How to navigate health insurance coming off of parent's insurance plan

Transitioning from pediatric to adult health care requires some education and growth. For those living with type 1 diabetes (t1d), learning how to navigate health insurance is an important coming-of-age step. Here's some crucial information to help you take on this aspect of your care.

What you need to know

The Affordable Care Act, passed in 2010, includes a provision that allows young adults to stay on their parents' health insurance until age 26. For many people, this shift is the first time they'll be obtaining their own coverage. Learning how to navigate health insurance can be a lifelong journey, so anyone doing it for the first time will want to start early and ask questions to line up the right plan in time for the transition.

Special considerations as a person with T1D

It's commonly asked what the best insurance plan is for people living with diabetes. Unfortunately, it's impossible to answer that question in a general sense. Even the available options can vary greatly depending on geographical location, employer versus marketplace, and the type of care each plan provides at what financial cost.

Living with a chronic illness that requires the use of daily medication and supplies along with regular medical care means choosing the right plan is that much more important. People living with t1d are typically moderate to high-use patients, which means it's vital to sort through the details of any plans you're considering instead of simply selecting what appears the least expensive at first glance.

In choosing the right plan for you, take into account your t1d needs, any other health considerations, and your budget. Here are some pointers for getting started on your own plan for the first time.

Make a list

Note the ways you most frequently use your current coverage so you can make sure these things are covered in your next plan. These might include insulin pump supplies, CGM supplies, test strips, lab work, and specialist visits, to name a few.

Explore your health insurance plan options

Explore the health insurance plan options available to you. Are you choosing between two employer-sponsored plans? Are you looking at your state's healthcare exchange, which can have limited or extensive options? If finances are a concern and you're not already offered insurance through your employer, keep in mind that there may be federal and/or state subsidies available to you if you purchase insurance from the marketplace. Additionally, Medicaid programs may be available depending on your income and individual situation.

Factor in a budget

What appears to be the most cost-effective plan may not be the most budget-friendly and helpful for you. Take the time to look beyond premium amounts. How much you pay each month to stay covered is just one piece of financial information to factor in when estimating your costs for the coming year. Consider if the plan has a deductible or how much you'll spend up front as well as the co-pay/coinsurance for your most frequently used items.

You also want to make sure the plan you choose has valuable coverage for the things that could end up being your highest-cost items. It doesn't make sense to "save money" on a plan that doesn't cover what you need in a way that's cost-effective for you. You'll end up paying more overall or going without, which can be dangerous.

Ask questions!

Ask as many questions as you need to determine your best option. Human resource (HR) benefit managers are a potential source of information for employer plans, and insurance navigators, brokers, and plan representatives can be helpful when you're looking at individual plans. You can also call your endocrinologist's office to find out what plans they take and compare that list with your options to stay with a provider you're familiar with during this period of transition.

Advice for learning to navigate health insurance for the first time

Prepare for the process with plenty of time so you can get the answers you need. Remember — just because you're an adult, you don't have to figure this all out on your own. You can still ask your parents, other trusted individuals, and patient advocacy organizations about making this change.

Additionally, your peers in the t1d community can help provide insights from having taken these steps themselves in the recent past, knowing they have similar concerns about obtaining the best possible coverage for their diabetes.

Finally, keep in mind that your choice is good for up to a year, so you can take the learnings from this experience and apply them in the next open enrollment season.

You're not alone in figuring out the transition to adulthood while living with t1d. Get more information about it here.