Hello,
I’m turning 26 this May and will no longer be on my parent’s health insurance. When should I apply for Obamacare? Now or come May?


Answer

When someone turns 26 they can apply for ObamaCare before their 26th birthday allowing the plan to start when they turn 26. Get the details below.

Under-26 coverage ends on a child’s 26th birthday. Given this, it's important to get coverage that starts before the young adult turns 26.

Below is important information on turning 26 from Healthcare.Gov:

  • When a child loses coverage on their 26th birthday, they qualify for a Special Enrollment Period. This lets them enroll in a health plan outside Open Enrollment.
  • They may qualify for premium tax credits and other savings based on their income.
  • Their Special Enrollment Period ends 60 days after their birthday.
  • If they enroll before their 26th birthday, coverage can start as soon the first day of the month they lose coverage. If they enroll during the 60 days after their birthday, coverage can start the first day of the month after they pick a plan.
  • If they don’t enroll in health coverage within 60 days of their birthday, they may not be able to get coverage until the next Open Enrollment period.
  • If they aren’t insured, they may have to pay the fee for being uninsured. If they’re uncovered for less than 3 months of the calendar year, they don’t have to pay the fee.

Rate and Comment on the Answer

Your email address will not be published. Required fields are marked *

1 2 3 4 5

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Jeanne Aaroe on

My question has been answered satisfactorily.

Marianne Fahey on

So, I have to enroll in a plan the month before I turn 26? It’s implied but not stated.

ObamaCareFacts.com on

Yes, that should be said not just implied. You can begin the enrollment process up to 30 days before you turn 26, and then you have until 60 days after turning 26 to enroll.

McKenna on

I turn 26 in March–what information do I need to have in front of me in order to start the process of finding a healthcare plan? I’d like to begin the process of looking at plans but I don’t know where to start. Any help/advice would be much appreciated!

ObamaCareFacts.com on

You can always contact Healthcare.Gov, but generally your last years tax information is what you need. You’ll base your tax credits off your projected income.

The exact items you “may” need is near the bottom of this page: https://obamacarefacts.com/obamacare-sign-up/

The list below probably includes MORE than you will actually need.

• Last year’s tax information for you and your family

• Projected incomes for this year

• Medical history – ObamaCare does away with pre-existing conditions and gender discrimination, so these factors will no longer affect the cost of your insurance. Smoking, weight and age still affect cost.

• Social Security Numbers (or document numbers for legal immigrants)

• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)

• Policy numbers for any current health insurance plans covering members of your household.

• A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for, but don’t enroll, in it.)

Kathy O'Hanlon on

My son turned 26 on july 19 2015. He had no income due to mental illness. He refused to enroll in Obama Care. What will the penalty be? I claim him as dependant.

ObamaCareFacts.com on

Yeah, so you will owe the fee for him unless he gets coverage or you don’t claim him. I know it is not the best answer, but it is largely a family issue that needs a family fix.

Gina Maune on

So I’m turning 26 in about a week and the website is telling me I’m not eligible for special enrollment. Will this change on the date of my birthday and allow me to enroll? (I provided the date in the application).

Michelle Mulrooney on

thanks

Anj on

My parent’s company covers me until the end of the month even though I turned 26 at the beginning of the month. The new insurance company wants something in writing from my parent’s company stating I am covered until the end of the month. My parent’s company refuses to send anything until coverage ends. What are my options???

ObamaCareFacts.com on

Coordinating your coverage through the Marketplace might help. It makes sense that they want confirmation, and it doesn’t make sense that the current insurer is being uncooperative. You can probably dig up an old bill, but you may also be able to prove this other ways. You won’t be 26, so you can’t stay on your parents plan, so that is logic-based proof in itself (not sure that’ll count though).

My guess is they are trying to following the rules and you can just explain your way out of this. But, still, why not go through the marketplace?

Daniel Jackson on

My question would be why are the rules written wrong in the first place? A company should be required to supply the Document within 30 days of turning 26 to give you time to get signed up thru your company and get proof of insurance cards. But we are talking about Federal laws and Insurance Companies.

Samantha on

Is this only applicable to those turning 26 that have been on their parents’ insurance?

ObamaCareFacts.com on

Yes you have to lose coverage due to turning 26 to qualify for special enrollment under these terms. There are other qualifying life events though.

