Roughly 15% of 26-year-old Americans, no longer on family plans, are uninsured — the highest rate of any age group. And the problem’s set to get worse

And, due to legislative changes affecting healthcare access, some are saying the problem is about to get worse.

The coverage ‘abyss’ at 26

Currently, young adults are allowed to receive coverage under their family’s health plan until they turn 26 years old, under law established in 2010 by the Affordable Care Act (ACA). Prior to this, most were kicked off family plans at age 18 or 21.

Prior to the ACA, young adults between 19 and 25 were “more likely than any other age group to be uninsured, given that many aged off of their parents’ plans or Medicaid/CHIP at 18, and few were working in jobs that provided health benefits,” according to a brief by the U.S. Department of Health and Human Services. That improved under the ACA, with the uninsured rate dropping from 31.5% to 13.1%.

The idea behind this change was that, by age 26, young adults would be more likely to have a job with a health plan. And even if they didn’t have a plan, they would have access to plenty of options via online health insurance marketplaces through the ACA.

But Rep. Maxwell Frost, who is the first Gen Z member of Congress, told The New York Times that even though the ACA was groundbreaking legislation. “There are pitfalls, and one of them is that when young adults turn 26, they fall into this abyss.”

Not all 26-year-olds can find a job with a health plan — or even a job, for that matter. Many Americans in their 20s are struggling to find full-time work or relying on gig work to get by.

Organizations with 50+ employees are required by ACA to offer health insurance to anyone working 30+ hours a week. But The New York Times says that this has led to many workers being brought on as contract employees whose work weeks don’t exceed 30 hours.

An analysis by KFF, a nonprofit health research group, found that 15% of 26-year-olds go uninsured — the highest rate of all age groups.

For those who are able to stay on a parent’s plan until age 26, turning that age often exposes the limits of the system. Many young adults then face a marketplace that can be more daunting than dependable.

Higher costs, narrow choices

For anyone whose employer doesn’t offer health coverage, online health insurance marketplaces exist through the ACA to provide options. But these marketplaces can be hard to navigate, and offerings vary by state (and by quality).

“Plans sold in the online insurance marketplaces have no stringent quality standards. Costs keep rising, and eligibility requirements and subsidies are a moving target,” according to Elisabeth Rosenthal and Hannah Norman of The New York Times.

Research from KFF shows that even if someone is eligible for Medicaid or subsidized marketplace coverage, “they may not be aware of these coverage options or may face barriers to enrolling.” KFF also points out that, in some cases, “even with subsidies, Marketplace coverage may not be affordable.”

Enrollees in marketplace plans “continue to struggle with high out-of-pocket costs, such as deductibles, coinsurance and copayments,” according to findings from the Center on Budget and Policy Priorities.

As a result, some may opt for a limited plan because it’s all they can afford, leaving gaps in their coverage. Or, they may end up with a plan that has a ‘narrow network,’ meaning access is restricted to a limited selection of doctors and hospitals.