Child aging off of parents' health insurance - next steps and options?
March 10, 2020 8:56 AM   Subscribe

Our older child is turning 26 next month and will no longer be eligible for health insurance coverage on my husband's plan. Because of some minor complications, and because we've had the luxury of not thinking much about it to this point, the best path forward isn't clear.

As best I can tell, these are her options:

1 - COBRA on Dad's plan. A non-option at $1100 a month.

2 - Coverage on her employer's plan. Complication: She hates her job and is planning to leave as soon as she lines up something else. If she leaves before the end of April (when she loses our coverage) and never makes it on to their plan, I assume she wouldn't be eligible for COBRA through their plan while she waits to be eligible for coverage at the new place, correct?

3 - Marketplace. This is where I get really fuzzy. Is she even eligible to sign up for an ACA plan if she has access to coverage through her employer? If not, then option 2 seems like the best/only path forward, regardless of her job-hunting.

But, if she can pass on her employer's plan for whatever reason, are there any particular kinds of plans to look for, or is it just as simple as adding up the monthly cost + deductible to figure out how much to budget for the year? I spent a small amount of time on the website last night but decided to bail and hopefully become better educated here before I head back to it.

If helpful for responses, she is generally very healthy. She sees a psychiatrist every couple of months and has a few MH-related prescriptions as well as a prescription for BCP. She lives in the Triangle region of NC, works full-time, and makes around $30k a year.

At this point, I'm mainly focused on figuring out health insurance and will deal with dental later, although I'm happy to hear advice on that as well.

Is there anything else we should know before we wade into all this? (For those wondering, I'm helping because she has some anxiety around finances and I am usually fairly good at this kind of thing, although this has me a bit tied up in knots myself. She'll do the legwork but I would like to be an educated support resource for her.)

Thanks for any advice you can provide, as well as links or other helpful info!
posted by Sweetie Darling to Work & Money (16 answers total) 3 users marked this as a favorite
 
Here's the relevant page on HealthCare.gov:

Changing to a Marketplace plan
If you have job-based coverage, you might be able to change to a Marketplace plan. But you probably won’t qualify for a premium tax credit or other savings. As long as the job-based plan is considered affordable and meets minimum standards, you won’t qualify for savings. Most job-based plans meet these standards.
posted by stoneweaver at 9:30 AM on March 10


Hi, I was your daughter only a few years ago! It's anxiety inducing so she has my sympathies. Is the only concern re: getting on her employer's insurance the fact that she might leave the job soon? If so, leaving the job will qualify her to enroll in an ACA plan. She can even enroll in it temporarily while she waits for new coverage to begin:
If you lose job-based coverage

What if I leave my job with insurance and start another job that has a waiting period before I can enroll in it?

You can buy a Marketplace plan to provide coverage until your new job-based insurance starts. Until then, you can qualify for savings on a Marketplace plan based on your income.

Once you enroll in the new job-based insurance you can keep the Marketplace plan, but you’d have to pay full price.

You can end your Marketplace plan any time without penalty.
If she buys a marketplace plan, she should make sure her current psychiatrist and meds are covered. When looking for plans, you'll be able to filter for ones that cover specific doctors and medications. You can add dental at the same time, and I would suggest doing so, it's pretty straightforward.
posted by brook horse at 9:40 AM on March 10 [4 favorites]


Whatever you decide or if you're still not sure, please keep in mind that you can call the HealthCare.gov people at the phone number at https://www.healthcare.gov/contact-us/ to get help.
posted by bright flowers at 9:51 AM on March 10


You have 60 days to sign up for COBRA retroactively.

From a previous question:
"What I usually tell people who will have a less than 60 day gap:

1. Fill out the COBRA paperwork
2. Put it and a check for the premiums in an addressed envelope with a stamp.
3. Put the envelope somewhere obvious.
4. Tell significant other / friend: 'If I'm in the hospital, mail that envelope.'
5. Once you get new coverage, shred the envelope.

If your gap will be more than 60 days you should probably enroll or find other coverage for the time."

So it seems that she should sign up through her employer. If she gets on, she'd be eligible for COBRA if she left that job. If she didn't, she'd be eligible for COBRA on your husband's plan.
posted by Mr.Know-it-some at 10:44 AM on March 10 [8 favorites]


Echoing Brook Horse - if she can get on her employee sponsored insurance, in most normal cases she should do so.

If/when she gets a new job she'll need to switch onto a new plan, but that will be necessary in any case.

Depending on her exact circumstances, she could consider a marketplace plan, but it's likely not the best option based on what you've told us. You can certainly call the hotline and ask for their recommendations if you want to double-check.
posted by matrixclown at 11:15 AM on March 10


If you never become enrolled in your employer's plan, you probably won't be eligible for COBRA. But COBRA is probably not the best option anyway. COBRA premiums are based on the average cost of insurance for your employer, which likely includes both young people and old people.

