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  5. Law And Legal Studies
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  9. Banking, Finance And Securities Law
  11. Insurance Gaps At Age-19 And Age-26 Health Insurance Eligibility Thresholds By Childhood-onset Condition Severity, Colorado 2014-2018.
  1. Home
  3. Research Domains
  5. Law And Legal Studies
  7. Commercial Law
  9. Banking, Finance And Securities Law
  11. Insurance Gaps At Age-19 And Age-26 Health Insurance Eligibility Thresholds By Childhood-onset Condition Severity, Colorado 2014-2018.

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Insurance gaps at age-19 and age-26 health insurance eligibility thresholds by childhood-onset condition severity, Colorado 2014-2018.

Mercedes V McMahon1, Megumi J Okumura2, Sara L Toomey1,3

  • 1Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.

Health Services Research
|January 13, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Young adults experience significant health insurance gaps around ages 19 and 26, particularly those with chronic conditions. Addressing this "unwinding" is crucial for continuous coverage.

Keywords:
health policyhealth services researchinsurance coveragemedically uninsured

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Area of Science:

  • Health Services Research
  • Health Policy
  • Insurance Studies

Background:

  • The Affordable Care Act (ACA) extended health insurance eligibility but created specific age-related cutoffs.
  • Transitioning from dependent to independent health insurance coverage at ages 19 and 26 presents challenges for young adults.

Purpose of the Study:

  • To analyze health insurance gap patterns in young adults related to age-eligibility cutoffs for Medicaid and commercial insurance.
  • To identify disparities in insurance gaps based on prior insurance source and clinical severity.

Main Methods:

  • Descriptive analysis of Colorado all-payer claims data from 2014-2018.
  • Defined insurance gaps as ≥3 consecutive months without coverage.
  • Stratified analysis by insurance source (Medicaid/commercial) and clinical severity (chronic, complex, disabling conditions).
young adult

Main Results:

  • Insurance gaps peaked within six months of turning 19 and 26, affecting 8.9% of Medicaid and 8.7% of commercially insured individuals.
  • Young adults aged 27-28 had significantly higher gap percentages compared to younger individuals (11-18).
  • Individuals with disabling conditions initially on Medicaid had lower peak gap rates (5.7%) than those initially commercially insured (10.5%).

Conclusions:

  • Significant health insurance gaps occur as young adults age out of eligibility.
  • Targeted interventions are needed to mitigate coverage loss during these transitions.
  • Attention to the
  • unwinding
  • of insurance at ages 19 and 26 is essential for young adult health.