When Brianna turned 26 in July 2020, she no longer qualified for coverage under her dad’s health insurance, but joining her company’s plan meant losing access to many of her current physicians. Between the stress of a global pandemic and recent knee surgery that required aftercare, the New Hampshire resident hoped to delay finding new providers until her employer’s planned insurance overhaul on January 1. Brianna chose to pay for COBRA, a continuing health insurance program from the U.S. government after a representative assured her that the new plan would be identical and continuous besides paying half the monthly premium. Based on this information, Brianna continued physical therapy for her knee, filled prescriptions, and had a primary care appointment. “My prescriptions were costing over $90 out of pocket, and the doctor’s office was telling me basic bloodwork and more wasn’t covered. I was assured by COBRA these would be reimbursed, and the coverage information just took a few months to kick in. Then I received a $900+ bill in January.” COBRA told her this was the out-of-pocket cost owed after insurance and that her new coverage was, in reality, very different than her old insurance. While Brianna needed health insurance for her knee care, she says the pandemic was also a strong influence on her decision to get new health insurance after turning 26. “If I was unequivocally guaranteed health care in the case that I contracted COVID-19, I would have been more willing to go with less personal coverage for a time until my company health care kicked in,” she says. Since May 2010, the Affordable Care Act has ensured that individuals could stay on their parents’ insurance until they reached 26, regardless of whether they are declared a dependent on their parents’ taxes. More than 10 years later, this inflexible deadline is creating another crisis inside a worldwide calamity.

A Crisis Within a Crisis

Almost four million people in the United States will become 26 this year. A similar number turned 26 in 2020. While some in this age range will have already transitioned to their own health insurance, for many, turning 26 means losing their health insurance, facing the cost of a new plan, and potentially being unable to see or afford their regular providers—in the middle of a pandemic. On top of everything else, this is an added mental health stressor for millions. “One of the most challenging aspects of the pandemic is the great unknown of what lies ahead, how our lives will continue to be impacted by undetermined changes, and the severity of those changes. Losing health insurance not only maps onto the very challenges inherent to the ambiguity of the pandemic, but it exacerbates them,” says Sabrina Romanoff, PsyD, a clinical psychologist at Lenox Hill Hospital in New York City. “Ultimately, these folks have even less protection and are more vulnerable to the effects of the pandemic due to the reduction of resources available to safely navigate it," Romanoff says.

The Stress of Insurance Uncertainty

Pandemic or not, there’s no telling when someone will need health care. For chronically ill people, the question is not when but how often. Mckenzie, an Illinois-based freelancer, has hyperthyroidism and PCOS. When she first got sick during her senior year of college and needed emergency surgery, her parents’ insurance covered it. Then, Mckenzie turned 26 last May as the pandemic spiked with no end in sight, and she was thrust into searching for her own insurance plan. “One of the scarier moments was when the agent asked for my zip code and told me that if I were to ever call an ambulance they’d probably take me to the closest hospital, which wouldn’t take my insurance,” says Mckenzie. “She said to me ‘If you’re conscious you better wheel yourself out of there and to a hospital across the city,’ which I will never forget as long as I live.” Finding a doctor that checks all the boxes she needs under her new plan has been a months-long process. As a freelancer who lost a lot of work this past year, health insurance costs a huge chunk of Mckenzie’s monthly income. But it isn’t something she can forego. “I have a chronic illness, so needing medical care is just a guarantee, but being able to afford that medical care isn’t. That’s really scary,” says Mckenzie. Owen, a New Yorker, understands this well. Since being diagnosed with epilepsy at 16, he has worked with the same neurologist covered by his dad’s insurance. As his 26th birthday looms next month, however, the headway he has made in treatment feels uncertain. “In the past, the co-pay has been incredibly reasonable. But I’m worried if my insurance doesn’t cover [my neurologist], or if they don’t cover regular EEGs, that I won’t be able to keep the progress we’ve made over the last several years in mitigating it,” says Owen. The cost of treatments like Owen’s is not something many people can afford out-of-pocket. “Debt is a really legitimate concern. Medical debt is still a lead cause of bankruptcy and financial hardship,” says Margarida Jorge, executive director of Health Care for America Now. “Young people are less likely to have savings or large incomes that can help with medical expenses, and many already have huge debt because of college loans.”

