Private Health Care Coverage for Young People

If you don't qualify for public health coverage like NC Medicaid, you can get private health coverage. The two main ways to get private health coverage are through a job, which is called employer-sponsored group health coverage, or by buying it on your own, which is called individual health coverage. Young people may have their own health plans or have coverage through their parents' plans.

In this section, we explain the different ways of getting private health coverage and the expenses you may have to pay if you have it.

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 have private health coverage, a set amount of money called the premium must be paid every month for you to be covered by the plan, regardless of whether you use any health care that month. Generally, if you have employer-sponsored coverage, the employer pays part of the premium and you pay the rest. Sometimes the employer pays the entire premium.

With private coverage, you also have to pay additional fees when you get medical care. The employer does not pay these extra costs.

Learn more about employer-sponsored health coverage.

Coverage Through Parents

Employers who offer health insurance to their employees must also offer it to their children who are under the age of 26. If you are under 26 and your parent has a private health plan through their job, you can join their plan. However, that means the plan's premium will be higher, and the employer may not offer to pay the additional cost of the premium.

Note: Dependent children with disabilities can continue to be covered under their parent’s plan past age 25. To qualify as a dependent child, you must be dependent on your parents for support and your disability must limit your ability to support yourself through work.

Buying Coverage

You can also buy an individual plan or a plan for your family on HealthCare.gov. It used to be that health insurance companies could deny your application or charge you more if you had a disability, but that's no longer true. Now, anybody under the age of 65 can go to HealthCare.gov and sign up for a private insurance plan.

If you buy a private plan through HealthCare.gov, you will have to pay the same types of costs as employer-sponsored coverage: a monthly premium, plus additional fees when you get medical care. Individual health coverage is usually more expensive than other coverage options, so you should only get an individual plan if you cannot get coverage through NC Medicaid, Medicare, or your job or a family member's job.

If you cannot get health coverage from any of those options, the government may help you pay your monthly premium with tax subsidies. If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($37,650 for an individual or $78,000 for a family of four), the government also helps you get a silver plan that has lower copayments and other expenses.

Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) 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:
	$15,650
	$5,500
	$15,060
	$5,380
	216
Income-based NC Medicaid, adults (138% FPG)
NC Medicaid for children (216% 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). Disability-based NC Medicaid eligibility is not included here. 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 HealthCare.gov article.

Costs of Private Health Coverage

In addition to the monthly premium, you usually need to pay additional fees when you get medical care:

• Copayments are a set amount you have to pay for a medical visit or service, like a doctor's visit, an X-ray, or a lab test.
• Coinsurance is a set percentage of the cost of a visit or service that you must pay.
• A deductible is a set amount of money that you pay out of your own pocket each year before the insurance company will begin to pay for certain services.
• The out-of-pocket maximum is the maximum you have to pay each year in fees for medical services, like copayments and your deductible. It does not include the money you spend on your monthly premium.

Which of these fees you have to pay and how much they cost depend on your plan. Read more about these costs and how to choose the right plan for you.