Blue Cross Blue Shield Turning 26 Grace Period

What Happens To Your Coverage

Turning 26? You could get help paying for health insurance.

If you wait too long to make your payment in full, well cancel your coverage. When we cancel it depends on how you bought your plan.

  • If you bought your plan on the Health Insurance Marketplace at and youre eligible for and receiving the Advanced Premium Tax Credit, well cancel after three months.
  • If you bought your plan on the Health Insurance Marketplace and youre not eligible for the Advanced Premium Tax Credit, well cancel after one month.
  • If you bought your plan directly from us and didnt use, well cancel after one month.

Aging Off Your Parents Plan: A Recap

Before the ACA, young people typically had few options for buying health insurance, but its different now. Before you turn 26, set aside some time to learn about full-coverage ACA plans and other options, including lower-cost but limited short-term insurance, assuming your state allows it. And always keep your enrollment deadlines in mind as you approach 26. With preparation, you can make aging out of your parents health insurance plan a lot less stressful and ultimately rewarding by enrolling in your own health plan.

When To Sign Up For Your New Plan

Theres a time in the fall called open enrollment, when people can sign up for insurance for the next year. In general, if you miss it, youll have to go without insurance until the next fall. But luckily, turning 26 qualifies you for special enrollment. Your special enrollment periodthe time you have to sign up for coverageis the two months before your 26th birthday and the two months after.

One exception to this is if youre signing up through your employer. Most likely youll have between 30 and 60 days after your birthday, but you should check with your HR department to find out when you need to enroll.

A good rule of thumb is to sign up for your plan by the 15th day of the month prior to when you want your coverage to start. If you want your coverage to begin on June 1, for example, sign up no later than May 15.

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Removal Of Member Cost

The provision – An expanded number of preventive health services will now be provided at no cost-sharing to the member for all individual and family plans which are not grandfathered. Preventive services include:

  • Preventive care for children up to age 16
  • All generally accepted cancer screenings, including breast, cervical, and prostate
  • Preventive services and immunizations for children and adults

This means that a member will not be charged a deductible, copayment or coinsurance for these services.

For Blue Shield plans – Most of these services were already covered by Blue Shield of California and Blue Shield Life. Those that were previously covered as medical benefits will now be covered as preventive services and members will no longer pay a copayment.

How To Enroll In A Healthcare Plan

When youre ready to purchase your own health insurance, you have several options. You can speak to someone in the human resources department about enrolling in a healthcare plan provided by your employer. You could also ask whether you qualify for COBRA coverage under your parents plan.

Through the Consolidated Omnibus Budget Reconciliation Act , you may be able to retain coverage under your parents healthcare plan for up to 36 months after turning 26. To be eligible for COBRA coverage, youll have to submit a written request to your parents boss. If your parent works for a company with fewer than 21 employees, your state may offer temporary health insurance that functions like COBRA coverage.

A third option is to sign up for a plan through the Health Insurance Marketplace. Lower-income individuals may qualify for the premium tax credit that reduces their tax liability. But government subsidies may no longer be available if key components of the ACA go up in flames. If you think you may qualify for Medicaid, thats another route you may need to explore.

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Health Insurance Through Your Employer

If you work for an employer who offers health insurance as part of their benefits package, this may be your best option. The employer pays a portion of the expense for you.

You will still pay a premium and may have copays or coinsurance. But these plans are attractive because the premiums come out of your paycheck before taxes.

Exchange Individual Grace Period Requirements

Under the rules of the Affordable Care Act , a patient on an exchange product who receives a premium subsidy from the government has a grace period of up to three months to pay premiums before their coverage is cancelled. Health plans may not disenroll members during this grace period, and are not obligated to pay claims incurred during the second and third month if a member’s premium is unpaid.

Health plans are required to notify providers in the second and third month of the grace period about the possibility that claims may be delayed or denied in the event that the premium is not paid.

For members on our exchange products, providers will receive notifications only via 271 transactions. You can either submit a 270 HIPAA-compliant transaction and receive a 271 response or view individual eligibility status on Availity Essentials.

On the 271 transaction, the message that will appear for exchange members who are in their grace period will be: MSG*HIX GRACE PERIOD.