Carmen Benton on

my son turns 26 in May. he has very little income and lives with us. we cannot claim him on our taxes. whose income is applicable when he applies for insurance? his or ours or both? if it’s his…he’ll get subsidies or at the least the state-run insurance plan. if it’s ours…he (we) will have to pay market premiums.

Jean Vergeront on

Why doesn’t the answer include that a child can stay on their parent’s Marketplace plan through the end of the year they turn 26? Very hard to find this. Waited on phone 40 min. and the agent read through a bunch of stuff before coming up with this answer too.

randy on

My wife turn 26 at the end of march and came off her parents insurance. I can’t put her on my insurance till July 1. We sign her up on the open market and still haven’t received a statement to pay. After contacting with company they said it didn’t processed. So they sign her up again but change the covered date to start in May 1. Just receive a letter saying her coverage was canceled because no payment was made. The letter is dated May 4 and we still haven’t received a statement. I’m afraid by the time this is straighten out, I’ll be able to put her on my insurance. Will we have to pay a fine for the three months she not covered?

ObamaCareFacts.com on

You can get an exemption for less than three months without coverage. You only need to have coverage 1 day in the third month. Worst case is you pay the fee for only one month and exempt the other two.

Mark on

I am on my parent’s insurance plan (employer) and turn 26 in late August (California state of residency). When is the soonest I can apply for coverage? Want to get things squared away before I turn 26.

ObamaCareFacts.com on

You can apply up to 30 days before you lose coverage (60 days in some cases). You then have up to 60 days after losing coverage.

The best bet is to apply early and avoid a gap in coverage.

Jennifer Altena on

My son turned 26 in June. He is currently living and working in South Korea. How do I complete the application for insurance if I cannot provide an employer in the US?

Ava on

What if a parent adds a child under 26 to her policy and that child does not want to be covered by the parent’s insurance plan for privacy reasons. Does the child have to wait until her 26th birthday to cancel the coverage?

NICA GREENWOOD on

QUESTION: I CURRENTLY 25 YRS OF AGE AND I TURN 26 IN SEPTEMBER. I CURRENTLY AM UNINSURED CAN I APPLY FOR THE INSURANCE WHEN I TURN 26 AND NOT BE FINED?

Allison on

I’m currently on my parents insurance plan. When I turn 26 do I lose coverage immediately (as in that day) or am I still covered under them for 60 days? I’m looking into new options now but didn’t know you could apply within 30 days of turning 26 and want to make sure I’m making the right decision which might be a few days after I turn 26.

Toni on

I would like to no approximately how much a 26 year old making over 16,000 a year would have to pay for insurance. Give some examples please

erin.georgen@gmail.com Erin on

First, insurers can charge more based on an age, so younger adults are offered less expensive premiums to begin with. Second, it really depends a little on what state the person is and how much over $16,000 their income is. Third, those under 30 years old can chose to purchase a catastrophic health plan and pair it with an Health Savings Account (HSA) which should be taken into consideration.

Catastrophic Plans- You can’t get cost assistance for catastrophic plans, but the tax benefits, flexibility, and independence offered by catastrophic plans makes them an increasingly good better and less expensive coverage option as one moves up the income scale. Everyone that is under 30 (even if they have a lot of health issues) should compare the total annual costs of catastrophic options (premiums and deductible) to the total costs of conventional health plans on the marketplaces (premiums and deductible, minus cost assistance). Often Catastrophic Health Plans are cheaper in the long run, especially when at higher incomes with no cost assistance. This is because the amount saved through lower premium costs for the year is often greater than the difference in deductibles for the Bronze, Silver, Gold, and Platinum Plans. And I found that this was progressively the case, with Bronze plans being the most similar in cost to catastrophic plans and Platinum plans being significantly more costly (high premiums) even for those who have chronic illnesses. The difference however, is that all the money saved from the Premium can be used on out-of-pocket medical costs immediately. It can be saved in an HSA and lower your MAGI and AGI (tax deduction). Also, you have insurance despite having to pay out-of-pocket for the initial costs, so you’ll get the prices negotiated by the insurer, but they may not cover the preventative care before deductible so be sure to look for one that does.

