Young and Uninsured: What to Know

Under the Affordable Care Act (ACA), many preventive services are covered at no cost when you see an in-network provider.

If you’re unsure whether something counts as preventive or diagnostic, call your doctor’s office. Ask for the billing codes, Marshalek says, then call your insurer and confirm coverage.

Routine medical care. This includes:

• Primary care visits
• Lab tests and imaging to diagnose things
• Treatment for chronic conditions
• Care for common issues like infections, minor injuries, or new symptoms

Emergency care. Think broken bones, severe pain, serious infections, and deep cuts or burns. ER visits may also involve imaging or hospital stays, and insurance helps protect you from the full cost.

Mental health care. Behavioral therapy, counseling, and medication for conditions like anxiety and depression must generally be covered at the same level as physical health care under federal law.

When to Pick a Health Plan 

There isn’t one “right” health plan for everyone. The best choice depends on:

• Where you get coverage
• How much you earn
• Your current health needs
• How much financial risk you’re comfortable taking 

Timing also matters. Knowing when you can enroll helps you avoid missed deadlines and rushed decisions, especially during big transitions.

In most cases, you can’t sign up for health insurance whenever you want. Enrollment usually happens during set windows, often tied to life events like starting a job or losing other coverage, or during the annual open enrollment period.

For example, if you’re turning 26 and coming off your parent’s plan, you often have about 30 or 60 days to enroll in health insurance. If you miss that window, you may have to wait until the next open enrollment unless you qualify for a special enrollment period.

Special enrollment periods are designed to prevent gaps in coverage when life changes. They can apply to both employer-sponsored and Marketplace plans, depending on your situation.

Common Plan Types for Young Adults 

Employer-Sponsored Plans

If your job offers health insurance, this is often the simplest and most affordable option.

What to know:

• Employers usually pay part of the monthly premium 
• Your share is typically taken out before taxes
• Some jobs have a waiting period before coverage starts

Many employers offer more than one plan. The main difference usually comes down to how costs are split between monthly premiums (what you pay each month to keep health insurance active) and your out-of-pocket costs (what you pay when you get care).

Key features to compare:

• Monthly premium: Lower premiums usually mean higher out-of-pocket costs 
• Deductible: What you may pay before insurance starts sharing costs
• Out-of-pocket maximum: The most you’ll pay in a year for covered care
• Copays: Flat fees, like $30 for a doctor visit or $300 for outpatient care
• Coinsurance: A percentage of the medical costs 
• Provider network: Doctors, providers, and hospitals who contract with a plan

Seeing in-network providers almost always costs less. Some plans don’t cover out-of-network care at all, except in emergencies.

What is a flexible spending account (FSA)? 

You can also find information through your state’s health insurance website or with the Find Local Help tool on Healthcare.gov.

When can you get Marketplace health insurance? 

You can usually sign up during open enrollment, which runs from Nov. 1 to Jan.  15. Outside of that window, you may still be able to get coverage or switch plans if you go through certain life events.

Common events that can trigger a special enrollment period include:

• Getting married or divorced and losing coverage
• Having a baby or adopting a child
• Losing qualifying health insurance
• Moving to a new ZIP code, county, or state

If you’re an American Indian or Alaska Native, you can sign up for Marketplace coverage any time of year and may change plans as often as once a month.

Rules vary by situation, including when coverage can start and what proof you need to give. For the most up-to-date enrollment details, visit HealthCare.gov.

Medicaid

Medicaid provides low-cost or no-cost coverage for people with limited income. Eligibility rules vary by state. If you qualify, you may:

• Pay little to no monthly premium
• Have very low copays or none at all
• Get strong protection against medical bills

What Are High-Deductible Health Plans (HDHPs)?

You may see these offered through your employer or Marketplace. They tend to offer lower monthly premiums compared to traditional insurance plans. But you’ll pay higher costs when you need care, at least until you meet the deductible.

What to know:

Preventive care is often free. That includes annual checkups, recommended cancer screenings (such as cervical cancer), and vaccines. These services are required to be covered at no cost under the ACA, even in high-deductible plans.

Some everyday care may be covered. Depending on the plan, you may get coverage for some primary care visits, mental health visits, and prescription drugs before you hit your deductible. You may need to pay a copay.

Many HDHPs can be used with a Health Savings Account (HSA). An HSA lets you set aside pre-tax money to pay for medical expenses. You can use those funds for things like deductibles, copays, and coinsurance. Unlike flexible spending accounts, HSA money rolls over every year.

HDHPs can make sense if:

• You’re generally healthy and don’t expect a lot of medical care.
• You’re not managing a chronic condition.
• You want lower monthly premiums.
• You could afford the deductible if something unexpected happens.

An HDHP can serve as catastrophic coverage. You pay less month to month, but you still have financial protection if a serious injury, illness, or emergency comes up.

That said, HDHPs may not be the best choice if you need regular care, take costly medications, or prefer predictable costs.

What About Disability Insurance?

Health insurance helps pay medical bills. Disability insurance helps pay you. It replaces part of your income so you can keep up with expenses like rent, food, loans, and utilities while you recover.

How disability insurance works 

Disability insurance pays a percentage of your wages if you’re unable to work due to a covered medical condition. Depending on the policy, that may include accidents, long-term illnesses, surgery, pregnancy, or childbirth.

Benefits typically start after a waiting period and last for a set amount of time. There are two main kinds.

Short-term disability insurance:

• Usually covers a few months up to about a year
• Often starts after a short waiting period, such as a few months
• Commonly comes with job benefits
• You can buy it on your own, if your employer doesn’t offer it

Long-term disability insurance:

• Can last several years or even until retirement age
• Usually has a longer waiting period, often several months or longer
• May be offered through work or purchased on your own

Some employers offer both short-term coverage and long-term benefits.

Disability insurance vs. government disability programs

Disability insurance is not the same as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Government programs are designed for people with long-term or permanent disabilities that make it hard or impossible to work. They have strict medical guidelines and are harder to get.

Even if you are approved, benefits can take months or longer to start. Employer-based or private disability insurance is typically easier to qualify for and not just for permanent disability.

What to Do if You’re Uninsured

If you don't have coverage, there are steps you can take to manage costs if you do need care.