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Young woman surrounded by question marks The Affordable Care Act (ACA) allows young adults to stay on their parents’ health insurance until the child turns 26.

The provision has allowed millions of 20-somethings to stay covered and not have to pay potentially high premiums on their own policies until they reach 26.

But what happens when these young adults have their 26th birthday? What are the health plan alternatives? Here's what you need to know about aging out of your parents' health plan.

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How long can children stay on parents insurance

Young adults can remain on their parents’ policy until they reach 26. However, there are exceptions. A handful of states allow children to stay on their parents’ coverage until 30 or 31.

For example, New York residents may stay on their parents’ policy until age 30 if they’re unmarried. In New Jersey, it's 31 for unmarried people who have no dependents, said Penny Gusner, senior consumer analyst for Insure.com.

Do you lose health insurance as soon as you turn 26?

Yes, you usually lose coverage from your parents when you turn 26. However, insurers and employers may give some leeway.

You can often keep your parents’ insurance until the end of your birth month. Some plans may even cover a dependent child until the end of that year.

A parent can contact the health plan or employer to find out when the child will become ineligible. It’s a good idea to inquire months before the 26th birthday so that your child can begin looking for other coverage.

How long after you turn 26 can you stay on your parents’ insurance?

If you need a plan through the ACA exchanges, you'll have a 120-day special enrollment window to buy a new health insurance policy regardless of when your parents’ plan’s coverage ends.

During this time, which begins 60 days before you turn 26 and ends 60 days after, you can purchase a new health plan. If you’re buying an individual plan that’s not on the ACA marketplace, you have 30 days after you turn 26.

If you’re going on an employer’s health plan, check with them about the window to get a health plan through the company. You usually have 30 days to sign for an eligible employer-based plan after losing other coverage.

Other ways to get health insurance

The ACA created easier ways for people to find an individual or small group policy. The law created exchanges, which allows people to search for and compare health plans in one place.

However, there are other ways to get coverage. Here are alternatives when you’re losing your parents’ health insurance.

Your employer’s health insurance

Probably the easiest and cheapest way to get health insurance is by getting it through your employer. Employers often pay a large portion of health care costs, which makes it a cheaper option than most alternatives for a young adult.

Pro: Less expensive than other options and usually excellent benefits.

Con: You’re usually limited to a handful of plans that the employer offers.

Spouse’s health plan

If a young adult is married, he or she can try to get added to a spouse’s health plan. Adding another person to the plan will likely increase premiums. It may even double them. However, you’ll get the health coverage you need and it’s usually more affordable than options mentioned below.

Pro: Less expensive than other options and usually excellent benefits.

Con: Adding a spouse will likely increase premiums -- possibly even double them.

COBRA

COBRA requires employers with at least 20 employees to extend health coverage to people who lose their employer-sponsored health insurance. Before the ACA, COBRA insurance was how most Americans got health insurance after being laid off.

Though COBRA is often an avenue for people who get laid off, it’s available for a child who ages out of their parents’ plan.

You have 60 days after losing coverage to elect COBRA coverage. You’re able to stay on a COBRA plan between 18 and 36 months, depending on the reason for losing your coverage.

There is a downside. COBRA is expensive. How pricey? You have to pay for all of the health plan costs plus an administrative fee of up to 2%.

The average annual family premiums for an employer-sponsored health plan is more than $20,000 and the employer picks up most of those costs. However, in a COBRA plan, the individual pays all of those health insurance costs.

Pro: Provides the familiarity and protection of the employer-sponsored plan.

Con: COBRA plans don’t have an employer’s financial help.

Individual health plan

An individual plan through the exchanges can be an affordable option depending on your salary.

People whose income is below 400% of the federal poverty level (about $50,000 or less for a single person in 2020) can receive subsidies to lower premiums or get tax credits to help pay for health care. California has even more generous benefits (600% of the federal poverty level).

