’re turning 26 this year, you’re probably focused on paying off your student loans and planning the next stage of your career. Your health insurance should be on your radar, too.

That’s because if you’re on your parents’ health insurance you will lose coverage upon your 26th birthday, as mandated by the Affordable Care Act (ACA). If you’re in this boat you might be confused as to what you need to do and where to look for coverage that fits your needs.

The good news: With a little planning and research you can seamlessly get your own health insurance coverage so you have peace of mind in case of a medical emergency.

Why 26 is an important age

The ACA lets you stay on your parents’ health insurance plan until you turn 26. This is if you live with them or not, in the same state or far away, or if you are married or single. That’s huge for young adults with bills to pay, or those who are socking away money for a big purchase like a house or grad school tuition.

This changes when you turn 26, and what happens depends on the insurance your parents have. For some insurance policies, coverage ends on your 26th birthday, and others cover you until the end of the month following your birthday or let you stay under your parents’ coverage until the end of the year.

What’s important here is to give yourself plenty of time to get covered. Review your parents’ plan well ahead of your birthday so you aren’t left without coverage as your big day nears.

“People turning 26 years old should do their best to plan ahead and give themselves time to really investigate their health insurance options because frankly, for most of them, this will be a brand-new process,” says Deb Gordon, author of The Healthcare Consumer’s Manifesto: How To Get The Most For Your Money. “Health insurance has its own lingo and quirks, and most people don’t really understand it well. One other reason to leave time for the process: Researching health insurance options can be a drag. Young adults should allow themselves time to procrastinate or avoid it out of boredom or feeling overwhelmed with enough time to get back to it to decide.”

Turning 26 is considered a qualifying life event for a Special Enrollment Period, which runs 60 days before and after you turn 26. Miss these windows? You can also wait until the next open enrollment period, which typically falls between Nov. 1 and Dec. 15 (this can differ by state). Note though, that waiting for the general enrollment period may mean you go a certain amount of time without insurance. Do this and you may face a fine and massive out-of-pocket costs in the event of a medical emergency.

You can avoid all this by signing up with a new provider no less than two weeks before the month you want your insurance to start. Want coverage on Apr. 1? Sign up by Mar. 15.

Where to get health insurance when you turn 26

Being in charge of your health coverage for the first time can be daunting. It doesn’t have to be if you know where to look and what’s available to you.

If you’re working, you may be able to get coverage through your employer, in an arrangement in which you both contribute to the cost of coverage. Ask your human resources department about the plan or plans offered, what’s covered and how much you’ll be expected to pay.

The Health Insurance Marketplace offers different insurance plans to individuals, families, and small businesses. Some states have their own, called exchanges. The federal government also operates a marketplace for residents of states that don’t have an exchange. Depending on your income, you may qualify for a subsidy to help offset the cost of coverage. You’ll also want to be aware of the open enrollment period—Nov. 1 to Dec. 15—during which you must elect coverage. Go to healthcare.gov to browse plans.

COBRA, or the Consolidated Omnibus Budget Reconciliation Act, might be a good option for you, depending on your circumstances (although it’s not always the most affordable). It allows you to stay on your parents’ healthcare plan for up to three years after you turn 26. First, check if you’re eligible. If so, you’ll have to submit a written request to your parents’ healthcare provider. The size of your parents’ employer might play a role in your getting coverage. If your parents have a very small employer (less than 20 employees), the company may be exempt from having to offer COBRA. It is usually the costliest option with a high monthly premium. In some of these cases, the state may offer temporary health insurance over the same period COBRA would have covered you.

Medicaid, a federal and state program that offers healthcare coverage for those with limited financial resources, is another option. If you fall under a certain income threshold, you may qualify. Check your state’s Medicaid website to see if you qualify.

Types of health insurance plans to consider

If you’re able to get health insurance coverage through an employer’s plan or Marketplace plan, you’ll likely have a few plans to choose from. Here are the basics about each plan and some additional resources to help you choose the right plan for your health needs:

Preferred provider organization (PPO): You don’t have to get a referral from your primary care physician to see specialists or other providers. You’ll pay higher premiums, copays (especially for out-of-network healthcare services), and deductibles.
Health maintenance organization (HMO): HMOs are typically the least flexible but cheapest. However, you’ll be responsible for 100% of out-of-network services. A primary care physician coordinates your care and must refer you to see additional providers. Out-of-network services are not covered.
Exclusive provider organization (EPO): EPOs are more flexible than HMOs and usually have more in-network providers available, but they’re often more expensive than HMOs and PPOs. You must choose a primary care physician, but you don’t need their referral to see other providers.
High deductible health plan (HDHP): Best for generally healthy people who don’t require frequent health care. You’ll pay a lower monthly premium in exchange for a higher deductible. That means you’ll pay 100% of healthcare costs upfront until you reach your deductible (which could be as high as $3,500 for an individual). Often includes an health savings account (HSA) option where you can allocate funds to pay these costs tax-free.

“Try to think of all your healthcare related expenses over a year and make a list,” says Karen Berger, Pharm.D., a member of the SingleCare Medical Review Board. “Keep this in mind when choosing between plans. If you tend to visit the doctor a lot and see a few specialists you’ll need more extensive coverage than someone who barely ever walks into a doctor’s office. If you get insurance through your employer you will likely just have a choice of one or two plans and perhaps different levels of coverage. Again, looking at your expenses can guide you.”