Turning 26? 5 Things to Know About Health Insurance

You’ve just turned 26 and it’s time to find health insurance. Up until now, you’ve probably been under your parents’ insurance. Maybe you’ve gotten a letter in the mail telling you your current insurance will expire soon. So what do you do?

You have 60 days before your birthday and 60 days after to get covered. Here’s a quick rundown of things to consider. Also, happy birthday!

1. First, learn the basics

Chances are, you haven’t needed to know health plan terminology like “PPO” or “deductible.” Now’s the time to learn.

A good way to start is to know different plan types. An HMO plan means that your PCP, or primary care provider, will make sure you get access to the health care you need OR who helps coordinate your overall healthcare.

Sounds like a mouthful, but it will all make sense, we promise.

In-network means your plan has made a contract with that doctor or health organization.

A PPO (preferred provider organization) means you can visit and receive care from any doctor without a referral, and that you can visit doctors even if they are not In-network under your plan.

Only you can determine what is best for your current situation.

2. See what plans your job offers

If you’re working, check with your company and see which health plans are offered.

This definitely makes things a bit easier, since you’ll be limited to the plans your employer has chosen.

Be aware that your premium, or the amount you pay for your health plan each month, can sometimes be automatically deducted from your paycheck. This is convenient for many people, but just be aware so there are no surprises.

A higher premium could mean you pay less out-of-pocket costs—that’s the amount paid from your own pocket for health care services. A lower premium could mean you may be charged higher for out-of-pocket costs.

Finally, take note of your plan’s deductible. That’s the dollar amount you need to pay for certain services before your health plan will pay for your health care services.

3. Have a plan B

If you don’t have access to employer-sponsored coverage or it’s unaffordable, or you have a part time job, individual coverage might be an option.

Check your state’s resources to explore options for individual coverage and whether you qualify for subsidized coverage:

4. Don’t forget to find out about your doctor

If you have a doctor you want to continue seeing, make sure she or he is in your new plan’s network.

If you are looking for a new doctor, always ask if they accept your (new) health plan.

You can use this search tool to see which doctors participate in Tufts Health Plan’s networks. Also, when you call the doctor’s office for the first time, make a habit of asking what health plans they accept.

5. Keep asking questions

Don’t be afraid to ask questions to make sure you understand all the important stuff. Use this basic list to get started:

  • Are dental and vision benefits a part of this health plan? 
  • Is my current doctor included in this plan’s network?
  • What’s covered for preventive care?  Or Do I have to pay for preventive care?
    • Does the plan cover an annual physical, flu shots? What else?
  • Do I need to get a referral to see a specialist?
    • A referral is the authorization needed before you can use other providers in the plan’s network, or in some cases, outside of the network.
  • What happens if I travel?
  • Is a fitness benefit included?

Does this sound like a lot to digest? If you read and do your research, it will be like second nature. And just know that you’re not alone in this process.