If you’re turning 26 and no longer eligible to be on your family’s health insurance plan or if you’re picking a health plan through a new employer, it may be difficult to know where to start. Insurance terms, plan designs and specialty benefit offerings may all be new. But it’s worth figuring them out.
Why it’s important: Young adults have the highest uninsured rates in the U.S., which can cause delays or difficulties accessing timely and cost-effective medical care, especially in emergencies. Insurance is also important for mental health support — especially since people born between 1997 and 2012, called Generation Z, report higher rates of mental health issues.
While it may be overwhelming at first, taking the time to learn your options and figure out what to watch for can ensure you'll choose a health plan that fits your needs.
Here are three things to think about when picking your coverage:
1. Mental health and wellness benefits: Caring for your mental health is a crucial component of your overall well-being. Some health plans offer advocacy services and employee assistance programs to help you find mental health services. They vary from plan to plan, so compare your options for things like:
— In-person therapy
Also, because caring for your physical health can often help your mental health, some plans also offer fitness memberships and wellness programs at no additional cost. There may also be incentives for completing a health survey or for everyday healthy living, such as exercising or avoiding nicotine.
2. Prescription benefits: You can view a list of medications and see how they’re covered on your plan’s preferred drug list (PDL). If you have ongoing prescriptions, keep an eye on your PDL to stay ahead of any cost changes, which may happen. Also, check to see if you can fill your prescriptions at a network pharmacy or through mail delivery, which may save you money.
3. Virtual services: Virtual care has gone from serving people who are already sick to preventive care and chronic condition management. Some plans now include virtual primary care and specialty services, including dental and hearing care. You may have the option of a plan that routinely starts with virtual care and connects to in-person services, only when necessary.
After you learn about what’s in your plan options, you’ll want to make sure you know how you’ll pay for care. When it comes to managing costs, one of the first things to consider is your monthly premiums and annual deductible.
Here’s how your premium and deductible options may be presented:
- Low-deductible plan: This coverage may be a good option for you if you plan to use a lot of health care services or if you take several prescription medications. Your monthly premium may be higher, but your deductible and out-of-pocket maximum will likely be lower.
- Balanced plan: This may be a good option if you want to save a little bit on monthly premiums while keeping down out-of-pocket costs.
- High-deductible plan: This may be a good option if you don’t plan on needing a lot of health care services and have the means to pay your deductible if an unexpected medical issue arises. You will pay less in premiums, but you will likely have a bigger deductible and higher out-of-pocket costs.
Use the quiz at the bottom of this article to help guide your decision about a plan.