Turning 23 can be a very challenging time for our TCKs. Not only do they stop receiving birthday cards and Christmas cards from TCKI, they are also abruptly removed from our company insurance policy. We recently went through this process with our daughter, and we have learned that there is an easy process. So, I thought I would walk you through this process, and at least give you some ideas how you can proceed. Let me also say that although the ACA (known as Obamacare) mandated that children be allowed to stay on insurance till they are 26, that does not apply to our company policy. Our policy falls outside that mandate. Our TCKs will still be removed from the policy on their 23rd birthday.
First, put your mind at ease, there is a process for your child to get insurance, even if there are some hoops to jump through. Of course, some of our kids will get jobs (imagine that) that will provide health care automatically. That is a bonus, but it is not always the case. It is important to note that because your kids are “adults”, they will need to handle the communication with the agent. Agents will want to talk with the adult, not with their parent. So, the rest of this will be addressed to the TCK.
There are two times that you can join insurance plans. Every year, there is a time called “Open Enrollment” in the fall. I have noticed (this year) that my mom’s tv has been inundated with commercials for new insurance plans. It is very confusing to her, so I have to filter it through with her. Open Enrollment means that you are eligible to join specific healthcare plans at that time. Once that time is closed, you won’t be able to join a new plan till the next year.
The second time you can join an insurance plan is when you are removed from your parents’ policy. You (or your parents) will receive a letter from the company stating that you are no longer covered by your parents’ insurance. That letter is more than a formality. You will need that official letter to be able to join an insurance plan at that time. But, here is the kicker. You only have a couple months from the time you are removed from your parents’ policy (your 23rd birthday) to join a new one, or you will have to wait until Open Enrollment. That is what happened to us. We missed the window, and had to wait a full year for our daughter to get on a regular insurance program.
Let me make this as simple as possible. Here are the 4 main options for healthcare once turning 23:
- You get a job that provides healthcare for you. Yay! That is usually a great option, but may not be available to you.
- You contact a broker that will find you a plan. This is a part of the Affordable Care Act, also known as Obamacare. Through this process, you need to be aware of a few key items. To qualify for an ACA plan, you will need to have some kind of income. If you don’t make enough money, then they will send you to Medicaid (more on that later). If you make too much money, the plan may become unaffordable. For our daughter, she only had to give an estimate of how much she thought she would be making, since she was just about to graduate from college. ACA brokers match insurance with the individual. It does not provide insurance for those without income, unless they are in a State with “Expanded Medicaid”.
- Please feel free to share your broker experience with me. We are looking to make a list of great brokers for our TCKs. As we get contact information for more brokers, we will make those available.
- Our daughter used Brandon Roerick, with Hometown Benefits Group. The insurance was $96/mo, plus $12/mo to Hometown Benefits as the broker. Coverage was actually provided by http://www.ambetterhealth.com/. We had our daughter add dental insurance for about $30/mo. While brokers are State-specific, Brandon was able to help our daughter get insurance in Texas as well.
- Don’t be scared of this word. We may think of it as a socialist program… but, it really is there to help people get coverage. It is expanding, too.
- First, understand that Medicaid is State program. Medicare is a Federal program. Every State will have different rules on how their Medicaid works. Medicare would only apply to those who are permanently disabled, and would never be able to recover from it, or those who are retired.
- ACA does not (necessarily) provide insurance for those without income, unless they are in a state with “Expanded Medicaid”. In those states, the broker will match them with the Medicaid options. Coverage of Medicaid differs in every State! Only 37 States currently have expanded Medicaid. Missouri will be added to that list on July 1st, 2021. See the article on NPR. It is important to know if your state has Expanded Medicaid, or not (see list here).
- If your State does not have Expanded Medicaid, then people only qualify for Medicaid under certain conditions. For Missouri, those are:
- children (kids under 18 that need health insurance)
- See the official qualifications here. These will change in July.
- A great place to start looking for Medicaid is with your local county Social Services offices. They keep the most current information on hand to help their county residents. I was able to find my county office on https://www.countyoffice.org. You are looking for the social services department. The county offices offer great resources and are a good place to start, if you don’t know where to go.
- Christian Medical Sharing programs. A few key things to know about these programs:
- They are NOT insurance. They are very clear to tell you that when you contact them. They are great for emergency, high cost, major medical problems.
- They tend to have a high deductible. For our daughter, they didn’t cover anything under $600 (It may have been more than that, I can’t remember). This meant that any time she went to the doctor for a sinus infection, or anything, it was 100% out of pocket. She struggled with migraines. None of that was covered. 100% out of pocket. Anytime she would need a prescription, she had to go see a doctor and get a prescription. Again, none of those things were covered.
- If she had been diagnosed with something major, needed an emergency surgery, it would have been covered. Disclaimer though: if any other means to pay for that major medical expense was available, they would not pay or require to be reimbursed.
- Companies: Medishare, Christian Healthcare Ministries, Samaritan Ministries.
So, just to sum up, you have options! Don’t allow yourself to become overwhelmed with the insurance programs. I have included websites that will give you places to go. The easiest is to call an insurance broker. Although, if you find one on the web, you may be inundated with spam emails for months ahead (yes, that is experience talking). Just be sure to contact the broker during “Open Enrollment” or immediately after going off parents’ insurance.
If you have further questions, please feel free to post them, or message me. We do have some connections with people that have worked in the field. We can help put you in touch with people that can help.