Private Health Care Coverage for Young People

In order to get private coverage, somebody—you, your employer, your parents, your parents’ employer—must pay for that coverage. In this section, we will introduce you to the basic ways you can get private health care coverage, as well as some of the expenses you may encounter with private coverage.

Coverage Through Work

Many, but not all, jobs offer health care benefits. That’s why private health care coverage through work is the most common way that Americans get their health care coverage.

If you get your health coverage through your job, usually your employer pays most of the expenses. This means that the employer pays hundreds of dollars each month, so that you have access to health care. Depending on your job, you will also have to pay a monthly amount in addition to what your employer spends. The total monthly expense paid for the private health care coverage is called the premium.

In addition to the premium you and your employer will be paying, you will have to pay various other expenses out of your own pocket. The most common health care expenses are called copayments. A copayment means that every time you have a doctor’s appointment, have a test done, or get a prescription filled you will have to pay some money. With private coverage, copayments generally range from about $10 to $50.

Depending on your health care plan, you may not have to pay anything for certain types of services (testing and vaccinations, for example). But you may have to pay a lot for other types of services. Some plans, for example, may require you to pay for half of all your hospitalization expenses, which can add up to hundreds or even thousands of dollars each day. Other plans simply do not cover certain medical expenses, such as wheelchairs or other durable medical equipment.

All plans have an annual limit on the total amount you have to pay in addition to your monthly premium. This limit is called the out-of-pocket maximum. So, if you have a plan with a $2,000 out-of-pocket maximum, once you’ve paid a total of $2,000 in copayments and other medical expenses, you won’t have to pay any copayments or other expenses for the the rest of the year. Note: You will still have to pay your monthly premium.

Coverage Through Parents

Generally, when people get private health care coverage through their jobs, they are allowed to pay an additional amount to have their family members added to the coverage, including their children Federal law says that parents who get new health care plans are allowed to add any children under the age of 26 to their plans.

Buying Coverage

Some people pay a health coverage company directly for their health care coverage instead of getting it through their jobs or parents. This is called individual coverage. With individual coverage, you will usually have to pay a monthly premium, copayments, and a deductible, depending on your plan.

Covered California is the easiest place to apply for individual coverage. It used to be that health insurance companies could deny your application or charge you more if you had a disability, but starting in 2014, that's no longer true. Now, anybody under the age of 65 can go to Covered California and sign up for a private insurance plan.

You should think about getting an individual plan through Covered California if you cannot get health coverage from:

• Your job
• Your spouse’s job
• Your parent’s job
• Medi-Cal, or
• Medicare

If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium via a tax credit. The federal and state governments also help reduce the fees for medical services for silver plans and if you make less than 250% of the Federal Poverty Guidelines (FPG), the fees may be as low as a gold or platinum plan.

Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,060
	$5,380
	$15,060
	$5,380
	$15,060
	$5,380
Income-based Medi-Cal, adults (138% FPG)
Income-based Medi-Cal, children (266% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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Read more about how to sign up for individual coverage in DB101's Buying Health Coverage on Covered California article.