Written By: Lisa Esposito
Updated (Feb 2012) by: Amy Sutton, Contributing Writer & HBNS Staff
This updated Prepared Patient feature offers advice for young people who are just starting out in managing their health care, including information on important provisions from the Affordable Care Act.
Your parents still might be willing to do your laundry, but if you're over 18, they can't make your medical decisions. Are you ready to navigate the adult health care system?
Len Ward, a Louisville, Ky., freelance writer in his late 20s, was born with a rare condition called endocardial cushion defect. Fortunately, he was symptom-free since his second open-heart surgery at 8 years old into young adulthood.
"I have a cardiologist," Ward said. "He's a children's cardiologist but he's well-versed in my condition. He's the only one who knows that much about it. For the foreseeable future I will be sticking with these doctors."
All too often, the health care system fails to keep up when children with chronic conditions reach adulthood, said Patience White, M.D., a professor of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences.
"It's not unusual for a young adult with a medical condition to be without a medical home or age-appropriate health care," said White, who is chief public health officer of the Arthritis Foundation. Moreover, the bulk of young American adults do not interface with the health care system during their adult years.
So what's wrong with that?
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You Have Adult Health Needs
Emerging adults "may not have heart disease but they have risky behaviors," said Angela Diaz, M.D., program and research director of the Mount Sinai Adolescent Health Center. Young adulthood is a time for safe experimentation, but in fact, common not-so-safe behaviors include unprotected sex, substance abuse, violence and preventable injuries.
Getting to know the health care system with regular screenings and checkups can pick up problems that would otherwise progress unrecognized and untreated.
The Agency for Healthcare Research and Quality says that check-ups should include blood pressure and BMI monitoring along with a comprehensive exam with cholesterol tests. Providers can make sure tattoos or piercing sites are intact and infection-free, offer counseling on alcohol misuse and screen for depressive disorders.
The Centers for Disease Control and Prevention also recommend regular STD screenings, including HIV screening, for sexually active young adults. Sexually active women 25 or younger should receive regular screening for the STDs chlamydia and gonorrhea because women in this age group have the highest rates of infection. The CDC also recommends that women should receive regular Pap smears to check for changes that might suggest cervical cancer starting at age 21 or within 3 years of the first time they have sex.
Think shots are just for kids? Think again. Immunizations, such as those for human papillomavirus (HPV), meningococcal disease and hepatitis A and B, also play an important role in protecting the health of young adults.
In addition to shots and checkups, young adults might need to get their lifestyle in sync to protect their health. Obesity rates for young adults are skyrocketing. Balanced nutrition also can be a problem for vegetarians or vegans. Some young adults have tried to quit smoking or find themselves struggling with substance abuse problems, but find they can't do it alone.
Your Way In: Gaining Access
Fortunately, there's help for young adults seeking the answers to their health problems. Older teens are "wonderful health care consumers," Diaz said. "For instance, we have a 24-hour on-call doctor. The kids use this appropriately, they don't abuse it."
"At the Mount Sinai Center, 10,000 New York City teens and young adults have access to free mental health, reproductive care, primary and acute care, and specialty care: for obesity, eating disorders, Gay/Lesbian health issues, interpersonal violence, and pregnancy prevention and treatment," Diaz said.
Some young people find that making the transition to adult health care is a bit uncomfortable. Inevitably, though, comes the time to cut the apron strings. At the Sinai Center, "the official age is 10 to 22," Diaz said. "Sometimes they don't want to go."
Although you seldom see adult patients in pediatric practices, "it still is a shock when a youth and their family learn that they cannot continue to be seen by their pediatrician," White said. The fact that there's no posted policy that warns you that you will have to move on to an adult health care provider is amazing.
Another bridge to the adult health care world might be the military health system; for others, it's college.
The University of Maryland Health Center in College Park serves a student body of 37,000, and includes a women's health center, mental health unit and an urgent care clinic as well as an orthopedic surgeon onsite once a week.
Between freshman and senior year, students do pick up patient skills, said Kelly Kesler, former assistant director of health promotion at the health center.
Some health visit basics they might not have known: "Okay, you can't just walk in and they're going to see you right now. You need to make an appointment,' Kesler said. Or at the pharmacy, some student had never had to bring in their own prescriptions. Some aren't sure of the difference between a generic and name-brand medication.
The transition process "is pretty straightforward," White said. "You need to know how to communicate about your medical condition and what to do to stay healthy, have a copy of your medical record, know how to make a doctor's appointment and get your prescriptions. You should learning these skills at 13 and have a transition plan by age 14."
Yet some 25-year-olds might not be able to say with confidence (1) "I know my medication and dosages," (2) "I know when to call my health provider to report a change in illness status" and (3) "I have an emergency plan."
Can you fill in the blanks about your family medical history? Could you locate your medical records? Could your kids?
"I believe my current cardiologist has all my medical records," Len Ward said. He doesn't sound too sure. "I wouldn't know where to start," added Ebonie Williams, a social worker in Manassas City, Va.
Taking control of your medical record doesn't have to be a big deal, White said: 'I just discuss what's in it and give it to kids on a flash drive; you just download it. They just put it on their computer. I ask them to keep it in a secure place where it stays confidential.'
'I can't emphasize enough the importance of prevention: learning stress-management techniques now, basics like sleep hygiene,' Kesler said. Above all, college health care 'is an opportunity for students to learn about advocating for themselves.'
Health Insurance Changes and Challenges
High school graduation, leaving for college, navigating in an increasingly tight job market - young adults face a lot of changes and moves. In the midst of all those shakeups, finding health insurance coverage often gets lost in the shuffle.
'This age group needs access and services but are least likely to get it,' Diaz said. In 2008, three out of every 10 uninsured persons was a young adult.
But thanks to recent changes to health care coverage laws, young people have increased options when it comes to coverage. The Affordable Care Act legislation, effective September 2010, means that parents can keep young adults on their health insurance plan until age 26. In the past, coverage ceased by age 18 or 21, leaving young adults who couldn't get coverage through employment adrift without many options.
Now, even young adults who are married, not living at home or not in school can be added to a parent's plan, as long as they're not eligible for coverage through their own or a spouse's employer. Research shows that a significant percentage of young adults are saying "Sign me up!" A 2011 survey of health care providers found that at least 600,000 young adults joined their parents' insurance plan within a few months of the passage of the law.
But having insurance doesn't always mean access to care will be easy.' Many recent college graduates no longer live in the same city or even state as their parents'and consequently, their health insurance networks. Finding a provider who will accept a particular plan'or even finding out if a given provider will accept a plan'can be tricky. Websites such as ZocDoc.com or a family's insurance provider's website might be a good place to start, but youth and families may need to make some phone calls to verify coverage.
Of course, for some young adults, insurance through their parents still isn't an option. If their parents can't or won't cover the cost of premiums and young adults are unable to pay, if parents don't have access to health care plans at their place of work or if parents are on Medicare, young adults may need to find coverage through an individual insurance plan (see sidebar for more information about finding an individual plan). And more changes are coming; by 2014, Medicaid requirements are set to expand, and many young adults with low incomes will be eligible for Medicaid insurance coverage.
In any case, a spirit of independence and advocacy - and a willingness to embrace developing changes in health care - can serve young adults well as they start navigating the health care system on their own.
'Students have an advantage over older folks like us,' Kesler said. 'They are very much attuned to health technology. They visit respected health consumer Web sites, they can use their iPhones as pedometers and they can use a variety of apps to track their health' online.