Turning 26? Health insurance options, grace periods, and what to do next
Most people can no longer stay on a parent’s plan once they turn 26 and will need to choose their own coverage. You can shop for a UPMC Health Plan product on Pennie®, Pennsylvania’s health insurance marketplace. This is a great option if you are self-employed, unemployed, or can’t get coverage through your employer. You may qualify for financial savings through Pennie to help lower the cost of your insurance.
What happens to your health insurance when you turn 26?
Under the Affordable Care Act (ACA), most people can no longer stay covered under a parent’s health insurance when they turn 26. Coverage ends either:
- At the end of their birth month.
- At the end of the calendar year (depending on the plan).
Do I have time to enroll in a health plan after turning 26?
Yes. Turning 26 and losing coverage under a parent’s health plan is considered a qualifying life event, which generally makes you eligible for a special enrollment period. This allows you to enroll in new health coverage outside the annual Open Enrollment period.
What are my health insurance options when I turn 26?
You can enroll in an Individual and Family plan through the UPMC Health Plan Marketplace or Pennie®, Pennsylvania's health insurance marketplace. You may be able to enroll in a plan offered by your employer if you are eligible for coverage.
Employer-sponsored health insurance
If you were on a parent’s health plan and lose coverage when you turn 26, you may be able to enroll in coverage through your employer. Keep in mind that enrollment timelines for employer-sponsored plans may differ from Pennie®'s annual Open Enrollment period.
Individual health insurance plans
When you turn 26, you can also purchase health insurance directly from an insurance company like UPMC Health Plan. This can be a good option if you are self-employed, unemployed, or do not have access to employer-sponsored coverage.
Pennie® (Pennsylvania’s health insurance marketplace)
Turning 26 and losing coverage under a parent’s health plan is a qualifying life event that generally makes you eligible for a special enrollment period. This is a time outside the annual Open Enrollment period during which you can purchase health insurance through Pennie®, Pennsylvania’s health insurance marketplace. If you enroll through Pennie, you may qualify for subsidies based on your income. These subsidies can help lower the cost of your health insurance.
Why choose UPMC Health Plan when you turn 26?
We know efforts to improve or maintain your health happen mostly outside the doctor’s office. That’s why we offer additional benefits and services for an affordable price. Take a look at what it means to be a UPMC Health Plan member.
Get care virtually or in-person with UPMC VirtualCare1
UPMC VirtualCare connects you to convenient, low-cost care your way.
Access to the care you need to get or stay healthy
- $0 preventive care that covers many health services for adults and children at 100 percent2
- No-cost preventive medications3
- Access to top-ranked doctors and hospitals4
Help to take care of your mental and physical health
- Six free counseling sessions through LifeSolutions®5
- Free health coaching to help you make healthy changes in your life
Support when you need it
- 24/7 video visits that are covered at 100 percent by most plans6 and are available through the UPMC Health Plan app or MyUPMC
- The UPMC Health Plan app for easy access to your health insurance information
- Our exceptional Health Care Concierge team, which can help you navigate your benefits with a quick chat or phone call
Turning 26 and health insurance: FAQs
When does my health insurance end when I turn 26?
When you turn 26, coverage under a parent’s health insurance typically ends either:
- At the end of your birth month.
- At the end of the calendar year (depending on the plan).
How long is the grace period after turning 26?
What happens if I miss my enrollment window?
Can I get health insurance before my birthday?
Is Pennie the only place I can buy coverage?
Contact Us
Questions? Call us toll-free at 1-877-563-0292 (TTY: 711).
1Available in the UPMC Partner and Select networks.
2Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
3Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.
4Go to upmchealthplan.com/best for award information. For network access details, visit upmchp.us/networkaccess.
524/7 video visits are available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old or older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.
624/7 video visits are available only to UPMC Health Plan members who are in Pennsylvania at the time of their virtual visit. Members may select a UPMC provider, subject to provider availability and discretion. Members or the member’s parent or legal guardian must accurately verify their physical location and that they are in Pennsylvania at the time of the visit. Limitations may apply for members of administrative services only (ASO) plans who have opted out of coverage. A parent or legal guardian must be present during the video portion of the visit for children younger than 18. Providers employed or contracted by UPMC retain discretion regarding the treatment of patients ages 0-2. 24/7 video visits for children ages 0-2 are unavailable from 11 p.m. to 7 a.m. in Pennsylvania.