For young adults with bleeding disorders, the subject of health insurance may not seem exciting, but it is important that young people and their parents begin thinking about health insurance before they need it. There are five reality checks that parents should reinforce:
1. Everyone needs health insurance.
2. Individuals with expensive, chronic medical conditions, like hemophilia and other types of bleeding disorders, need reliable health insurance.
3. Health insurance with very good coverage is needed to avoid large out-of-pocket costs.
4. Most young adults will usually need to get their own health insurance.
5. Health insurance is often very expensive. However, it should always be maintained because the cost of bleeding disorders care usually far exceeds the cost of an insurance premium.
When Does One Need to Get Health Insurance?
New health insurance is needed when current insurance coverage ends, usually due to a “personal change.” Some of these include:
- Reaching the age limit for an insurance policy
- Having a change in student status: graduation, going to school part time, dropping out of school
- Working part time rather than full time
- Getting married
- Changing some aspect of disability status
“Personal Changes” and the End of Coverage
1. Coverage under a parent’s employer health plan
- Many employer health plans end dependent coverage when a young adult turns 19 if not going to school full time or at age 25 if going to school full time and claimed as a dependent by a parent. Actual dependent coverage, however, varies from plan to plan. Some states have raised or are considering raising the age until which a child can be covered under a parent’s insurance plan.
- If an individual gets married, he or she will no longer be covered as a dependent.
Verify coverage by: calling the insurance plan, reviewing the insurance policy online or in a current benefits booklet, or contacting the human resources department at work.
2. Coverage under Medicaid
Medicaid is also called Medical Assistance, Title 19.
- Medicaid coverage for children usually ends when a child turns 19 years old.
- Medicaid through Supplemental Security Income (SSI) for disabled beneficiaries can end (along with SSI payments) if the young adult is determined no longer disabled or if income or assets exceed allowable limits. Work earnings and new spousal earnings (as a result of marriage) are two examples of income changes.
3. Coverage under individual insurance plan
- If a young adult has an individual plan—usually through a state high-risk plan or a state-sponsored individual health plan—his coverage will generally not be affected by “personal changes.” An exception may be if he becomes eligible for coverage under a group health plan.
Health Insurance Planning
Families need to plan ahead for when a parent’s insurance will no longer cover a young adult. It’s a good idea to start the process when your child is between 16 and 18 years old. Sit down with your son or daughter and review his or her educational and vocational goals. Together you can determine when your child will need his or her own insurance.
[Steps for Living: Health Insurance]
If a young adult is covered as a dependent under a parent’s policy and he or she:
- Plans to go to a college or technical school after high school, he or she won’t have to worry about health insurance until after graduation.
- Doesn’t plan to attend college or technical school after high school graduation, he or she will have to get insurance at age 19.
- Stops going to college or technical school full time or drops out, he or she will need to get insurance (one possible exception is a medical reason that is insurance-approved).
If a young adult receives Medicaid as a recipient of either Children’s Health Insurance Program (CHIP) or SSI:
- For CHIP, coverage will usually end when the young adult turns 19, and he or she will need to get other insurance. Be sure to verify actual end-of-coverage age and “personal change” criteria in the state.
- For SSI, once a young adult turns 18, he or she must re-qualify as an adult. This is usually not a problem, since Social Security disability requirements for adults and children are similar.
- For SSI, if a young adult is considering employment, work income may affect Medicaid eligibility (as well as SSI payments). Find out if and how Medicaid benefits will be affected. Medicaid can sometimes be continued through special work incentive programs through Social Security and the states. This applies to individuals who work (despite their disability) and are over the income limit.
It is important to pursue other health insurance options well in advance, such as:
- COBRA (insurance continuation up to 36 months for dependents through a group policy of a parent who works for an employer with 20 or more employees);
- Employer insurance plan for the young adult;
- Spousal health insurance (if the young adult gets married);
- State high-risk plan or state-sponsored individual plan;
- Individual HIPAA plans after COBRA; and,
- Special Medicaid programs for individuals who work despite their disability.