Medicaid – In 2017 a person making up to $16,394 a year would qualify for Medicaid in States that expanded Medicaid (138%). In other states the least expensive health insurance option on the Marketplace would likely cost little to nothing (advanced Premiums Tax Credits applied to bronze plan for example), but wouldn’t be eligible for Cost Reduction Subsidies (CRS) for out-of-pocket expenses like the high deductibles. This is the best option if you qualify in your state.

Silver Plan – If you are between 100% and 250% FPL ($11,880 to $29,700 in 2017) you would get both types of cost assistance by choosing a Silver Plan. The premium cost your would be responsible for would scale, but is still based on a wide range of factors (like location, average cost of bronze, whether you are a smoker). It is however capped at an ever increasing percentage of your income as you earn more income (up to 400% FPL), you can learn more about it here (see The chart that shows adjustments for each poverty level). CRS on the other hand, is only available between 100-250% FPL. This type of assistance is paid to the insurers directly and in exchange you are responsible for a much lower deductibles and copays, but the transition is much less smooth than the premium tax credits.

TIP: Some state Marketplaces don’t actually show you this when you are searching which can be incredibly frustrating and confusing. This is because technically its the same plan as the one with a $5,000 deductible, but the CRS the insurer gets on your behalf caps the amount of deducible and copay that you are responsible in progressively lower tiers the lower your income (down to 100% FPL). See “Cost Sharing Reduction Examples” on this page.

the main point is, I can’t give any really definitive examples without more details, but these are the most likely best bets. The more income someone earns, the more they are responsible for. If it goes over 8.13% they can apply for an exemption.

Chloe on

I’m moving out of states by myself in a month and I’m turning 26 this coming June.
What should I do in this case? should I apply new plan right now since I’m moving out?

shelly on

My son is turning 26 in January, no longer eligible for my dependent plan. He lives with his GF but they are not married. If he does NOT get his own plan (and he’s no longer a dependent) who gets taxed as the “household”? Me, with his legal address, or the GF (whom he’s not married to?)

Patricia Pellicore on

If I deduct the maximum allowable contribution to my HSA for myself and my dependent and she turns 26 in May – will that deduction get reduced to the single rate deduction after her birthday?

ObamaCareFacts.com on

Yes, if she is the only other person in the family you’ll need to switch to an individual plan and will only be able to fund your HSA at the individual rate. I think HSAs are prorated (in terms of contribution limits) in a case like that, however that part should be double checked with a tax professional.

James Harris on

My fiancee turns 26 in the second half of January. She is currently on her parents’ health plan through one of their employers.

Am I correct in thinking that she looses the right to her parents’ health plan effective January 1st, and that she must procure health insurance either on the marketplace or through her employer to take effect January 1st? The deadline for January enrollment in her state is December 15th.

According to the HR department of the parent’s employer, she is able to stay on the parent’s family plan until May (when the employer plan’s fiscal year ends from what I gather). I am dubious of this, but resolved to do more research.

We are not getting married until October. Her premium tax credit through the exchange would be lowered due to us getting married. As I understand it, her ‘income’ for that purpose, even when she is still single, is 1/2 of our joint income for the year.

Thanks for the help.

Erin on

Turning 26 is a Qualifying Life Event and she will qualify for a Special Enrollment Period. Getting Married also qualifies for Special Enrollment. There are some other resources for understanding how marriage affects Premium Tax Credits when filing taxes linked into this answer here.

Coryn Law on

My son turned 26 on November 15, 2016. he is no longer covered under my NYSHIP plan. His employer says he needs a ‘heppa” letter stating he is no longer covered so they can provide coverage. Where do I get this letter?

Erin on

There is no letter or form required to qualify for employer coverage and the Affordable Care Act doesn’t require employers to keep track of what insurance employees have. They are simply required to offer coverage to most of their employees, including your son. And it requires your son to have minimal essential coverage, but not what insurer he must have. If your son has any issues getting the employer coverage he should call the states Insurance Commissioner for advice.

Jason kress on

This was very helpful. The only downside is that you referred me to the NY state market site and it is down.

Annalisa Switzer on

Can my son sign up for Obamacare during open enrollment now, even though he’s currently covered under my husband’s employer health insurance, or does he have to wait until 30 days before he turns 26 this June?

Would signing up earlier protect him in any way from changes that may happen to Obamacare during the next administration? He will qualify (under the current 138% rules) for a subsidy.

Erin on

First, a provision of the ACA requires insurers to offer family coverage that includes even non-dependent adult children up to 26 years old. Those children, however, aren’t required to be on their parents plan unless parent/s will be claiming the dependent exemption on their year end taxes.

