Beneficios para los jóvenes

La elegibilidad de los jóvenes para cobertura médica privada

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. If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($31,900 for an individual or $65,500 for a family of four), the government also helps you get a silver plan that has lower copayments and other expenses.

Aclaración: Para los años 2021 y 2022, no hay límite de ingreso para recibir subsidios para el pago de las primas de los seguros privados individuales. (El límite anterior era del 400% de FPG para los subsidios federales y 600% de FPG para los subsidios estatales.) Para recibir subsidios, todavía tiene que cumplir con los otros requisitos y la prima que paga depende de su ingreso y su plan.

Límites de ingreso para beneficios de salud
Catastrophic plans
If you are under 30, you can sign up for a catastrophic plan with a high deductible. You will have to pay the deductible before this type of plan will pay for most Essential Health Benefits, though you will be able to see your primary care provider up to 3 times and get preventive care without paying the deductible. Note: The government will not help you pay for a catastrophic plan, so it could be more expensive for you than a bronze or silver plan on Covered California.

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