Benefits for Young People

Private Health Coverage for Young People

To get private health insurance, somebody — you, your employer, your parents, your parent’s employer — must pay for that coverage. This section introduces the basic ways you can get private health coverage and explains some of the health expenses you may encounter.

Coverage Through Work

Many employers offer health benefits. That’s why private health insurance through work is the most common way that Americans get their health coverage.

If you get health benefits through your job, your employer pays part of the cost, with the amount depending on the employer and the plan options they offer. You also probably have to pay some money each month to have coverage. This monthly expense is called the premium.

Health Insurance Expenses

When you have health insurance, you generally do not have to pay additional fees for certain preventive care services, such as routine testing and vaccinations, but depending on your plan, you may have to pay a portion of the cost for other services.

In addition to the premium, these are some of the other expenses you may have to pay when you have health insurance:

  • A copayment is a set amount you have to pay for a medical visit or service. The amount of the copayment can depend on the service you get, or the type of doctor you see, such as a primary care doctor or a specialist. Example: Your copay to see your primary care doctor might be $35, but you might pay $50 to see a specialist.
  • Co-insurance is a set percentage of the cost of a visit or service that you pay. Example: If your insurance plan pays 70% of your health expenses, you would pay 30% as co-insurance.
  • A deductible is a set amount of money that you pay out of your own pocket each year before the insurance company begins to pay for certain services. Once you have paid the deductible, you do not have to pay it again until the next calendar year. Example: If your insurance has a $2,500 deductible, you have to pay $2,500 of your medical expenses before your plan will start paying for covered health expenses. Note: After you pay the deductible, you will still have to pay copayments and co-insurance.

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. Example: If your plan has a $4,000 out-of-pocket maximum, once you’ve paid a total of $4,000 in copayments and co-insurance, your plan will pay for covered health expenses for the rest of the year. Note: The monthly premium isn't included in this maximum and will still have to be paid.

Coverage Through Parents

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

Essential Health Benefits

All ACA-compliant health plans, no matter who pays for them, must cover the Essential Health Benefits (EHBs). This means that they offer comprehensive coverage, including regular checkups, vaccinations, chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, among other things.

Buying Health Insurance on Your Own

Some people pay a health insurance company directly instead of getting it through their jobs or parents. If you get a plan on your own, you will pay a monthly premium, copayments, and a deductible, depending on your plan. Depending on your household income, you may qualify for help in paying your monthly premium, if you get your plan through Get Covered Illinois/

Get Covered Illinois/ is the official ACA Health Insurance Marketplace in Illinois. It helps you find the right plan for your needs and budget, and it is where you can see if you qualify for help paying your monthly premium. It used to be that health insurance companies could deny you coverage or charge you more if you had a disability, but that's not true anymore. Now, it's much easier to get private insurance.

You should only think about getting health insurance through Get Covered Illinois/ if you cannot get health coverage through:

If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium via a tax credit if you get your plan on Get Covered Illinois/ If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($36,450 for an individual or $75,000 for a family of four), the government also offers 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
Catastrophic plans
If you are under 30, you can sign up for a catastrophic plan with a high deductible. You have to pay the deductible before the plan pays for most Essential Health Benefits, but you can see your primary care provider up to three times and get preventive care without paying the deductible. Note: The government does not help pay for catastrophic plans, so it could be more expensive for you than a bronze or silver plan on Get Covered Illinois/

Read more about how to sign up for individual coverage in DB101's How Health Benefits Work article.

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