I Was Terrified of Getting my Own Health Insurance at Age 26
Especially having a chronic illness and little money. But, as with most situations, it actually turned out okay.
Probably my heaviest, gnawing, soul-draining worry between the ages of 22 and 25 was knowing I would have to get my own health insurance at the age of 26. If you don’t know, that’s because the ACA states that adult children can only stay on their parents’ health insurance until they turn 26. Apparently, that is the age you are supposed to be a responsible, successful, self-sustaining adult. I am now 26, and I am only kind of one of those things.
In reality, as a chronically ill human who has had to make use of specialist doctors, hospital stays and countless prescription drug refills, getting quality health care coverage — not to mention paying for it — is a nightmare.
I even took a job that I wasn’t particularly excited about because I could get my own health insurance through the company. This was at the beginning of 2019, and shortly after I took that job, my health tanked and I had to quit after barely a month of working there.
I didn’t start to really recover from that extreme downswing until about ten months later, around late October to early November 2019. By then, I had been unemployed for almost the entire year, and I had depleted most of my savings, but I was alive.
Longstanding medical crisis averted, the looming dread of (not) having health insurance returned, full force. I had to figure it out quickly because I would turn 26 in January, and though it’s no longer illegal to not have health insurance, I couldn’t really afford a lapse in coverage. (Knowing me, that would be when I would slip on some black ice and brake my arm, and then boom: $20,000 of medical debt.)
So, hopefully now you will benefit from my fevered Google searches on how to apply for Medicaid and/or get health insurance on the open marketplace when you turn 26 and you don’t have employer coverage and the government is unceremoniously kicking you off your mom’s superior health plan. You’ll see that it took me a while, but it all worked out in the end.
Fortunately, turning 26 qualifies as a special circumstance where you can enroll in health insurance on the open marketplace within the two months before or after your birthday, during which time you could technically not be covered at all. Whether you want to take that chance is up to you, (at the most you could avoid a couple of monthly payments, assuming nothing befalls you medically) but I wasn’t about to tempt fate like that.
My mom and I decided that I would go off of her plan at the end of the year, so that she could switch to a high-deductible plan for herself, and I would get coverage that would start immediately January 1st, just before I technically turned 26.
Applying for Medicaid
At first, I assumed I would qualify for Medicaid — a.k.a. government subsidized low-cost or free health insurance for low-income Americans, not to be confused with Medicare, which is for senior citizens 65 and older — since I was extremely unemployed and poor. Medicaid is funded by both federal and state governments, so the rules for qualifying are different in each state. I live in Wisconsin, where the income limit for Medicaid is about $12,000 a year. I was making $0, so I qualified easily.
If you know the health plan you want to participate in, you can sometimes apply for Medicaid coverage directly through that organization. For example, I was initially considering Children’s Community Health Plan, because that’s where my mom works. The coverage would not be exactly the same as I had previously, but it would be with the same provider that I was used to. But I had some issues with their application process, so I ended up applying directly through the state.
I had to make an account and authenticate it (which I found really annoying because I have the soul of an 80-year-old man sometimes) and then go through the application process. I won’t take you through it step by step, but it wasn’t too difficult. You do have to estimate how much money you will make annually, which, since I was applying for coverage in the new year, I estimated for 2020. At the time, I put down zero because though I was planning to return to the working world, that goal had not materialized yet. If I had remained unemployed, I would have had to go back in and update my income information once I had a job to reassess my eligibility for Medicaid.
I submitted the application online, and then it was a waiting game for a couple of weeks. Which, of course, is exactly when I got both of the part-time jobs I had applied for.
Getting Rejected by Medicaid
I got both of these jobs one after the other, the lower-paying one coming first. Once I got the job, I called the company that was managing my application (this is outsourced by the state) and explained that I had just gotten this job so my income had increased. However, I wasn’t expecting it to pay more than $12,000 a year, so I thought I would still qualify for Medicaid. No problem, they said, just have your employer fill out this form attesting to your income and send it back to us.
Okay, cool, that was easy enough, but my spidey senses were telling me that this would end up being more complicated than I thought.
I get the form, give it to my manager, (Chad, nice guy) and he promptly fills it out and returns it to me. I submit the form and settle down to do some more waiting. This is around the beginning of December, so it’s starting to get a little too close to 2020 for comfort.
While I’m waiting, I get a call from the other job I had applied to, which though still part-time, pays much better. Congrats, the HR lady tells me, we want to offer you the job! I gratefully accept, but realize that I will now have to also report this income to the Medicaid overlords. I call them, request another form, send it to HR at my new company, get it back, and add it to my Medicaid application. This is starting to get irritating.
Shortly after, I get a letter in the mail with my new insurance card that says I qualify for Medicaid. Yay! Health insurance I don’t have to pay for! The saga is finally over, except of course it isn’t.
I was now technically going to make more money in 2020 than the $12,000 limit, but I hadn’t made it yet, and somebody over the phone had told me that Medicaid would cover me until I reached that $12,000 mark sometime in the new year.
Apparently they were wrong, because the next time I logged into my online account in mid-December, thinking everything was fine, I saw a big fat rejection notice.
Your benefits will be ending Jan. 01, 2020.
What the frick? I literally had just gotten my new insurance card in the mail, but apparently that was only for December, which I didn’t even need since I was still on my mom’s insurance. UGH.
I found this out on December 16th, so I had to quickly get my butt in gear and apply for coverage on healthcare.gov.
Applying for Coverage on the Open Marketplace
This was the real process I was always afraid of, the one resulting in exorbitant monthly premiums and the highest of deductibles and out-of-pocket limits and shitty coverage. With major trepidation, I slowly created an account (another one) and filled in my information, pretty much the same stuff that was on the Medicaid application.
Then I saw these bright, shining beautiful words:
“You qualify for a low-income tax credit.”
While I would no longer be poor enough to qualify for Medicaid, I was still poor enough to qualify for some handy government assistance with my monthly premiums. Which no one ever told me was a thing — but it is! This credit turned out to be $313 dollars. $313 dollars!
When I accepted the credit and clicked onto the next page to see my plan options, the lowest plans started at $0 dollars a month.
I think I actually did a fist pump to the air.
After combing through all of my options, I ended up going with a bronze-level plan with a monthly premium of $8.20 per month, and a dental plan at $12 per month. So that brought me to a grand total of just over $20 a month for health insurance.
I had literally been in a cocoon of anxiety for years thinking I would have to be paying $300-$400 a month just for health insurance that I would probably never use because the coverage would be so bad that it would cost me a hundred bucks just to sneeze in the direction of my doctor’s office, never mind specialty care or any procedures I might need.
To be fair, the coverage I got is still not the greatest, but it’s not the worst, and these days I don’t need to use it as much as I used to. If I need to, I can see my primary and see my therapist at reasonable out-of-pocket costs. Cue everyone in Europe with socialized medicine laughing at me.
So basically, getting affordable health insurance wasn’t as bad as I thought it would be for a chronically ill, under-employed 26-year-old. And if I can do it, all you younger millennials can do it too.
I think there’s a lot of misinformation out there about the process of applying and getting health insurance on the open marketplace. If you’re considering going without because you think it will be too expensive, please apply and see what assistance you might qualify for. You’ll be glad you have at least some coverage if, God forbid, you get injured or sick and you need medical care.
The bottom line is:
No matter how many times it happens, I still have to re-learn every time: don’t worry about something that you don’t know for sure is going to happen.
Thanks for reading!