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Home > Resources > PAF Publications > Greater Understandings > Insurance for Young Adults

Health Insurance for Young Adults: Why you need it & how to keep it


HIPPA

Health Insurance Portability and Accountability Act (HIPPA)

Provides protections for beneficiaries covered by group health plans.

  • Limits exclusions for preexisting conditions
  • Prohibits discrimination against employees and dependents based on their health status
  • Guarantees renewability and availability of health coverage to certain employees and individuals


In order for protection under HIPAA there cannot be a lapse or break in coverage of more than 63 days.

Once a member is no longer covered by a plan they will be issued a certificate of credible coverage to a new insurer. To learn more about your protections under HIPPA, visit http://www.dol.gov/topic/health-plans/portability.htm.




COBRA

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Provides that certain employees with 20 or more full-time employees or equivalent in the previous 12 months are required to offer continuation of coverage under COBRA to qualified beneficiaries. A qualified beneficiary is any individual covered by the plan the day before the qualifying event. Each beneficiary can elect COBRA independently. To learn more about your rights under COBRA you may visit, http://www.dol.gov/dol/pwba.





Upon graduation of high school, young Americans have the world ahead of them with a host of decisions and choices to make. When a young patient is diagnosed with a progressive illness such as cancer, so many choices are taken away. It can feel as though the future has now been decided for them and they have no choices available to them. A student continuing their education at a college level may find it necessary to withdraw from classes in order to return home to have treatment for their illness. One promising reality is to keep in mind is that as diagnosis tools and treatment options improve, students are able to return to complete their education. One important area of immediate concern is health care coverage. If formerly covered under a parent's plan, one may no longer qualify under the definition of the plan because of loss of dependent status under the plan rules, (the patient is no longer a full time student). If covered under a student plan through the college or university, again the eligibility requirement will now be met. The obstacle of immediate concern is maintaining or securing health coverage for needed medical treatment. The challenge, long term is maintaining health coverage for any future needs. There are protections and resources available to patients and education will empower the patient and help them avoid problems that can disrupt much needed medical care.

A student, covered by a parent's plan, is eligible to elect coverage under COBRA should they lose dependent status as defined by the plan language. Under COBRA, the qualifying beneficiary and the qualifying event determines the length of time COBRA coverage is available. Loss of dependent status under plan provisions provides that COBRA benefits are obtainable for a period of 36 months. The premium for COBRA coverage is more expensive as the employer no longer contributes their portion to the plan. Therefore, the patient has to pay up to 102% (100% of the premium cost and a 2% administration fee) for the premium. Although this may seem to be anoutrageous amount to pay, the cost of treatment would far exceed the cost of a COBRA premium. Some states have health insurance premium payment benefits under their Medicaid program. If an individual is eligible for coverage under a COBRA plan, the state may provide benefits in the form of premium payments and allow the individual to maintain current coverage rather than be provided Medicaid benefits. To find out if your state offers this benefit you can contact your local Medicaid office.





Maintaining credible coverage is a concern for any individual but to a patient diagnosed with a progressive disease it is critical. Under HIPPA, beneficiaries covered by group health plans are safeguarded. A student will have to be diligent in maintaining group health coverage. Under private or individual plans, the insurer may impose a complete preexisting exclusion of anything related to your critical diagnosis. For patients facing coverage concerns, you may seek the assistance of a professional case manager at the Patient Advocate Foundation, toll-free at 1-800-532-5274 or via the internet at help@patientadvocate.org.

Individuals who currently do not have health insurance coverage and are in need of diagnostic services should contact your local health department. Patients diagnosed through certain programs may be entitled to immediate coverage through state or federal reimbursement programs.





For patients facing a critical diagnosis, especially at a very young age, maintaining health coverage and understanding all available options can seem overwhelming. The Patient Advocate Foundation offers direct patient services by professional case managers to assist patients through all of the insurance obstacles that they may face. PAF services and publications are provided at no charge to patients.