Second, there is no 138% rule for subsidy. If your son’s income is under 138% of the Federal Poverty Level and you don’t claim his dependent exemption when you file at tax season he is eligible for Medicaid (if your state expanded Medicaid). If your son isn’t offered employer coverage, your son can also purchase his own marketplace health insurance through the marketplace as long as you don’t claim him as a dependent on your taxes. If you claim him on your taxes as a dependent on your taxes than you are responsible for his coverage and will owe the fee if he is not covered. You would also need to report any income that he has earned over the Dependent filing threshold ($6,300 for 2017) when reconciling your Premium Tax Credit.

Lastly, there is no real way to protect against legislation or repeal outside of being politically engaged and pressuring your elected representatives. That being said any repeal of the Affordable Care Act is likely to have a transition of at least a year to allow people, insurers, and providers to prepare and adapt. Some of the Republican’s have suggested a 3 year transition. We will all have to wait and see, but I encourage everyone who has had benefit or issues with the Affordable Care Act to make sure that your legislators know what is and isn’t working, as well as, what are important to you for any future healthcare reform. While I can’t guarantee it Trump’s Medicaid pick Seema Verma was involved in Medicaid expansion in Indiana acting to ensure Indiana expanded by encouraging compromise. In the end Indiana did expand Medicaid, but charges premiums between $1-$27 dollars monthly for incomes between 0% and 138% FPL. Trump and Republican lawmakers have both mentioned funding Medicaid through block grants to states. All of this seems to point to a future for Medicaid in any healthcare reform to come.

Jess Kilner on

I am currently pregnant. My birthday is in May, and I will turn 26. Baby is due in Feb/March. My parents insurance will NOT cover the baby after the hospital visit. So my boss has enrolled me in the marketplace (with caresource) starting January for both my husband & I, and so I can add our baby once she is here. Now, my parents could not REMOVE me early from their policy without being penalized and paying even more for my sister until I age out, which again is in may. So my name will remain on the policy until then. NOW, should I began just using ONLY the caresource from marketplace as my primary come January since it is in my name? Or do I use both, as a primary and secondary until may comes just for myself? With this benefit me or disadvantage me???

ObamaCareFacts.com on

In a situation like this both plans probably have annual contracts (and annual cost sharing). So, there is no right answer.

You can use any coverage under which you are covered by contract, so whichever plan offers the best cost-benefit is the plan to use.

In other words, whatever is going to have the cheapest net cost. If your parents’ plan already hit its deductible then that could be the best, but if that coverage isn’t working and you now have the new coverage, that could be best.

Hope that makes sense. No inherent disadvantage to having two plans, aside the fact you owe both premiums but they don’t share “cost sharing” (thus making it a bad longterm solution for the average person).

Caitlin on

I am 25. I will be 26 in February, I have a pre-existing condition that requires medication.I do not want to lose my current health insurance before I have to. Should I wait to enroll till after my birthday? If I apply now it goes into effect immediately and cancels my current insurance.

Erin on

You can stay on your parents plan until you are 26 and then you will qualify for special enrollment period to sign up for Marketplace insurance or you will want to take employer insurance if it is offered. Just FYI, there’s not likely to be many changes in the insurance options available to you between now and then, so you may want to use this time to look closely at the plans available to you and their Pharmaceutical Schedule and Provider network. Then you will at least know which plan and insurer you want to go with when its time to switch.

Claudia Auth on

I have 2 kids, 22 and 25 who will soon age out of our health insurance. We just found out both have a fairly serious genetic disorder. I can’t find any information about this. Neither one will be starting out their new job careers with employers funding their insurance. Nor will they make a salary to afford health care. So how do I find out how to advise them?
The “repeal/revise” of ACA is scaring me.

Erin on

Write, call, or email every legislator that represents you and tell them to make sure your kids have coverage. Nothing is going to change about health insurance this year and if we all focus on what we can do to make sure that all of our families are protected, maybe what comes next will be better. That means communicating honestly and specifically with the people who write the laws.

Mandi on

I turned 26 January 7th and am covered under my parents till the end of the month. I get married June 3rd. Is their anyway I can go without coverage and not pay a fee for that amount of time? I will be under my fiances insurance right after we get married.

