Author Kimberly Lankford
Young adults can stay on the family health policy until age 26. But if they go away to college and are outside the insurer’s network of doctors, families need to reconsider their insurance options.
Q: My son is about to graduate from high school and will be living at home until he moves away in late summer for college. Can he just stay on my health insurance policy when he’s in college?
A: Health insurers that provide dependent coverage must continue to cover adult children until they turn age 26. But you should find out whether your son will have access to in-network providers after he goes to college.
If your plan’s network extends to the city where he’s moving, then staying on your plan is usually his best bet. But if his new city doesn’t have in-network providers, he may have much higher out-of-pocket costs or very limited coverage, depending on your type of plan. Some preferred-provider organization (PPO) plans provide coverage for out-of-network providers. But they usually charge higher co-payments, require bigger deductibles and set a higher out-of-pocket spending limit for out-of-network providers (often double the cap for in-network providers). And most health maintenance organization (HMO) plans typically don’t provide any coverage for out-of-network providers, except in emergencies.
If your son won’t be near any in-network providers while at school, consider the type of care he might need while he’s away, what would happen if he were to get sick or injured, and how often he’ll return home. You may, for instance, want to keep him on the family plan—even if it will cost more—if he’s generally healthy and the school allows students to be treated at the campus health clinic for a minimal charge, says Lisa Zamosky, senior director of consumer affairs for eHealthInsurance.com. “In that case, he can get routine care at the clinic and plan to handle other necessary visits with his regular doctor while home on vacation,” she says. “In the case of an emergency, the Affordable Care Act requires all emergency-room visits to be charged as in-network, regardless of which ER you end up in.”
Another option is to buy campus insurance at his college. Compare the price of that coverage with the cost of keeping him on your policy and paying extra for any out-of-network care or clinic visits. “Be aware that many schools require kids to show proof of insurance before they start, and some will automatically enroll students in the campus insurance if they don’t actively opt out by showing proof of alternative insurance,” says Zamosky.
He could also check out buying an individual health insurance policy through your state’s health insurance exchange. (Go to Healthcare.gov to find a link to your state’s marketplace.) If he’s still your dependent, he won’t qualify for a government subsidy to help with the premiums based on his own income. But it’s still worthwhile to compare the costs and coverage with his other options.
Also, consider “catastrophic” plans, which are available only to people younger than age 30. “They offer the same preventive care and other benefits as other ACA plans but come with lower premiums and higher deductibles,” says Zamosky. (Catastrophic plans are not eligible for premium subsidies.)