Private Health Coverage for Young People

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 point out what sorts of health care expenses you may encounter.

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.

Getting private coverage and public coverage at the same time

You are allowed to get private health coverage and public health coverage, such as MO HealthNet, at the same time. You don’t have to quit MO HealthNet just because you are now covered by private coverage as well. That can be a help, because MO HealthNet may pay for some services that your private health coverage doesn’t cover.

Another option is that you can have MO HealthNet pay your premium for your private health insurance. For example, if you have private coverage and pay a $200 per month premium for your insurance, MO HealthNet may be willing to pay the $200 per month. That’s called the Health Insurance Premium Payment (HIPP) program. HIPP may also pay your copayments or deductible. To learn more about HIPP, click here.

Coverage Through Parents

Federal law says that parents who get health coverage through their jobs are allowed to add any children under the age of 26 to their plans. Usually, a parent adding a child to their employer-based coverage will have to pay some or all of the child's monthly premium.

Buying Individual Coverage

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

Healthcare.gov 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 Healthcare.gov and sign up for a private insurance plan.

You should think about getting an individual plan through Healthcare.gov if you cannot get health coverage from:

  • Your job
  • Your spouse’s job
  • Your parent’s job
  • MO HealthNet, or
  • Medicare

If you cannot get health coverage from any of the above options and your family’s income is between 100% and 400% of the Federal Poverty Guidelines (FPG), $48,560 for an individual ($100,400 for a family of four), the government may help you pay your monthly premium via a tax credit. If your family’s income is between 100% and 250% of FPG, $30,350 for an individual ($62,750 for a family of four), the government will also help you get a plan that has lower copayments and other expenses.

Note: If your income is below 100% of FPG ($12,140 for an individual; $25,100 for a family of four), you cannot get government help paying for your insurance. You could still get an individual plan on Healthcare.gov, but you would have to pay the full premium yourself.

How Does Your Income Compare to FPG?
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 three times and get preventive care without paying the deductible. If your income is below 400% of FPG, 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 Healthcare.gov.