A big push for the Affordable Care (ACA) has been attracting more young people, as they’re typically healthier. This enables insurance companies to avoid older, sicker enrollees’ higher medical costs, while beneficiaries are spared higher premiums. As of Dec. 26, 2016, the Department of Health and Human Services (HHS) tallied about 4 million sign-ups for people under 35. And an estimated 770,000 of those 18-34 years old were new enrollees. But newly enrolled millennials have certain things to be aware of, to ensure their coverage works smoothly and effectively.
Thanks to Obamacare, people can remain on their parents’ health insurance plans until the age of 26. After that, they have to purchase their own coverage. This age-related milestone is considered a Qualifying Life Event (QLE), enabling consumers to select ACA-compliant coverage at any time, even outside the annual Open Enrollment Period of Nov.1, 2015-Jan. 31, 2016. When you enroll, you’ll have 60 days to select a plan. If you fail to do so, you may face IRS-imposed tax penalties. While you may avoid these if you qualify for hardship exemptions, you can expect to pay the greater of:
- $695 per adult and $347.50 per child, for a maximum of $2,085 per family; in 2015, this was $325 per adult and $162.50 per child
- 5 percent of your income above the tax filing threshold; in 2015, this was 2 percent
You don’t have to pick the same plan as your parents, though. They may have employer-based coverage or vision or dental insurance, which may not be necessary for younger enrollees. As for where to purchase coverage, Healthcare.gov is designed for people living in states utilizing the ACA Marketplace. If your state has its own exchange (or the District of Columbia), specific websites are available. If you prefer private insurance, the healthcare law requires that insurance brokers’ premiums must be equal to those on Healthcare.gov.
What your coverage provides
Whatever policy you select, it must provide coverage for the 10 Essential Health Benefits. These are: 1) ambulatory patient services; 2) emergency services; 3) inpatient hospitalization; 4) maternity and newborn care; 5) mental health and substance abuse services; 6) prescription drug coverage; 7) rehabilitative and habilitative services; 8) laboratory services; 9) preventative and wellness services and chronic disease management; 10) pediatric oral and dental care.
In addition, all metal levels of coverage receive the same preventive coverage. Healthcare experts feel that the higher levels of coverage really only matter when members are sick or have prescription medications. However, research found that in 2015, 65 percent of Americans’ plans had more benefits than needed. All ACA policies ensure coverage for pre-existing conditions. Preventive services, including cholesterol screenings and vaccinations, are free. There are also high-deductible plans, which cost less and have lower premiums. But if you experience a serious illness or accident, you’ll pay the full annual deductible.
Consider the financial factors
Your plan’s costs are important, but the monthly premium is only one part. You need to take into account the plan’s deductibles (costs before insurance), copayments (costs for covered services) and out-of-pocket maximums. You should also make sure you can visit your preferred doctors and facilities with your policy by selecting the proper plan type: Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs); or Private-Fee-for-Service (PFFS) plans.
Your 2016 policy costs will depend on your expected income. Government subsidies and tax credits may be available, but if you earn more money than estimated, you’ll have to pay it back.