Tying Healthcare to Employment

Another issue for 26-year-olds aging out of their parents’ insurance coverage stems from the lack of jobs available that provide health insurance or the income to purchase their own. While unemployment is down from its April 2020 high of 14.8%, it is still 6.0%, which is 2.4% higher than it was pre-pandemic in February 2020. “As Americans, living in a country that abides around 30 million uninsured and millions more poorly insured, we have long been inured to the cruelty of our employment-based health insurance system; but the COVID-19 pandemic revealed in a new and shocking way how indefensible this for-profit healthcare system really is,” says Stephanie Nakajima, director of communications at Healthcare-NOW. Take Lily, a Michigan resident who worked full-time in the music and events industry pre-COVID. Her job provided health insurance, but she was furloughed indefinitely in May 2020. She eventually found a new job, but this one doesn’t have benefits. Lily can use her mom’s insurance now. But she doesn’t know what she’ll do when she turns 26 in October. “I really believe individuals my age in the US are getting crushed from every side. The lack of affordable healthcare, the continuous rise of the cost of living—we can’t win,” says Lily. Lily’s mom works in the events industry too, and the family also fears that her benefits could end, leaving Lily, her mom, and her sister uninsured. “The economic fallout of the pandemic caused many to lose their employer-sponsored healthcare right when they needed it most, and plunged many others into the kind of economic precarity that forces people to choose between essentials like food and medicine,” says Nakajima. For the 28.2% of American workers who are self-employed, like Mckenzie, there’s no option to get insured through an employer.

Then there’s the increasing necessity for mental health care. Since the pandemic began, four in 10 adults in the U.S. have reported experiencing anxiety or depression, up from one in 10 in January 2019. Like the other problems that have arisen, losing health insurance and potentially access to providers can exacerbate this—especially if it may inhibit your mental health treatment. “Many folks have created a sense of equilibrium for themselves as their lives have stabilized amid the chaos,” says Romanoff. “But that equilibrium is delicate, and a loss or change to the system can have strong ripple effects on other areas of functioning. “One major aspect of this loss relates to feeling unprotected both through the tangible benefits health insurance provides, and through the loss of relationships with providers who bore witness and collaboratively endured the hardships of the pandemic.” The fragility of navigating mental illness this past year is something Laura, a Minnesotan with depression, anxiety, and ADHD, knows well. When Laura lost her job due to COVID-related staff reductions a few days after her birthday in August 2020, she went on her mom’s insurance, and the cost of her medicine skyrocketed. “I had felt so lucky up until that point to find a medication that worked so well for me and my brain, and that was suddenly taken away,” says Laura. “I remember breaking down at the pharmacy when the specialist explained that one of my prescriptions was suddenly $294 a month. I walked away with a tear-soaked face mask and without a refill.” In total, the cost of her medications had increased from $30 to $399 each month.  “I went off my meds for a little bit following the pharmacy breakdown,” adds Laura. “I totally spiraled, and who can blame me? How are you supposed to tirelessly apply for jobs and be resilient when you feel like you’re dying? I had no job, no partner, no therapist, and suddenly, no medication.” While Laura is back on her medication now and in therapy—albeit with a big dent in her bank account—she will have to stop counseling once she turns 26 in August. “Mental health services are not covered under my work’s insurance,” Laura says. In losing extended coverage, she will not be able to afford medicine and therapy.

