Turning 26… A Short Story of Health Insurance Woes…

Health insurance turning 26 birthday card

Do you lose your health insurance dependent coverage on your 26th birthday, at the end of the month or at the end of the year?

I turned 26 this year. Other than experiencing a mid-20s crisis, this basically had one major implication for me – loss of my health insurance dependent coverage on my parents’ plan. Since I’m working on a startup right now and don’t have a large employer to offer me coverage, this meant I now had to purchase “Obamacare” (i.e., health insurance on the exchanges).

But I don’t want to talk about that. I want to tell you first-hand how ruthless the health insurance companies can be… BCBS in particular…

My doctor called in a prescription for me on July 24th, one day before my 26th birthday. (Keeping in mind the “26 year old loss of coverage deadline,” I made sure this was done beforehand). Now I had remembered reading that when exactly your coverage terminates depends on your policy. In fact, according to BCBS’ website, termination can be:

“…the day the dependent turns 26, the end of the month in which they turn 26, or the end of the year in which they turn 26.”

Even if it was the former, I was good cause my doctor punctually put in the order before my birthday.

Or so I thought…

I went to CVS to pick-up my prescription on July 24th. They said they didn’t have the item in stock and would have to call it in to another nearby branch. I didn’t have time that day so I thought to pick it up the day after.

On my birthday, July 25th I go to the other CVS store with my fiancé. After spending 15 minutes updating them with my health insurance information, they regret to inform me my health insurance is expired and would not be covering this prescription, despite it being called in before the deadline. Now I would have to pay $300+ out-of-pocket versus the $20 co-pay that I would have paid if I was insured (i.e., if CVS had had it in stock the day before).

Turns out my plan, a solid PPO plan from one of the largest health insurance companies in U.S., had the most restrictive dependent coverage policy clause: loss of coverage on “…the day the dependent [me] turns 26.”

Happy Birthday.

I didn’t end up paying the $300 – funny thing is I got the same medication for five bucks on my India trip a couple weeks after.

This is the state of health care purchasing in America.