Picture this: You go to the doctor because you think you might have a sexually transmitted infection. It turns out you do. Your doctor prescribes an antibiotic, and everything seems fine — until the pharmacy calls your parents to confirm you are covered under their insurance.
This is a reality for legal adults under the age of 26 in the United States. Although this policy marks a huge improvement over being uninsured, being on your parents’ insurance means you forfeit some degree of privacy. The Affordable Care Act, passed in 2010, enabled young adults to remain on their parents’ or guardians’ health insurance until they turn 26. While it’s impossible to provide an exact figure, the number of qualifying adults who have taken advantage of this benefit stands in the millions.
“Sometimes young people don’t really know much about their health insurance or how it works, especially if they’re still on their parents’ plan,” says Dr. Holly Gooding, an adolescent medicine specialist at Emory University School of Medicine in Atlanta. “I think that’s a big part of this issue: helping people to understand the really complicated landscape of health insurance in our country.”
Here’s what to know about how it all works.
It’s complicated
At 18, you are legally an adult in the United States, but there are limits to how much privacy you can expect regarding your health care if you are covered by your parents’ insurance.
It’s routine for insurance companies, for example, to send an explanation of benefits to the parent or guardian who holds the insurance policy as part of their standard billing and claims processes. An EOB spells out the details of your visit, including any exams or tests you may have received.
The federal Health Insurance Portability and Accountability Act outlines rules for when insurers can disclose personal health information. HIPAA contains a privacy rule that allows patients to ask their insurer not to send an EOB form to their parents, but the insurer isn’t obligated to honor that request.
HIPAA also stipulates that people can ask that their health plan communicate with them at an alternate location. Someone might ask that EOBs be sent to a different address than that of the policyholder, for example.
Location matters
Lawyer Elizabeth Gray, a teaching assistant professor at George Washington University, says she thinks of HIPAA in simple terms: “It’s the bare minimum of privacy, like a lock you would get on a door from Home Depot. If states want to add additional locks to that door to keep people away from those patient records, they can.”
A number of states, including California, Colorado, Washington, Oregon and Maryland, have taken steps to clarify and strengthen the health insurance confidentiality protections in HIPAA.
Insurers in California, for example, must honor a member’s request that their information not be shared with a policyholder if they are receiving sensitive services such as reproductive health or drug treatment, or if the patient believes that sharing the health information might lead to harm or harassment.
If you’re uncertain about your state’s policy, check with your insurance company.
Doctors’ dilemma
When it comes to sensitive subject matters, doctors can choose or agree to keep their patients’ information private from their guardians. However, they can’t necessarily control other entities within the system that might do so, such as insurance companies that send EOBs to policyholders.
Gooding does her best to assure her teen and young adult patients that she will keep their conversations private and confidential — but she also makes a point to inform them about certain cases when she can’t.
“If they are thinking about hurting themselves or if they’re expressing suicidal thoughts, we need to inform other people about that so that we can keep them safe,” Gooding says. “If it’s one of the provisions that’s protected in my state, I will tell them that I will protect their privacy to the best of my ability, but that there may be other entities that could disclose their private information.”
Research confirms that teens and young adults may avoid seeking care for reproductive and sexual health issues because of concerns about their parents being privy to that information. People are also often reluctant to risk their privacy related to mental health, substance abuse treatment, gender-affirming care and, in some cases, vaccinations.
Gooding advises skittish patients to seek care either at a state or county health department, where services are typically free of charge.
Conversation starters
Gooding tries to encourage patients, especially living independently, to open up to their guardians — if, of course, they feel safe to do so. Research has shown that young people who talk openly with their parents about their sexual health have lower rates of STIs and unintended pregnancy.
“I encourage [young adult patients] to think about this as an opportunity to let their parents in on this aspect of their life that may not feel very comfortable to them,” Gooding says.