The Risks of Sudden Insurance Changes

There is a significant risk associated with having to end medications prematurely and without medical guidance. “Individuals may experience withdrawal or discontinuation symptoms due to running out of their medications. In some cases, this could cause seizures and life-threatening conditions,” says Leela R. Magavi, MD, an adult, adolescent, and child psychiatrist and regional medical director for Community Psychiatry, California’s largest outpatient mental health organization. She has written letters appealing to insurance companies to extend patients’ coverage.  Even when a person has a decent insurance option through their job, being forced to switch can be financially and mentally trying. Gabrielle works at a Boston-area hospital that offers health insurance, but only for a small provider that her primary care doctor and therapist do not accept. After turning 26 this past January, she had to choose between giving up her trusted therapist or paying $125 out of pocket weekly—on top of $46 a week for her new insurance. For the past two years, Gabrielle has seen the same therapist for anxiety, depression, panic attacks, low self-esteem, binge eating, and PTSD. “To say I love my therapist is an understatement. She has helped me in more ways than I can count, and I look forward to our weekly sessions,” she says. While Gabrielle is temporarily paying this amount, she also began a search for new employment offering her previous insurance. She is now starting a new job where she will qualify for that insurance after 60 days. When discussing the long-term effects of losing mental healthcare during the pandemic, Magavi doesn’t mince words: “Losing mental healthcare during the pandemic could cause some individuals to lose their will to live.”

Actions Taken—and Needed—to Rectify This Crisis

Mental health professionals, policy experts, and individuals experiencing this firsthand all agree: A birthday is not reason enough to jeopardize someone’s insurance, especially amid a global pandemic. The medical and financial consequences of doing so are far too dire. “We really still don’t know enough about how COVID impacts health, but we know that there can be long-term physical and psychological consequences from disease even when people recover,” says Jorge. “People without insurance are more likely to forgo testing, treatment, and after-care for COVID-19 because they are nervous about racking up debt.” Under the Trump administration, expansions in medical coverage were mainly limited to free COVID-19 testing and vaccines. “Once someone had COVID-19, they still had to get treatment, maybe be hospitalized, and then even deal with medical treatment afterward,” says Jorge. Whether it be Brianna’s knee surgery, Laura’s mental illness, or Owen’s epilepsy, medical conditions haven’t stopped requiring care because of the COVID-19 pandemic. “We saw a lot of people forgoing treatment altogether last year for all their conditions because they lost their jobs or their coverage—free testing and vaccines didn’t help there,” says Jorge. The new administration has taken further steps with the American Rescue Plan’s (ARP) passage. For people who enroll in healthcare through HealthCare.gov, the ARP provides tax credits that decrease a single person’s premiums by an average of $50 per month. The Centers for Medicare & Medicaid Services has worked to expedite the process of applying for Medicaid with policies such as presumptive eligibility and waving premiums, says a CMS spokesperson. These policies, among others passed, have made healthcare more affordable for some. However, they do not directly address the core issue here: being removed from your parent’s health insurance at 26. For young people who depend on their parents’ coverage, it is a looming deadline.  The pandemic makes the Obamacare-age cutoff especially cruel, but the hardship will continue long after the pandemic. In the end, the solution many have advocated, as with so many problems in healthcare, is to move beyond incremental improvements and implement universal physical and mental health care for all Americans. This comprehensive care would not depend on an employer or a person’s medical conditions. “The pandemic, the ‘gig’ economy, and many other factors should be pressing lawmakers to update our understanding of what people really need on healthcare—that’s more options for portability, affordability, and continuity,” says Jorge. “In addition to increasing affordability under ACA and expanding access to Medicaid coverage and services as the American Rescue Plan has done, we need a public option for healthcare.” A majority of Americans agree. A 2020 survey from Pew Research found that 63% of U.S. adults believe the government is responsible for providing health care coverage to all. The option also has financial merit. A 2020 review of 22 single-payer healthcare cost projections showed consistent projections of net savings.   In the short-term, Nakajima recommends emergency coverage being extended to anyone uninsured for the duration of the pandemic. Though she agrees that substantial changes are needed around health insurance. “Every one of our peer countries provides its residents comprehensive public healthcare through a largely taxpayer-funded, progressively structured healthcare system,” says Nakajima. “It’s time we realize how morally bankrupt our patchwork, for-profit healthcare system is and finally enact comprehensive, cradle to grave healthcare that can never be taken away from you—especially during a pandemic.” The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.