oman in overalls stares up at thought bubble with financial money concerns, doctor stethoscope, insurance card, switching medications trying new treatments, measuring tape weight

Aging Out of the Health System

Last updated: December 2022

My daughter turned 26 this year and is no longer eligible to continue on my husband's health care plan. I have worried about this day since my kids were young. Now in their twenties and very much independent, one has insurance through an employer, and the other, my daughter, has no insurance. Although fairly healthy, she has a few chronic illnesses she deals with. Aging out of our health care plan has put her in a tight spot getting care for conditions, especially her asthma and allergies.

Currently six months past her birthday, we have been able to manage so far, by using discounted prescription plans such as GoodRx and paying out of pocket for visits. But, I fear for the long-term, of having no insurance should she find her asthma exacerbate or flare acutely. Though currently, she could get by paying out of pocket, we worry should she need hospitalization or more pricey treatments and medications that it could put her in a financial pickle in the long run. Before this happens, we have been wracking our brains and thinking outside the box when it comes to paying for health care and medical services until it is offered through other means.

In need of insurance now that she has aging out of her prior plan

My daughter's asthma and other conditions have been medically managed since around 2 years of age. With specialty care - our PPO is wonderful coverage for her conditions, especially throughout her young life – her health has been managed well. And, having health insurance has kept us financially stable. As of April this year, though, turning 26, she has aged out of my husband's employer's medical health plan and we worry for her future.

Not having health care can have devastating consequences for an individual. It can financially destroy a person. We worry exacerbation of her conditions or flare and having no insurance will put her in a position that can jeopardize her – either financially or medically - feeling she has to make a choice to go or not go to the ER when necessary due to money issues. Dealing with this urgent dilemma, we have been talking about it the whole year prior, reminding her of the fact she will need to make a decision as to a direction in her career and life choices that may afford her the benefit of health care.

Options available

Brainstorming we’ve discovered several options available to her in reference to getting the healthcare she desperately needs. Currently, she has a position in a small boutique working as a junior design assistant. And, although the pay is fairly favorable for her, no health care is offered in this position. The first and most important option would be to find a position offering health care and other benefits. Considering switching jobs, she really enjoys what she is doing, she has placed this at the forefront of her mind should she find it necessary.

Other options individuals take are joining a spouse's plan or getting an individual health plan through the Affordable Care Act. My daughter is not married, nor in a position to marry, which takes that option off the table. Looking into a plan of her own it was pretty expensive and unaffordable with the pay she currently brings in and her current living expenses. Unless she wanted to move back home to cut her expenses, this option was low on the list. She is pretty independent and considering this would have to be one of the last options to consider.

The next choice for attaining health insurance is applying for state insurance. Medicaid is an option as she is considered low-income. And, this could assist her should she find it necessary, but getting this insurance can be tricky, time-consuming, and difficult – yet still an option. The next would be purchasing short-term insurance, which is low on the list as well as it would not cover hospitalization. This type of plan is not optimal for her due to the plan not being required to cover the ten essential health benefits or any preexisting conditions, which include preventative and wellness services as well as chronic disease management.

The last selection, which seemed optimal for her to choose, was school health insurance. If she returned to continue with her Master's program she could get coverage through the school - for at least as long as she was enrolled - something she had previously planned to do, yet the last 3 years of the pandemic did not allow. Not only does this plan cover her as she continues schooling, but it also puts her in a position to attain employee-offered benefits once she graduates and rejoins the workforce in a position more suitable for her career.

A decision reached: the best for her and continuing to manage her asthma

There are feasible opportunities available to my daughter in attaining health insurance, and it is essential for her to do so to maintain her asthma and other chronic health conditions. For many, especially the young in our workforce, it can be difficult or seem impossible. But with these options above it is obtainable. My daughter chose to attend school. Of all places, she chose a program and discipline in Scotland, where there is comprehensive free health care. Looking back at all the fear I've had over the years, I couldn’t ask for a better decision from my daughter. Fears squashed, she's currently away at the University of Edinburgh, medically I know she is covered; should she need care, she can turn to her medical doctors for help.

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