Affordable Care Act: What to do at age 26

My daughter will be turning 26 in October and lives in New York.  She in unmarried, unemployed, and a single mother. My daughter and my grandson live with me.  She is currently covered under her father’s health insurance.  He lives in Connecticut, but works in New York.  He has been notified she will not be insurable through his company after the end of the year due to her age.  What affordable insurance options do we have for her?  Thank you.

Plan Ahead Grandma

 Dear Plan Ahead Grandma,

Step One

First, I suggest that investigating her father’s coverage to confirm that she will indeed be taken off of his plan.  If he has something in writing from the plan, then go to step two; if someone just made an off-hand comment to him, then call the number on the back of her ID card and ask.  Get it in writing just to be sure.  His plan may have to cover her until she turns 30 if it is issued in New York State, subject to New York State laws; and is fully insured.   It is possible that his plan is self-funded and thus escapes New York’s “Age 29” law.  (It does not matter where he lives; the state where he works is very likely where the coverage is issued.)

Step Two

Even if she can stay on his plan through age 29, I encourage you to have her apply for New York Medicaid.  Your daughter will qualify for Medicaid, if she is earning less than 133 percent of Federal Poverty.  Since she is unemployed, she will qualify.  New York is offering the Medicaid “expansion”, so all adults at that income level can qualify for it.  She would have qualified anyway as a parent.  This will be no cost to her, except she may have small co-pays for drugs or doctor’s office visits.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.