Health insurance is essential, but navigating it can be tricky — especially for younger adults and those on Medicare. Each group faces unique challenges that can lead to costly mistakes or denied claims. Understanding these pitfalls and how to stay healthy can save you time, money and stress.
WHAT YOUNG PEOPLE SHOULD KNOW
For younger adults, the biggest hurdle is affordability. Many lose coverage at age 26 when they age out of their parents’ plans. Without employer-sponsored insurance, they often face high premiums or confusing enrollment processes on the ACA Marketplace. Some opt to go uninsured, risking large out-of-pocket costs for emergencies. For individual coverage, research options online and opt for higher deductibles to reduce cost, but keep coverage in place.
WHAT MEDICARE BENEFICIARIES SHOULD KNOW
Medicare beneficiaries, especially those under 65 with disabilities, often struggle with enrollment complexity, limited provider networks and unexpected out-of-pocket costs. Mistakes like missing enrollment windows or misunderstanding plan coverage can lead to gaps in care or denied services. Contact an advisor to help you understand your options.
WHAT TO DO IF YOUR CLAIM IS DENIED
A denied claim isn’t the end of the road. Here’s how to respond:
- Review the denial letter or Explanation of Benefits (EOB) to understand the reason; it could be a coding error, lack of preauthorization or a coverage issue.
- Contact your provider’s billing office to check for clerical errors. They may be able to resubmit the claim.
- Call your insurance company to clarify the denial and ask about the appeals process.
- File an internal appeal with supporting documents like a doctor’s note. You must defend your position to the insurance company.
- You may request an external review if needed, and an independent third party may help overturn the denial.
- Persistence pays off, as more than half of appeals are successful.
STAYING HEALTHY AT ANY AGE
Preventive care is your best defense.
- Stay active: Aim for 30 minutes of movement most days. Strive for a healthy weight.
- Eat well: Focus on whole foods, lean proteins and healthy fats.
- Sleep enough: Quality rest supports immunity and mental health.
- Stay connected: Social engagement boosts emotional wellbeing.
- Get regular checkups: Health screenings can catch issues early.
Whether you’re just starting out or navigating retirement, understanding your health insurance and prioritizing wellness will help you live a longer, healthier life.