On Availity Essentials, the message that will appear on the Patient Information page, under Plan/Product Information for exchange members who are in their grace period will be: HIX GRACE PERIOD. The coverage information for exchange members who are in their first month of delinquency will show “Active.” Members who are in their second or third month of delinquency will show as “Active Pending Investigation.”

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What Happens To My Coverage If I Dont Pay My Bill On Time

You pay in advance for your coverage.

You confirm your enrollment when you make your first payment. So its important that you pay your bill on time and in full. If you dont, your plan could be canceled.

After making your first payment, you’ll have a grace period if you don’t pay your bill on time. You’ll need to pay anything you owe by the time the grace period ends. If you don’t, you could risk losing your coverage.

If your payment doesnt go through or you dont have enough money in your account to make the full payment, well send you a letter to let you know. As soon as you know, call the customer service number on the back of your Blue Cross ID card. Well take your payment over the phone so you’ll be able to use your coverage.

Is There A Penalty For Not Enrolling In Health Insurance When I Turn 26

We will make it only by grace

No, there is no longer a federal tax penalty for not having health coverage. However, some states have their own individual health insurance mandates.

While you may not be charged a penalty for not having health insurance, having continuous coverage can help you save money in the future. Even if youre relatively healthy right now, health insurance provides financial protection. Accidents happen, and a health plan protects you from high, unexpected medical costs.

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You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. Please click Continue to leave this website. Or, if you would like to remain in the current site, click Cancel.

This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jerseys Health Insurance Marketplace. This website does not display all Qualified Health Plans available through Get Covered NJ. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ.

Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross Blue Shield Association. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. The Blue Cross® and Blue Shield® name and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. The Braven Health name and symbols are service marks of Braven Health.

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Information in Other Languages

Blue Cross Blue Shield North Carolina

| March 16, 2021 | Insurance Education

You never plan to get sick or have a medical condition. So when the unexpected happens, having health insurance can give you peace of mind.

Health insurance also helps you maintain good health. People with health insurance are more likely to stick to routine care or check-ups when something seems a little off.

Here are a few stories from members sharing how health insurance has helped them in times of need:

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If Your Parents Health Plan Is Offered Through An Employer

You will qualify for a Special Enrollment Period. This means that you can apply for health insurance up to 60 days before or after your 26th birthday. Check with your parents health plan benefits administratior to find out exactly when your coverage ends. Some employers will allow you to stay on your parents group plan through the end of the plan year.

Where Do I Find More Information For Health Care Reform

Blue Cross and Blue Shield companies have a variety of resources to help you every step of the way. Here are 5 ways to find out more about health insurance.

  • to find your local Blue Cross Blue Shield company (If you aren’t a member yet, click “I don’t have my membership card” to search by state or zip code.
  • Visit AskBlue to learn more about healthcare reform and whether you might be eligible for help paying for your coverage
  • Visit to shop for healthcare coverage, or be directed to your local state exchange
  • 1-800-318-2596 or 1-855-889-4325 to speak with a representative from the health insurance marketplace
  • The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.

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    Why Get Health Care Coverage

    • We’re a name you can trust. With 80 years of experience, BCBSIL is a trusted name in health care coverage. Stay protected with a company that has stood by generations of Illinois families.
    • Accidents happen. Even if youre in good health, you never know when you might have an accident or get sick. A trip to the hospital could cost more than you might expect. Learn more about the benefits of health care coverage.
    • You may get financial assistance. BCBSIL has many health plan choices to fit your needs and budget. And if you earn less than $48,560 a year, you may be able to get help paying for your health care coverage costs. Estimate your subsidy, also known as a premium tax credit.

    You Can Stay On Your Parents’ Plan Until Your 26th Birthday

    The healthcare law requires insurers to allow young adults to remain on a parents plan only until their 26th birthday. If you are younger than 26, you can join or remain on your parents plan even if you are:

    • Attending school
    • Not living with your parents
    • Not financially dependent on your parents
    • Eligible to enroll in your employers plan

    When you turn 26, then you have the option of either joining your employers health plan or buying a health insurance plan individually either through the Marketplace or through an insurance company. If you do not buy a health insurance plan at all, then you may have to pay a fee.

    Up until you are 30 years old, you may qualify to purchase a catastrophic plan. A catastrophic plan, is only for single people under age 30, or people who qualify through financial hardship. Catastrophic Plans cost less money, but have fewer benefits. They include preventive benefits, but don’t cover as much when you are sick. And they usually have high deductibles.

