25-year-olds (and all of us) struggle with complex & flawed health insurance options

October 3, 2022

Summary: The vexing experience of finding health insurance hits the nearly 26-year-olds as they must exit parents’ health plans. Their focused dilemma echoes our collective dilemma: so many insurance options, all of them flawed. What we need is one high quality option: single payer.

For 20-Somethings, a Confusing Rite of Passage: Finding Health Insurance
The New York Times
Sept. 30, 2022
By Isabella Simonetti

Whether they are 25 and about to age out of a parent’s plan or entering the work force for the first time, young Americans are tasked with making crucial decisions about their health care at a time when they may have little understanding of how insurance works.

Depending on the situation, a young adult might weigh these choices: staying on a parent’s plan till 26, joining an employer-sponsored health insurance plan or buying coverage on their state’s marketplace. Someone with an income up to 138 percent of the federal poverty level may even qualify for Medicaid, which offers free or inexpensive health care for low-income Americans, including pregnant women and seniors. The next open enrollment period (the period when you can sign up for coverage) for marketplace plans that comply with the A.C.A. runs from Nov. 1 to Jan. 15, 2023 for most states. Many employers offer open enrollment periods, too, that are typically in the fall, but the timing varies from company to company.

The marketplace plans offer different tiered private insurance options with government subsidies for people whose income falls below a certain threshold. While the service is mainly available through Healthcare.gov, some states, including California and Pennsylvania, operate their own websites. Although the open enrollment period is fixed, those who have experienced a so-called qualifying event, like losing insurance through an employer or being forced off a parent’s insurance after a 26th birthday, have 60 days from that event to enroll in a marketplace plan. If you miss the cutoff, you will have to wait until the next enrollment period, unless there has been a major event like a natural disaster.

For those deciding whether or not to join an employer plan, it is wise to compare its cost and coverage with that of a parent’s plan. If a parent’s plan is cheaper and offers better coverage, asking your parents if they will share the cost with you might be the best solution.

Be careful about taking on the cheapest plan an employer offers, because often that will mean having to pay a higher annual deductible before coverage kicks in.

Among employer plans, there may be the option to choose between a Preferred Provider Organization plan and a Health Maintenance Organization plan. A P.P.O. plan generally is more expensive on a monthly basis but may offer more out-of-network coverage, which could be necessary if you have specific medical needs. An H.M.O., though, is typically less expensive and includes a smaller group of providers.

Comment by: Don McCanne

The 26-year-old seems to have the epitome of American style health care coverage: a conglomeration of market plans, government plans, and government subsidies, with qualifications varying based on personal circumstances. Thus, medical benefits can vary, financial protection can vary, and eligibility for health care professionals and institutions can vary, resulting in unstable care access security and unstable financial security in the face of health care needs. On top of that, the 26-year-old also has an obligation through the tax system to help pay for the health care of others through government programs such as Medicare, Medicaid, the VA, county hospitals and clinics, and so forth.

It seems that the 26-year-old would be much better served by an efficient system that would automatically provide health care whenever needed and that was funded equitably based on ability to pay through progressive taxes. Of course, that would be of benefit not only at 26, but also throughout life as a well-designed single payer program such as Medicare for All.

Instead, we offer the American 26-year-old this highly dysfunctional, expensive hodgepodge of a health care financing that has far worse outcomes than in other wealthy nations. Wouldn’t they prefer care nirvana through single payer?

At 85, with some recent medical setbacks, I’ve been granted a gift of a little extra time, and I’m going to use it to shout to the heavens for a sane, humanitarian health care system for all of us. I am not alone. Remember, the Commonwealth Fund recently noted that a majority of Americans want President Biden and Congress to make health care spending a top priority this year, and many polls show 2/3 support for single payer.

When I was president of PNHP, John Conyers brought us single payer Medicare for All legislation. It would be only a matter of time to move it through the legislative process. What happened? Special interests. And they have continued to prevail ever since. It’s time for Congress respond to the needs of the people instead. It’s time to give citizen action life. Our voices need to finally drown out those of the special interests. To the streets!