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Medicare Advisor, insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

Insurance options can be a difficult thing to navigate for adults, let alone young people experiencing significant hardship. Don’t assume that you can’t get health care if you have limited resources or lack family support. Options are available for young people to receive essential health coverage, often for free or low cost even if you can’t get health insurance from your family.

This guide can help you or a loved one find the health care you need as easily as possible. Read on to learn what types of health insurance are available to vulnerable youth, who qualifies, and what coverage includes, along with resources where you can get help.

What You Should Know About Health Insurance Options for At-Risk, Homeless, and Vulnerable Youth

  • Low or no-cost health coverage is available: If you’re not on a parent’s health insurance policy, you have options for coverage, including Medicaid, CHIP, and the Health Insurance Marketplace.
  • Navigators can help: Getting qualified for health care coverage may feel overwhelming, but health care navigators can help you identify options, apply, and use your coverage.
  • Essential care is covered: Health insurance through Medicaid, CHIP, and the Health Insurance Marketplace must conform to Affordable Care Act standards to cover essential health services, including preventive care and pregnancy.

Can Vulnerable Youth Get Health Insurance?

If your access to health insurance is limited due to poverty, homelessness, or other challenging life circumstances, you are eligible for low-cost or no-cost coverage. However, getting access to health care can feel daunting.

“Determining eligibility for health insurance programs can be complicated,” acknowledges Meghan Kimmel, president of Portico Healthnet, a Minnesota-based organization that helps uninsured individuals and families access affordable coverage and care by navigating the healthcare system.

Considerations that impact youth eligibility for health care coverage include:

  • Age
  • Who you live with
  • How much money you or your parents make
  • Tax dependency status
  • Immigration status (if applicable)

Not sure how to get connected with health insurance for homeless and at-risk youth? Ask for help. “The best option is to find a navigator to help with the options and the application,” Kimmel says.

Health insurance from a parent or guardian

Until you turn 26, you can stay on your family’s health insurance plan. Staying on a family plan is possible even if:

  • You don’t stay in close contact
  • You don’t live at home
  • You’re pregnant or parenting
  • You have a job

If you cannot, for any reason, get health insurance from a parent’s plan, know you have options. You should and can access low-cost or no-cost coverage through Medicaid and CHIP through the Centers for Medicare & Medicaid Services and the Health Insurance Marketplace.

Getting Health Insurance as a Vulnerable Youth

There are three main health insurance programs available for vulnerable young adults, including:

  • Medicaid
  • Children’s Health Insurance Program (CHIP)
  • Health Insurance Marketplace

“State and federal governments have established options for youth to access insurance,” Kimmel explains.

Medicaid and CHIP for At-Risk Youth

Medicaid for at-risk youth offers essential health coverage to qualifying applicants, including preventive care, prescriptions, reproductive health, and mental health services. Medicaid is available if you’re an inmate of a public institution.

CHIP is the Medicaid Children’s Health Insurance Program for uninsured families and children—including vulnerable and at-risk young adults—with limited financial resources who do not meet the Federal Poverty Level (FPL) or other qualifications Medicaid requires. It provides essential health coverage, including dental and vision.

Qualifying for Medicaid or CHIP

Qualification depends on age, income, household size, and state of residence. You can be eligible for Medicaid if you’re under the age of 19 and earn less than 133% of the Federal Poverty Level (FPL) annually.

If you exceed the Medicaid income level, you may qualify for CHIP depending on your state’s eligibility requirements. Like most health insurance coverage, eligibility varies by state. However, you can refer to the Medicaid and CHIP Eligibility Levels fact sheet for guidance or connect with a health insurance navigator near you who will walk you through the entire process.

If you’re over 19, you can access Medicaid and CHIP in states with expanded coverage, or if you are under age 26, aged out of the foster system, and were enrolled in Medicaid while in foster care. Youth who are pregnant, parenting, or who have a disability also qualify for Medicaid coverage.