When you compare plans on the exchanges, the site will tell you if you’re eligible for subsidies and provide premium estimates when you give your income data.

If you don’t qualify for subsidies, an individual plan can be pricey. Likely not as expensive as a COBRA plan, but more costly than if you enroll in an employer’s plan. People who don’t qualify for subsidies can also get an individual plan outside of the exchanges. These plans are directly through a health insurer and are more expensive than subsidized plans on the exchanges.

Individual plans through the exchanges are broken into four categories based on premiums and out-of-pocket costs:

  • Bronze -- lowest premiums; highest out of pocket costs
  • Silver -- higher premiums than Bronze but lower than Gold; lower out of pocket costs than Bronze
  • Gold -- lower premiums than Platinum but higher than Silver; lower out of pocket costs than Silver
  • Platinum -- highest premiums; lowest out of pocket costs

More than three-quarters of members in the exchanges market have either a Bronze or Silver plan. Not many insurers offer Platinum plans.

Gusner said people buying an individual health insurance plan should consider the overall price of the plan, the amount you pay toward your care and the flexibility you will have to see specialists and doctors in your network. Compare plans from at least three insurers, if possible.

“There is, of course, the cost of the premiums with each, but then also the co-payments, deductibles and coinsurance. Compare the numbers to see which insurer makes more financial sense,” said Gusner. “Then there is the network of doctors and hospitals; does one give you better choices for the area in which you live?”

To be sure you're choosing from among the top-rated carriers, review Insure.com’s ranking of the Best Health Insurance Companies, based on a survey of 3,160 policyholders on customer service, price, claims handling, website/app merit and renewal.

Pro: ACA plans offer comprehensive benefits.

Con: If you don’t qualify for subsidies, individual plans can be expensive.

Medicaid

You may be eligible for Medicaid if you’re considered low-income.

Salary requirements differ by state, though. Three dozen states expanded Medicaid eligibility so that people up to 138% of the federal poverty level ($17,000 for a single person in 2020) are eligible. Other states have stricter guidelines.

Medicaid provides the same level of comprehensive health insurance as a private insurer, but the coverage comes at much lower costs that are based on your income. Check with your state’s Medicaid program to see if you qualify.

Pro: Inexpensive coverage with similar benefits found in an employer-sponsored health plan.

Con: Despite Medicaid expansion in 36 states, most Americans still don’t qualify for Medicaid.

Short-term health plan

Short-term health plans are low-cost, but they also have limited benefits.

A short-term health plan is available for a year and you can renew it two times. So, in effect, you can keep a short-term plan for three years.

Some states forbid companies from offering those plans. Critics charge that they don’t provide the comprehensive coverage found in an ACA plan. For instance, you may have trouble finding a short-term plan that covers maternity, mental health and prescriptions. In that case, you may wind up paying for that care yourself.

If you’re thinking about a short-term plan, make sure to read the fine print to see what is and isn’t covered.

Pro: Low-cost plan can provide a safety net for catastrophic emergencies.

Con: Plans have limited benefits and can lead to hefty out-of-pocket costs.

Should you skip health insurance if you’re a young adult?

Health insurance is no longer a requirement in most states. The ACA demanded that nearly all Americans get health insurance. However, Congress removed the penalty for that fine. Now, only five states (California, Massachusetts, New Jersey, Rhode Island and Vermont) and the District of Columbia require residents to have health insurance.

Americans in 45 states aren’t required to have health insurance, but it’s still wise to get coverage -- even if you’re young and healthy.

Going without health coverage could cause huge out-of-pocket costs when you need care. It may also cause you to delay care and prevent you from receiving necessary preventative care.

“It’s not advisable to go without insurance because you never know what can happen. While you're young and healthy today, accidents can happen as well as severe illnesses that are totally unexpected,” said Gusner. “If you’re young and healthy and want to pay less, you can look into a high-deductible health plan like a Bronze plan in the exchanges. Those plans have lower premiums, but higher out-of-pocket costs if you need health care services.