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Achieving Universal Coverage



What Young Adults Should Know About Open Enrollment

young adult registering for flu shot

Open enrollment in the Affordable Care Act (ACA) marketplaces begins this Friday, November 1, and runs through Sunday, December 15, in most states. Six states and the District of Columbia have extended deadlines. During last year’s open enrollment, more than 11 million customers enrolled in marketplace plans; one-quarter of those were between the ages of 18 and 34.

Young Adults’ Uninsured Rate Dropped Significantly After the ACA

Young adults have made the largest gains in insurance coverage of any age group since the ACA began. Major provisions in the law, including subsidized private insurance in the marketplaces, expanded eligibility for Medicaid, and the option to stay on a parent’s health plan until age 26, helped young adults get affordable health coverage. (In some states, including New Jersey and New York, young adults may stay on parents’ policies even longer.) However, despite substantial gains made since 2010, young adults are the group most likely to be uninsured. Uninsured young adults are disproportionately Latino and low-income.

The ACA’s dependent coverage provision went into effect in September 2010. By 2011, the uninsured rate among those ages 19 to 25 dropped from 33.8 percent to 27.9 percent, while it held steady for those ages 26 to 34. In 2014, eligible young adults could sign up for coverage in the marketplaces and many qualified for either subsidies or Medicaid. As a result, the uninsured rate among young adults dropped dramatically in that year and, by 2016, had fallen to 13.9 percent among those ages 19 to 25 and 16.4 percent for those ages 26 to 34. Unfortunately, the coverage gains for this age group have stalled since then. An estimated 10 million people ages 19 to 34 were uninsured in 2018.1

Young Adults Are Concerned About Affordability, Many May Be Eligible for Marketplace Subsidies or Medicaid

Young adults who go without insurance because they don’t anticipate needing health care have, in the past, been referred to as “young invincibles.” In 2018, the majority of uninsured young adults did not visit the marketplaces. When asked why, only 16 percent said it was because they didn’t think they needed it. One-third reported affordability concerns. But half of uninsured young adults in 2018 had incomes that may have made them eligible for either expanded Medicaid or subsidized marketplace plans.2 Last year, most people who visited the marketplaces and selected plans received financial assistance to pay for them. On average, those who received financial help paid $87 per month for their premiums.

Now Is the Time to Sign Up for Coverage

If uninsured young adults do not sign up during their state’s open-enrollment period, they will not be able to get coverage through the marketplaces in 2020. However, anyone who loses coverage during the year — for example, because of a job change — can qualify for a special enrollment period. People with incomes under 138 percent of the federal poverty level (about $17,000 for an individual) can enroll in Medicaid at any time in expansion states.

Going without insurance disrupts access to doctors, introduces barriers to care when it is needed, and leaves young adults and their families at risk for high out-of-pocket costs if they experience a serious illness or severe injury. For example, adults ages 18 to 24 have the highest rate of injury-related visits to the hospital emergency department of all age groups. Preventive services like vaccines are free under the ACA and help young adults stay healthy. Young adults who need coverage but don’t sign up for it could experience devastating consequences to their health and financial well-being.

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1 Analysis of the 2019 Current Population Survey by Ougni Chakraborty and Sherry Glied of New York University for the Commonwealth Fund.

2 Authors’ analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2018.

Publication Details



Munira Z. Gunja, Senior Researcher, International Program in Health Policy and Practice Innovations, The Commonwealth Fund

[email protected]


Munira Z. Gunja, Gabriella N. Aboulafia, and Sara R. Collins, “What Young Adults Should Know About Open Enrollment,” To the Point (blog), Commonwealth Fund, Oct. 31, 2019.