Turning 26? 5 Things to Know About Health Insurance | What We Do | Tufts Health Plan

You just turned 26 and it’s time to find health insurance. Until now, you’ve probably been under your parents’ insurance. You may have received a letter in the mail telling you that your current insurance will expire soon. so what do you do?

You have 60 days before your birthday and 60 days after to get coverage. here’s a quick rundown of things to consider. also, happy birthday!

Reading: How long to get insurance after 26

1. first, learn the basics

chances are you didn’t need to know health plan terminology like “ppo” or “deductible”. now is the time to learn.

A good way to start is to learn about the different types of plans. An hmo plan means your pcp, or primary care provider, will make sure you have access to the health care you need or help coordinate your care general medical.

sounds like a mouthful, but it will all make sense, we promise.

in-network means that your plan has contracted with that doctor or health organization.

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A ppo (preferred provider organization) means you can see and get care from any doctor without a referral, and you can see doctors even if they’re not in your plan’s network.

Only you can determine what is best for your current situation.

2. See what plans your job offers

If you’re working, check with your company and see what health plans are offered.

This definitely makes things a bit easier as you will be limited to the plans your employer has chosen.

Please note that your premium, or the amount you pay for your health plan each month, can sometimes be automatically deducted from your paycheck. this is convenient for many people, but be careful so there are no surprises.

a higher premium may mean you pay less out of pocket; that is the amount you pay out of pocket for health care services. a lower premium could mean you may be charged more for your out-of-pocket costs.

Finally, take note of your plan’s deductible. that’s the dollar amount you must pay for certain services before your health plan will pay for your health care services.

3. have a plan b

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If employer-sponsored coverage is not accessible or affordable, or you have a part-time job, individual coverage may be an option.

Check your state resources to explore individual coverage options and if you qualify for subsidized coverage:

  • if you live in massachusetts, check with the massachusetts health connector.
  • if you live in rhode island, check with healthsource ri
  • 4. don’t forget to find out about your doctor

    If you have a doctor you want to keep seeing, make sure he or she is in your new plan’s network.

    If you’re looking for a new doctor, always ask if they accept your (new) health plan.

    You can use this search tool to see which doctors participate in the Tufts Health Plan networks. Also, when you call the doctor’s office for the first time, make a habit of asking which health plans they accept.

    5. keep asking questions

    Don’t be afraid to ask questions to make sure you understand all the important things. use this basic list to get started:

    • Are dental and vision benefits part of this health plan?
    • Is my current doctor in this plan’s network?
    • what does preventive care cover? Or do I have to pay for preventive care?
      • Does the plan cover an annual physical and flu shots? what other thing?
      • Do I need a referral to see a specialist?
        • A referral is the authorization needed before you can use other providers in the plan’s network or, in some cases, out-of-network.
        • What happens if I travel?
        • Is a fitness benefit included?
        • Is that a lot to digest? if you read and do your research, it will be like second nature. and know that you are not alone in this process.

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