But an ACA plan for a 26-year-old is probably lower cost than the your employer's cost of COBRA because you are younger than the average employee.

So:
Go ahead and sign up for employer's plan even if you might leave later.

Meanwhile, try to find another job with good health insurance.

If you find yourself in between employer job coverage, you can wait up to 60 days to select either COBRA or an ACA plan. If you have no medical emergencies during that 60 days, then you've saved two-months of useless premiums. Just don't miss the 60-day deadline.

If you do have an medical emergency in the 60-day window, then immediately sign up for COBRA and your coverage will be retroactive.

If you have to go beyond the 60-day window, then sign up for an ACA plan. For your age, an ACA plan will be the lowest price because any COBRA plan price includes the average cost of both young and old employees, while your ACA plan is priced for 26-year-olds only.
posted by JackFlash at 11:25 AM on March 10


If she has a new job lined up to start but benefits don't kick in until the gap period, she negotiate with the new employer to get on the plan early. Not all employers will do this, but it's definitely something she can discuss with them.
posted by DoubleLune at 11:34 AM on March 10


How much is employer coverage? Seems to me that unless it's prohibitively expensive, that's the best option. That's how these things go here. Even if she's only on it for a month or two, it still fills the gap.
posted by bluedaisy at 12:46 PM on March 10


And in some places, you have to prove you have other coverage not to be on your employer's plan.
posted by bluedaisy at 12:47 PM on March 10


For budgeting, look at the monthly plan cost and deductible -- but don't overlook the out of pocket maximum. This can be several times more than the deductible and is your worst-case scenario. When my husband and I compare insurance plans, we factor in the monthly cost + deductible + OOP max to determine a plan's total maximum costs.

(I learned this the hard way - I didn't realize I had a $12,000 out of pocket max until I landed in the hospital for an emergency appendectomy and bills kept coming long after I'd hit my $2500 deductible. Worst case, but it can happen!)
posted by writermcwriterson at 12:57 PM on March 10


Is she even eligible to sign up for an ACA plan if she has access to coverage through her employer?

Depends on the cost and other details of the employer's insurance. Also, if she expects to only be employed for part of the year, that reduces her expected annual income and may change whether she qualifies for an ACA plan.

She can set up an account for an ACA plan online and fill out all the relevant questions, and stop short of buying a plan. But that'll let her know what her options are there.
posted by ErisLordFreedom at 8:30 PM on March 10


Is she even eligible to sign up for an ACA plan if she has access to coverage through her employer?

Anyone can buy an ACA plan if they are a U.S. citizen or legal resident. Anyone. That's it, regardless of access to an employer plan.

Whether they can can get a subsidy for an ACA plan depends on access to an employer's plan and the quality and affordability of that employer plan.
posted by JackFlash at 10:06 PM on March 10


She should sign up for her employer plan now to begin the date her coverage through you ends. When she leaves that job, if there's a gap she can figure out what to do then based on her specific circumstance. But this is the simplest, fastest, and probably cheapest solution; no further anxiety necessary.
posted by metasarah at 8:38 AM on March 11


She should get on her employer’s plan, which she will be eligible for as soon as she turns 26 (loss of other coverage is a qualifying event). This will be a better deal than the marketplace.

If she leaves her job before getting a new one, she can buy on the marketplace. At her income level, depending on what state you live in, premium assistance should make her premium less than $100 a month on the marketplace, but I think this will only work if she doesn’t have the option for employer coverage.

I have always timed it so my employer coverage continues through the end of a calendar month (typical for it to last through the month you quit in) and the new coverage starts on the 1st of the next month.
posted by amaire at 9:58 AM on March 11


If they decide to buy their own insurance... I find dental coverage a bit of a luxury add on in the US when you're not on an employer provided plan, sadly. If there's any procedures they may need (i.e., wisdom teeth pulled) get them before they age out of your plan (if it's a good plan). At the very least do the math if two cleanings a year costs less paid cash than paying monthly insurance + whatever co-pay and balance on a marketplace plan. Of course, this is assuming they are relatively healthy and don't get cavities every visit.

The ACA plans I've seen have many limits/maximum visits on mental health so it is imperative they are informed when looking at plans on what plans cover their doctors and meds and use in-network resources. Every year when I shop for insurance I can narrow down policies to 2-3 based on networks alone because a lot of the plans will not cover your daughters doctors or meds. I guess this is all to say be informed and do your homework when buying insurance. A group (company issued) plan is almost always better for doctor availability and broader networks but an ACA plan for a 26 year-old making $30k might be cheaper (but potentially cover a lot less and be less useful to someone who actually uses their healthcare like your daughter).
posted by Bunglegirl at 10:37 AM on March 11


FYI when you sign up for COBRA retroactively, they also bill you retroactively for those months.
posted by dum spiro spero at 10:38 AM on March 11


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