Erin on

Unfortunately no, but since you are under 30 you can choose a catastrophic plan for those months which will likely have the lowest premiums (unless you are eligible for tax credits). Basically, you should set up a profile on the marketplace, check the option available to you for traditional coverage, then check catastrophic coverage prices, and decide which one will work best for you for those months. You can go up to 3 months without coverage without owing the fee, so if you really want to go without coverage for as long as you can, wait until April. Otherwise, just get insurance so you’re covered in the event you have a major medical problem between now and your wedding. Congratulations to you and your future though.

Melanie Tucci on

I will be turning 26 on March 22nd of this year (2017), and will be relying on Obama Care after that date. I have health conditions that make it absolutely essential for me to have a health care plan ASAP after turning 26.

I am concerned about a possible repeal of the ACA through the new administration before my birthday. I called and spoke with customer service through healthcare.gov and the woman I spoke to assured me that Obama Care is locked in for this year and can’t be touched. She doesn’t think that come March 22nd, I will have any issues enrolling in a plan.

She also told me that the earliest I can receive coverage is April 1st, which would leave an 8 day gap in my insurance plans. I do not need daily care but this still makes me nervous to not have insurance for these 8 days.

My questions are:
1) Is it true that Obama Care is locked in for 2017?

2) Is there a way to avoid the 8 day gap between my birthday and April 1st?

Thank you!!

Debbie Crater on

Should my son even bother trying to enroll in this program, given the flux of the government change? He will turn 26 in June and will need to come off my plan.
These answers were very helpful, but I’m not sure they are still valid.

Lakeshia Monroe on

I turned 26 in February and ned to enroll in an health insurance plan.

Deborah Horne on

Thank you. I am relieved.

Emmy on

I just turned 26 this week and will be starting a full time job (with insurance) in August. Since I only need insurance for about 4 months, how should I go about this?

Erin on

If you aren’t eligible for employer insurance or your parents insurance, you’ll be eligible to purchase health insurance through healthcare.gov or your state’s health insurance marketplace. You’ll also be eligible for cost assistance if your income is below 400% of the federal poverty level. Turning 26 is a qualifying event for a Special Enrollment period.

mark on

im 26 but i have no job do i still need to enroll?

ObamaCareFacts.com on

If you have no income you won’t owe the fee, but you should still see what your options are. You may qualify for free or low cost coverage through Medicaid with no income (or little income) and with a little more income for marketplace coverage at a low cost. You should start by contacting HealthCare.Gov.

Donna on

My daughter turned 26 on Sept. 24, 2017. We completed an application for ACA on the government site. It was accepted and they said she could be a candidate for Medicaid. We submitted the application weeks ago and still have not heard back from the State of Illinois. It is my understanding that she has to be accepted or denied before she can purchase a policy on ACA – is that correct? The acceptance letter states that if she is accepted to Medicaid but denies it she will no longer be able to take any subsidies on ACA. We are approaching the 60 day special enrollment (Nov. 24) and we are not sure what to do. We are paying for Cobra now and it is very very very expensive. Thank you.

ObamaCareFacts.com on

You are generally correct, but you can follow up directly with your state’s Medicaid office and probably get the best answer that way. You can also call healthcare.gov and explain your situation there. Both can help.

https://www.medicaid.gov/about-us/contact-us/contact-state-page.html

Samantha Davis on

I’m not working but am in college

ObamaCareFacts.com on

If you turn 26, and you don’t have employer coverage, then you have access to marketplace tax credits. However, if your income is low enough then the only option would be Medicaid. If you are unsure, contact healthcare.gov and let them guide you. People at college sometimes have an additional option in the university health plan.

Miles Weinhold on

I turn 26 in about one month. I also just started a new job and am scheduled to start receiving health care coverage and benefits with two months. Should I enroll in this program or should I just go a month without coverage, since I would only be fined if I was uninsured for a period longer than 3 months?

ObamaCareFacts.com on

You don’t get fined anymore in most states, but even if you are in a state that has a fee, you still have that less than three months exemption (as far as I am aware; I know each state is subject to unique rules).

You should therefore be able to go without coverage or get 1 month of short term to cover the gap https://obamacarefacts.com/insurance-exchange/short-term-health-insurance/

NOTE: it is smart and responsible to get 1 month of short term, because this protects against worst cases. Very likely won’t need it, but good to have.