Health coverage now that you're 26
Turning 26 is an important birthday when it comes to your health care coverage and eligibility. Up until now, your health insurance has probably been covered by your parent’s plan. Unless you have an exception to stay on their plan, turning 26 means that your health insurance will end. While health insurance can be overwhelming and a bit confusing, we’re here to help. Check out the helpful information below to learn more about health insurance and your plan options with Sentara Health Plans.
What is health insurance and why do you need it?
At the most basic level, health insurance helps protect you, financially, from unexpected sickness or injury. Health insurance will lower the cost for things like hospital and doctors’ bills, medications, or treatments associated with illness or injury. And often times, preventive care is covered in full, or at no cost to you.
When you choose a health insurance plan, you’ll pay a premium (a monthly fee) and in return the insurance company agrees to share the cost of covered medical services with you. Let’s look at a possible real-life scenario.
Meg and Kara both have sore throats that won’t go away. They both visit an urgent care and are seen by a provider. Both are tested for strep throat and prescribed a prescription to treat their diagnosis. Kara has no health insurance and Meg has an Individual & Family Health Plan from Sentara Health Plans. The graphic below illustrates their potential fees.
Meet Kara and Meg
Kara (uninsured)
Urgent care visit: $150-$250*
Strep test: $35-$50*
Prescription: $8-$40*
Total cost: $193-$340
*Costs are estimated.
Meg (insured by Sentara Health Plans)
Urgent care visit: $50
Strep test: $0
Prescription: $15
Total cost: $65
*Costs based on 2025 Sentara Health Plans Sentara Gold 800 Ded. Urgent Care visit may include the strep test, but the urgent care may file a separate claim for the test itself. If so, the test won't be free and the member will be charged the appropriate cost share of approximately $10-16.
If you’re on your parent’s plan through their employer, coverage typically lasts through the last day of your birth month. For example, if you turn 26 on May 5, then you are covered until May 31. Please note, some employer plans do offer coverage through the end of the year, so it’s best to have your parents confirm the coverage end date.
If you are on your parent’s Marketplace plan, coverage ends December 31 during the year in which you turn 26.
In either scenario, turning 26 is considered a qualifying life event so you do not have to wait for the annual Open Enrollment Period (Nov 1 – Jan 15). In order to keep yourself covered after your parent's policy ends, you can sign up for your own health plan under the Special Enrollment Period (SEP) - either at the end of the month or end of the year of your birthday.
There is a lot of terminology and acronyms when it comes to health insurance! Check out our resources where you can:
- Get definitions of common terms.
- Learn health insurance acronyms.
- Watch videos to better understand how health insurance works.
Our Individual & Family Health Plans offer more choices with a wide variety of deductible and copayment options to choose from and enhanced access to affordable, high-quality care. The plans also offer over a hundred preventive care services and prescription medications1 for men, women, and children—all at no charge.2 This includes your annual physical:
- Adolescent sports physicals
- Annual mammogram for women
- Statin medications for adults at risk for heart disease, and much more
- Our value-added benefits include on-demand virtual consults3
- A 24/7 Nurse Advice Line4
- Gym memberships and much more
You may also be interested in a plan created just for self-employed sole proprietors.
1 Check your Plan documents to find out which medications and services are covered.
2 Sentara Health Plans offers over 100 preventive services and medications that are covered at no cost to the member when administered by an in-network plan physician or pharmacy. An office visit copayment may be charged to health plan members for some services. To review a list of services that are covered, please visit sentarahealthplans.com/members/manage-plans/covered-preventive-services.
3 For most plans, virtual consults have no additional charge when accessed through our secure member portal or mobile app. Mental health and substance use disorder virtual consults may carry an additional charge. This is a separate benefit from telemedicine visits scheduled with a member’s provider.
4 Value-added services; not a covered benefit.
*bettercare.com/costs/urgent-care-cost-without-insurance, bettercare.com/costs/strep-test-cost, bettercare.com/costs/cost-of-antibiotics-without-insurance.