When a young adult hears those life-altering words “you have cancer,” likely the last thing on their mind is figuring out how they will get or keep health insurance for the rest of their lives. Some young adults have health insurance coverage through their parents, but what happens when they age out of that policy or if their parents lose their health insurance? Or what if those twenty-somethings are just starting out in their careers and have jobs that may not offer health insurance benefits? What happens when that young adult wants to switch jobs? Figuring out your health insurance options can seem incredibly challenging; hopefully this post will give you a place to start.
Under the Patient Protection and Affordable Care Act (ACA) eligible young adults now have the option of staying on their parent’s health insurance plan until they are 26 years old. These young adults do not have to be dependents under IRS standards, can live on their own, be married, and even have their own children! This rule gives young adults additional options and helps to bridge the gap that may occur between leaving school and finding a job that offers health insurance benefits.
Also under the ACA, children under the age of 19 cannot be denied when trying to purchase an individual health insurance policy because of a pre-existing condition. These are often referred to as “child only plans.” These types of plans may be a great option for families where the parents do not have employer-sponsored health insurance or when their plan at work does not cover dependents. Unfortunately, many states do not have health insurance providers offering these child only plans. Also, states have different rules about open enrollment periods. This is a useful list of where each state stands.
For those young adults over the age of 19, who have employer-sponsored health insurance but are losing that coverage, may want to consider utilizing COBRA. COBRA is a federal law that allows people with group coverage to keep their existing coverage even though they have experienced a qualifying event. Qualifying events include: leaving or losing your job or reducing your work hours or aging out of your parent’s policy when you turn 26. Under COBRA, you may be able to continue your employer-sponsored health plan for 18 to 36 months, depending on which qualifying event you experience. To qualify for COBRA, you (or your parents) must work for a private employer with 20 or more employees or work for the state or federal government. While COBRA is a wonderful option for many, it can also be challenging because you become responsible for paying the entire amount your employer was paying for your health insurance and, in some cases, an additional 2% administrative fee.
When young adults are diagnosed with cancer they may worry that they aren’t going to be able to ever leave their job if it provides them with health insurance. However, a federal law, the Health Insurance Portability and Accountability Act (HIPAA) gives you several health insurance protections. First, HIPAA gives you the ability to buy a HIPAA plan if you have exhausted your COBRA coverage, have a pre-existing condition, and are not eligible for any other type of health insurance coverage. You also have to apply for a HIPAA plan within 63 days of your COBRA coverage ending. For information about HIPAA plan options in your state, contact your state insurance agency.
Second, HIPAA limited the length of time that group health insurance plans could impose pre-existing condition exclusion periods (PECEP). This is a period of time when your health insurance plan will not cover anything related to your pre-existing condition. The maximum PECEP that can be imposed is 12 months from the start of your coverage under that plan. Third, HIPAA gave people a way to reduce or eliminate PECEPs through the use of “creditable coverage.” Creditable coverage can generally be any health insurance policy you have had in the past. However, it is important to note that some student health insurance plans do not qualify as creditable coverage, so ask about any coverage being offered by a school. As long as you have not had a gap in your coverage of more than 63 days, you are able to apply the time you have had health insurance in the past to your new employer’s PECEP. So if your new employer’s plan is imposing an eight (8) month PECEP and you have had health insurance for the last five (5) months at your old job, you can subtract the 5 months of previous coverage from the 8 month PECEP, leaving you with only a 3 month PECEP. To show that you have creditable coverage, you can request a copy of your “Certificate of Creditable Coverage” from any of your previous insurers.
Lastly, if you have a pre-existing condition and have been uninsured for the last six months, you may be able to get a Pre-Existing Condition Insurance Plan. Plans vary by state so visit www.PCIP.gov for more information.
In 2014, the ability to get an individual health insurance plan will increase greatly and will become more simplified. That is when insurance companies will no longer be allowed to deny coverage to an individual with a pre-existing condition, such as cancer. Additionally, insurance companies will not be able to consider an individuals’ pre-existing condition when determining premium rates. In 2014, individuals and small businesses will be able to purchase health insurance policies though their state’s health insurance exchange. The details of each state’s exchanges are still being worked out, so stay tuned!
For more information about all of the health insurance options that might be available to you in your state, visit www.HealthCare.gov
Monica Fawzy Bryant is a cancer rights attorney, speaker, and author, dedicated to improving access to and availability of quality information on cancer survivorship issues. Monica has provided numerous educational seminars, written articles and blogs, and appeared on community television and radio channels discussing cancer-related legal issues. She can be followed on twitter at @NavSurvivorship. Monica is the COO of Navigating Cancer Survivorship, a national, nonprofit organization that provides education and resources on the entire continuum of cancer survivorship issues to survivors, caregivers, and healthcare professionals.