Those ‘aging off’ parents’ health coverage face a conundrum

Kelcey Hatch, of Marysville, a student at The Art Institute of Seattle, turns 26 in July.

Hatch now gets health care through her mom’s insurance, provided by the Lake Stevens School District. But she will lose it on her birthday, the age at which she’s no longer eligible to be included on her mom’s health insurance.

“I’ve always had really good insurance,” Hatch said. “It’s a really big change.”

She plans to graduate in September and hopes to land a job — one with benefits. But if not, beginning Oct. 1, she and 113,000 other uninsured people in Snohomish County will be able to shop for insurance through the state’s new health insurance exchange.

The online service will allow consumers to shop and compare prices and benefits from nine health insurance plans, much like online shopping for new cell phones and cars.

Anyone who doesn’t sign up for insurance will pay a fine of $95 per adult and $47.50 per child up to a maximum of $285 for a family.

The fine is included in the federal Affordable Care Act, more commonly called Obamacare, with a goal of encouraging people who don’t have insurance to buy it.

Consumers will be able to look at plans grouped into four pricing groups, bronze, silver, gold or platinum.

With cheaper “bronze” plans, consumers will pay less in up front premiums, but more in co-pays and deductibles, the amount paid out of pocket before insurance begins covering some of the costs, said Stephanie Marquis, a spokeswoman for the state’s Insurance Commissioner’s office.

Individuals making less than $45,960 or families of four making less than $94,200 may qualify for tax credits to help them pay for their health insurance premiums.

The cost for individual health plans won’t be posted until Oct. 1, when the online insurance exchange opens. A state Insurance Commissioner’s website. The health insurance plans go into effect on Jan. 1.

Beginning next year, businesses with 49 or fewer employees are not required to provide health insurance but could qualify for a tax rebate if they do.

Those with 50 or more employees will have to pay a penalty if they don’t offer affordable coverage.

“I think one of the biggest misunderstandings is people who have health insurance seem to be confused they have to do something,” Marquis said. “If people have employer-sponsored health insurance, most don’t have to do anything.”

Individual insurance plans also will be available that aren’t listed on the state’s insurance exchange, but the state’s online site is where people can qualify for a subsidy to help pay for insurance, Marquis said.

The fear that insurance will be too costly is the most common reason given by the uninsured for why they don’t have insurance, according to a poll conducted earlier this month by the Kaiser Family Foundation.

The poll also shows that 71 percent of adults 26 to 30 say it’s important to have insurance, but one quarter of those in this age group says they don’t think they need insurance because they’re healthy.

Hatch said she worries about how to bridge the gap between the end of July when she no longer has insurance through her mom’s plan, her graduation in September, and a hoped-for job after graduation.

“Me and my mom started looking at things,” she said. “It’s pricey.”

But even landing a job might not provide the answer. Her current job as a graphic artist doesn’t include health insurance benefits.

“It’s like do I find something in the meantime that’s somewhat affordable or do I wait and hope that nothing happens in that time frame?” she said.

“It’s really hard for somebody who is working and I’m paying for a large portion of school out of my own pocket,” Hatch said. “I’m already trying to make ends meet and now there’s this other expense.”

Her roommate, Breanna Finch, who turns 26 in November, said Hatch recently told her she was considering temporarily going without it.

“I said, ‘No, don’t, you never, ever, know what will happen,’” Finch said.

At age 18, Finch was diagnosed with Crohn’s disease, a chronic inflammation of the gastrointestinal tract.

She graduated last year from the University of Wisconsin Oshkosh and currently works for AmeriCorps, a national community service program.

In November, when she no longer has health insurance through her parents’ plan and her gig with AmeriCorps is over, she said she hopes to find a job that provides insurance benefits.

“A lot of people my age aren’t worked up about it,” Finch said of the upcoming mandate of have health insurance.

The experience of a friend underscored what could happen without it, she said. He “aged off” his parent’s insurance, but didn’t really think much about it. He unexpectedly came down with a difficult-to-diagnose disease and ended up with $9,000 of medical debt, Finch said.

“He was thinking about declaring bankruptcy; he didn’t know how to pay it back,” Finch said. “People don’t realize how important it is until they’re sick.”

Sharon Salyer: 425-339-3486; salyer@heraldnet.com.

Changes coming

Starting Jan. 1, no adult can be denied health insurance because of a medical problem, sometimes called a pre-existing condition. The rule already is in place for children.

All health insurance bought by individuals and small employer health plans that go into effect on Jan. 1 must include coverage for the following:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorders
  • Prescription drugs
  • Rehabilitative services, such as physical therapy, speech therapy and occupational therapy
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Source: Washington State Insurance Commissioner’s Office

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