    While insurance companies are required to allow parents to keep their children on their plan until age 26, your parents arent required to keep you on their plan. This is because you always have the opportunity to buy your own plan.

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    But I Heard That Open Enrollment Is Over Can I Still Apply

    Yes, you can still apply because YOU have a qualifying life event. Loss of Coverage is the most common life event, and thats what youve got. You turned 26 and aged off your plan. As long as you apply for coverage within 60 days of getting kicked off of your parents plan, your life event is legit, and you can get coverage outside of Open Enrollment, during the Special Enrollment Period.

    You May Be Eligible To Receive Financial Assistance

    Earning Points

    You may be eligible for financial assistance from the government to help pay for part of the cost of your health insurance coverage. If you qualify, the government will pay its portion directly to your insurance company, lowering the cost of your monthly premium payment.

    You can find out if you qualify for financial assistance using our financial assistance estimator.

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    I Want To Make Sure I Get That Discount

    If you think you might qualify for a discount, be sure to enter your income information and household size. If you have $0 income, youre a ringer for Medi-Cal. If you make over $17,000 a year and less than $47,000 a year, then youll likely get a discount on a regular plan. The lower your income is, the greater the discount that you get.

    As far as household size, if youre single, then just put 1. If youre married and/or have children, then count all the people that you include when you file your taxes. If youre married, you have to file taxes as married filing jointly in order to qualify for a discount.

    The discount is usually referred to as a government subsidy or an up-front tax credit. Up-front is the key word. If you qualify for a subsidy, then youll never have to pay the full price. Youll just pay the discounted price each month as your health insurance premium.

    Be Prepared For The Next Step

    Any coverage you had under your parents health plan can end as soon as the first of the month following your 26th birthday. This includes any Adult Vision and Adult Dental coverage you had with your parents plan.

    Heres where you need to be prepared so you dont experience a lapse in coverage. In the months leading up to your 26th birthday, find out if your parent who insures you is enrolled through an employer or through the Health Insurance Marketplace.

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    What Happens To Your Claims

    If you dont pay your bill on time, you will enter a grace period. If we do not receive payment in full, you may have to pay for any health care services you received during your grace period. Unless your plan has been canceled, well start your coverage back up as soon as we get your payment in full.

    If you are not eligible for the Advanced Premium Tax Credit or you bought your coverage directly from us, your grace period is 31 days. During that time your claims will be pended.

    If youre eligible for and receiving the Advanced Premium Tax Credit, your claims will be processed differently than normal during a 90-day grace period.

    • During the first month, we will pay your claims normally.
    • During the second and third months, your claims will be pended. That means theyll be held by us and will not be paid or denied. Any pharmacy claims will be rejected. Youll need to pay out-of-pocket for them.
    • After three consecutive months without payment in full, youll be responsible for any pended claims.

    A retroactive denial may occur after a service is performed and your provider has billed us for this service. Retroactive denials can occur when:

    Ways to prevent retroactive denials:

    • Be sure your premiums are paid on time.
    • Ensure that your provider has submitted the necessary information in situations where a prior authorization is required.
    • Be sure to know your benefits and do not use them without being sure your services are a benefit.

    Extension Of Dependent Coverage Up To Age 26

    The provision – Dependents have the option of staying on their parents group or family medical plan up to age 26 or re-enrolling in the plan. Dependents are eligible regardless of student, residency, employment or marital status.

    For Blue Shield plans – Blue Shield is applying this same extension of coverage to dental, vision, and life insurance* plans as well.

    For more information, please see our Frequently Asked Questions .

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    If Your Parent Bought Health Coverage Through The Health Insurance Marketplace

    You can stay on your parents plan until coverage ends on December 31 of that year, no matter when your birthday is. If you havent found other coverage, you can apply for a new health insurance plan during Open Enrollment. The Open Enrollment period typically begins in November and ends in December.


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    We do not sell insurance products, but there may be forms that will connect you with partners of who do sell insurance products. You may submit your information through this form, or call 855-617-1871 to speak directly with licensed enrollers who will provide advice specific to your situation. Read about your data and privacy.

    Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage. Our editorial staff is comprised of industry professionals and experts on the ACA, private health insurance markets, and government policy. Learn more about our content.

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