What You Need to Know About Turning 26
Turning 26 can be a difficult time for many young adults aging out of their parents coverage. See below to learn what you need to know about transitioning off your parents’ plan, exploring new options, and staying insured.
Health Insurance Options After Turning 26
Employer-Sponsored Health Insurance
If you’re employed, check if your job offers health insurance benefits. Employer-sponsored plans are often more affordable than individual plans because employers typically share the cost of premiums.
ACA Marketplace Plans
The ACA Marketplace offers a variety of health insurance plans tailored to different needs and budgets. Losing coverage under your parents’ plan qualifies you for a Special Enrollment Period (SEP), allowing you to enroll in a plan outside the regular Open Enrollment Period.
- Medicaid: If your income falls below a certain threshold, you may qualify for Medicaid, a free or low-cost health insurance program.
- Catastrophic Health Plans: If you’re under 30 or qualify for a hardship exemption, you may be eligible for a catastrophic health plan.
- COBRA Continuation Coverage: COBRA allows you to temporarily continue coverage under your parents’ employer-sponsored plan for up to 36 months.
Important Deadlines & Enrollment Periods
There are multiple opportunities when you turn 26 to enroll in new coverage:
- Special Enrollment Period (SEP): Starts when your coverage under your parents’ plan ends and lasts for 60 days
- Open Enrollment Period: Typically runs from November 1st to December 15th, depending on your state
- Employer Enrollment Periods: Check with your employer for specific dates if you’re eligible for workplace coverage.
What Seniors Need to Know About Turning 65
Turning 65 is a significant milestone. One of the most important aspects of this age is becoming eligible for Medicare, the federal health insurance program. It’s essential to understand your options, deadlines, and available resources. Below, we’ll walk through what to expect and how to navigate this stage.
The Basics: What is Medicare?
Medicare is a federal health insurance program primarily for individuals aged 65 and older. It also covers some younger individuals with disabilities and those with End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease (ALS), or Railroad Retirement Disability.
Medicare is divided into several parts:
- Medicare Part A (Hospital)
- Medicare Part B (Medical)
- Medicare Advantage (Also called Medicare Part C)
- Medicare Part D (Drug Coverage)
Medicare Deadlines & Key Dates
Initial Enrollment Period (IEP)
Your Initial Enrollment Period (IEP) is a seven-month window around your 65th birthday:
- Starts three months before the month you turn 65
- Includes the month you turn 65
- Ends three months after your birth month
Note: If your birthday falls on the 1st of the month, this window shifts (4 months before to 2 months after your birth month)
During this time, you can:
- Enroll in Medicare Parts A and B
- Choose a Medicare Advantage Plan or Supplement Plan
- Sign up for a Part D Prescription Drug Plan
Automatic Enrollment
If you already receive Social Security or Railroad Retirement Board (RRB) benefits, you’ll likely be automatically enrolled in Medicare Parts A and B. You’ll receive your Medicare card in the mail about three months before your 65th birthday. If you’re not receiving these benefits, you must sign up for Medicare through the Social Security Administration.
Special Enrollment Period (SEP)
If you’re still working and have health coverage through your employer or union, you may qualify for a Special Enrollment Period (SEP) to sign up for Medicare without a late enrollment penalty after your Initial Enrollment Period ends. The SEP typically lasts for eight months after your employment or group coverage ends.
Annual Enrollment Period (AEP)
Every year from October 15th to December 7th, you can add or make changes to your Medicare coverage, including: Enroll in, switch, or drop Medicare Advantage plans; Enroll in, switch, or drop Medicare Part D prescription drug plans.
Open Enrollment Period for Medicare Advantage Plans (OEP)
If you're enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare from January 1st to March 31st each year.
Late Enrollment Penalties for Medicare
There are a couple of late enrollment penalties to know. These occur when you do not sign up for Medicare during your IEP:
- Part B Penalty: A 10% increase in premiums for each 12-month period you were eligible but didn’t enroll.
- Part D Penalty: 1% of the national base premium for every month you were without prescription drug coverage when eligible.
How to Choose the Right Medicare Plan
Finding the right coverage is crucial and that’s where Panchura Health Advisors can help. Working with a knowledgeable Insurance agent provides you with the best opportunity to find the right plan for you and your family. For more information, read below to get a high-level overview of the differences and what each plan type offers.
Medicare Part A (Hospital)
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services.
Medicare Part B (Medical)
Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Advantage
Also called Medicare Part C, these plans combine the benefits of Original Medicare (Part A and Part B) into a single plan with additional coverage, like dental, vision, hearing, wellness, and more.
Medicare Part D (Drug Coverage)
Medicare Part D Prescription Drug Plans (PDPs) work alongside Original Medicare (Parts A and B) and Medicare Supplement (Medigap) plans to provide prescription drug coverage. Part D coverage is typically included in most Medicare Advantage plans.
Original Medicare vs. Medicare Advantage
Original Medicare (Parts A and B): Offers nationwide coverage but does not include additional benefits like dental or vision. Beneficiaries often purchase supplemental Medigap policies to cover out-of-pocket costs. Medicare Advantage (Part C): Offers an all-in-one plan through private insurers, often including additional benefits and lower out-of-pocket costs, but with more restricted provider networks.
Medigap vs. Medicare Advantage
Medigap supplements Original Medicare, while Medicare Advantage plans are an alternative to it. Medicare Advantage plans often include additional benefits such as vision, dental, and wellness programs, but they usually require using in-network providers. Medigap plans work alongside Original Medicare, allowing you to see any Medicare-approved provider and offering more predictable costs.
Long-Term Care
Medicare does not cover most long-term care services, such as nursing homes or personal care. If this is a concern, consider exploring other insurance options.
Prepare for Your Appointment
To be prepared for your appointment, we need a few things. A list of your current prescription medications. And a list of all the doctors you see. Please complete our online form to provide us with your contact information. We will get in touch with you as soon as we can and get started on your personalized insurance plan.