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As teens become young adults, it is important for them to know something about health insurance so that they have a good grasp on what coverage will be the best choice for their future. Families can use the following information to help promote conversations about health care financing with their teens.
During transition, a teen should think about what insurance coverage they have now and when it will need to change. Additional good questions to ask are: How will you pay for your healthcare? What types of insurance are you eligible to get? How do you pick which option is the best choice for you? Health insurance is both a financial decision and a healthcare decision. Eligibility may be based on income, school or employment status as a teen ages.
Basically, health insurance coverage is an agreement between an individual (or the group the person is purchasing the plan with) and an insurance provider to share the cost of an individual’s healthcare. The insurance provider might be a private company or a public government program.
Understanding the Terms
There are some basic health insurance terms that are important to understand:
When a teen considers their options, they will want to weigh what plan is appropriate for them. Making that choice is based on two questions:
Here are the typical options for young adults:
If a young adult decides they cannot afford health insurance, they may have to pay a fine through their income tax submission for not having insurance. The tax penalty may be a small percentage of their household income or an amount for each adult in the household.
Those answers will vary depending on each teen’s needs. For a teen with no chronic health conditions or no significant anticipated health costs, sometimes a less expensive plan might be the right option. But what if that person then experiences a significant illness or injury at some time during that year? The same plan that sounded good at first, because it is cheaper, will provide less coverage and require significantly more out-of-pocket costs. Part of making the choice relates to whether a person is willing to take the risk that they won’t have significant health costs in the coming year.
If a teen or young adult has trouble finding satisfactory coverage, then seeking further advice is a good next step. Social workers and disability advocate organizations are strong resources to help with this advice. Healthcare.gov has a special page just for young adults.
There are also some options for local safety net programs. Particularly for youth with chronic conditions in Indiana, the Children’s Special Health Care Services (CSHCS) program provides supplemental medical coverage for youth and families that meet the program’s financial and medical diagnosis criteria and have paid for treatment related to their child’s condition up until age 21.
Community health centers are public and private non-profit healthcare organizations that serve a medically underserved population. This is often based on low income levels. For those without health insurance coverage, fees are usually assigned on a sliding scale based on income. The Indiana Primary Health Care Association may be able to recommend a local community health center. There may be other free clinics based in community and religious organizations which can serve as another way to fill in access gaps.
Pharmacy assistance programs are another possible way to lessen costs. Medicare.gov offers one source for pharmacy assistance programs.
Community mental health centers are located across the state as well. They often provide mental health services that often include outpatient visits as well as home and school options. The Indiana Council of Community Mental Health Centers can help with finding a center.
Visit the trusted websites below to learn more about healthcare financing for young adults.