Applying for Medicaid or CHIP

You can apply for Medicaid or CHIP with a health insurance navigator or by visiting HealthCare.gov. When you fill out your income status, the marketplace automatically directs qualifying applicants to the state Medicaid agency. If you don’t have a permanent address, Medicaid advises using an assister’s (someone helping you fill out the application), trusted friend’s, or service provider’s address.

You can enroll in Medicaid or CHIP at any time; there is no specified enrollment period.

Federal and State Health Insurance Marketplaces for At-Risk Youth

The Health Insurance Marketplace is essentially a coverage aggregator where anyone can search for health insurance to suit their needs. Filling out the initial information at HealthCare.gov will direct you to Medicaid if your situation qualifies you for it or to low or no-cost coverages available through the marketplace with discounts or credits.

The Health Insurance Marketplace and state health insurance exchanges provide affordable coverage for vulnerable youth, including young adults:

  • Experiencing or at risk of homelessness
  • In the foster system (currently or previously)
  • Pregnant and parenting
  • Living significantly under the federal poverty level
  • With disabilities

You can get health insurance as a young person even if your parents or guardians do not have coverage.

Qualifying for a marketplace plan

If you don’t qualify for Medicaid or CHIP, you can still access low-cost coverage through the Health Insurance Marketplace. You can get a subsidy that pays for some of your monthly health insurance premium through the marketplace if you have a household income between 100% and 400% of the FPL.

Applying for a marketplace plan

Visit HealthCare.gov to start an application. You’ll fill out personal information, including your name, age, Social Security number, and income. Once you apply, you’ll find out how much of a subsidy you qualify for and can compare and sign up for available plans.

“There are many options available to youth, often at no or low-cost to them or their families,” Kimmel says. “I urge anyone knowing or working with a vulnerable youth or their family to reach out to a navigator for help.”

What Do Health Insurance Programs for Vulnerable Youth Cover?

Health insurance coverage for at-risk youth depends on the state. Still, as Kimmel says, “All include the essential health benefits required through the Affordable Care Act, such as preventive care and prescription drugs.”

Specifically, the ACA requires that Marketplace plans offer “essential health benefits” that include:

  • Diagnostic tests
  • Hospital visits
  • Mental health and substance use disorder treatment
  • Prescription drugs
  • Preventive and wellness services, including reproductive health
  • Rehabilitative services
  • Surgical procedures
  • Traditional health and health services like primary care and specialist visits

Medicaid and CHIP benefits for at-risk youth are outlined in states’ program plans. However, there are some variances.

  • If you are under age 21, Medicaid is required to be “comprehensive” and include the above benefits. Otherwise, Medicaid and CHIP must include primary care and specialty visits, hospital and outpatient care, lab and x-ray services, family planning, and other services defined as mental health, prescription drugs, and substance abuse counseling.
  • If you are over age 21, those “other services” depend on the state in which you live and are not guaranteed.

What’s important to know is that even if you’re homeless, have a disability, or are pregnant, you can access the essential healthcare coverage you need.

Get Help Finding Health Insurance

Identifying programs, understanding eligibility, and applying for and using your health insurance can be difficult, especially if you’re not used to advocating for yourself. You can get help from a health insurance navigator: a trained individual or organization that helps you look for health insurance you can afford.

Navigators not only identify the coverage you can qualify for; they also help with the application process. Application support can be beneficial for removing barriers if you don’t have internet access. Navigators tend to be multilingual, so you can get assistance in your language if you do not speak English. A navigator can also help you understand how to utilize health insurance plans best and act as trusted advisers throughout the entire journey.

It’s free to work with a health insurance navigator. They are unbiased and not affiliated with agents or brokers, so they’re working in your best interest to find health coverage that works for you.

“[Health insurance navigators] are committed to increasing the number of people with health care coverage,” Kimmel explains, noting that navigators are industry experts and often compassionate individuals.

To find a health insurance navigator, you can visit LocalHelp.HealthCare.gov. You will enter your city, state, or ZIP code to find results. Or call 800-318-2596 or TTY 855-889-4325. Someone will pick up the phone 24 hours a day, seven days a week.

Additional Resources

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