How to Navigate the Healthcare System as a Young Adult

Of all the various things that make up successfully “adulting,” definitely one of the most complex is navigating the U.S. healthcare system. But few things are more important than ensuring you know how to get the care you need when you need it.

Whether you are preparing to head off to college, you’re already in the “real world,” or you are a parent who wants to make sure your child is on the right path, you need to know how to get insurance coverage, find a doctor, and make sure you are properly advocating for yourself when you need care.

Don’t Worry. Start Preparing.

While the U.S. healthcare system is confusing and intimidating, taking the time to learn about your options and rights will help you feel more comfortable in time. And the earlier you start to prepare, the better.

That means, if you are able, talk to your parents about:

• Insurance coverage options
• How to find a doctor who takes your insurance
• Where to go for care, including urgent care clinics
• What type of appointments you need to make, such as a physical or for any ongoing health problems

You may be able to continue seeing your pediatrician, but if not, it’s important to learn about the above steps.

Understand Your Insurance Coverage Options

If you’ve spent your whole life up to this point just going to the doctor and letting your parents take care of the details, you may not know about all of the insurance options out there. These can include:

• Staying on your parents’ insurance until you turn 26, which the Affordable Care Act allows: This could likely provide you with better coverage, depending on what your parents have. However, if you live in another state, this might not be a very good option, since most of your care would likely be considered “out of network.”
• Getting insurance through your employer: Workplace coverage is common, but it’s important that you look at how much money will be coming out of your paycheck. Additionally, if you have a health condition that your workplace plan won’t cover, you need to think about what treatment would cost.
• Buying private insurance: You could purchase health insurance directly from your state’s exchange. This may give you an opportunity to purchase a plan that has a very low premium and high deductible, which may make more sense at your young age. However, you should know what that would mean if you had a true health emergency or received an unexpected diagnosis.
• Purchasing insurance through your college: Many colleges offer insurance coverage plans for their students. Many times this is the most economical situation. You should make sure if the plan covers any visits with specialists who are not on campus, should the need arise.
• Enrolling in Medicaid: If you are struggling financially, you may be eligible to enroll in Medicaid, which has been expanded greatly over the last decade. Just like any other insurance plan, however, there will likely be limits.

It’s important to understand your options and your budget before making any decisions for coverage. Also familiarize yourself with the definitions of terms like:

• Premium
• Deductible
• Lifetime coverage caps
• Exclusions

Learn About Healthcare Laws

While you don’t need to become a policy expert, you should be aware of some of the basics of the most important healthcare laws. These include:

• Affordable Care Act: Also known as “Obamacare,” the ACA makes it illegal to deny insurance coverage to people with preexisting conditions, such as a family history of cancer. This law also sets up a system of state exchanges where people without coverage can purchase plans, which may be subsidized if you make less than a certain amount of money.
• COBRA: This law allows you to maintain your work-provided health insurance for a certain period of time if you leave your job. You should be aware that maintaining this coverage under COBRA will be much more expensive than what came out of your paycheck.
• HIPAA: The most prominent part of HIPAA that you will likely be familiar with is provisions related to your privacy. The law gives you the power to decide how your health information will be used, and prevents your doctor and insurance from sharing that information without your permission.
• HITECH Act: This law encouraged the development of electronic health record keeping and improving security.

There are also a host of state laws regarding insurance, vaccinations, and many other issues. You should familiarize yourself with those laws where you live.

Develop Your Skills

It’s not enough to just make an appointment when you need one. Confidently communicating your issues to your doctor and insurance company, following doctor’s orders (including medication), understanding insurance forms, and knowing the right questions to ask are essential.

You should work on:

• Discussing your healthcare needs and questions
• Understanding medication instructions
• Filling out and understanding bills and other forms
• Knowing when to follow-up after appointments

Learn Your Health History

If you’re meeting with a new doctor, it’s not enough to just say that you “feel fine” at the time of your first appointment. Your doctor will want to know about any past health issues affecting either you or family members. This can include relatives who have had cancer or other conditions where you might be at a higher risk. Take the time to discuss these issues with your parents or other relatives, so that you know how to confidently speak about them to your doctor.

Get Help if You Need It

Even those of us who have had many years of experience navigating the healthcare system still encounter moments of great confusion and frustration. Until there are any major changes, however, this is the system we have.

But that does not mean you just need to grin and bear it alone. Chances are, your parents, family, or friends, or anyone you feel comfortable discussing your healthcare situation with, have encountered similar situations. They can share important advice with you.

Additionally, the federal government provides online help for acquiring insurance. There are also likely attorneys near you who have experience dealing with unfair insurance claim denials or serious matters like medical malpractice.

There is help out there. While the healthcare system is complex, giving yourself time to learn and get comfortable will help you be more confident about taking charge of your care.