Understanding the ins and outs of health insurance can be confusing. It can be especially stressful if you’re a young adult living with a chronic kidney disease (CKD) such as C3 glomerulopathy (C3G) or immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN).

Knowing how health insurance policies work and what you should look out for can help you get coverage for the care you need. It’s essential to reach out to your insurance company if you have any questions about your health insurance policy.

Here are some tips for young adults living with C3G or IC-MPGN as they navigate health insurance.

Consistent Health Insurance Is Essential

Both C3G and IC-MPGN are rare kidney diseases that often occur in young adults and require lifelong care. Health insurance is important because these conditions can vary among individuals and be complicated to treat.

Treatments for C3G and IC-MPGN are changing. People with these conditions require specialized care, costly therapies, and ongoing monitoring for disease progression, kidney function, kidney damage, or kidney failure. Expensive tests are frequently needed as well.

Depending on what a kidney biopsy (examining a small kidney sample) shows, a range of therapies may be needed for either C3G or IC-MPGN. Along with treatment for high blood pressure, you may need immunosuppressants, corticosteroids, complement inhibitors, or other therapies to treat nephrotic syndrome, abnormal immune system activity, or other complications.

The cost of care may be high, and health insurance can help you continue treatment and maintain your quality of life.

Health Insurance Can Change for Young Adults

Several factors can affect health insurance for young adults. Staying in school, getting older, and getting or losing a job are some of the situations that can affect your eligibility for various health insurance policies.

Keep in mind that regulations may vary depending on which state you live in.

You May Be Able To Get Coverage on a Parent’s Policy

If you’re under age 26, you may be able to get health insurance coverage on a parent’s plan. A parent’s job-related health insurance typically allows for coverage of offspring up to the age of 26, even if you don’t live with your parents, aren’t considered a tax dependent, or get married.

In some states, you may be able to stay on a parent’s job-related insurance past the age of 26. It’s important to check the specific guidelines of the policy.

If you have a parent who is insured by the U.S. government-regulated Health Insurance Marketplace — also known as the health insurance exchange — you may also be eligible for coverage. Many young adults can get coverage on a parent’s plan up until the end of the year that they turn 26.

If your parent takes a tax credit for the plan and you’re a tax dependent, you would be eligible for a parent’s Marketplace plan. If your parent doesn’t take a tax credit, you would be eligible even if you aren’t claimed as a tax dependent.

If You’re a Student, Your School May Offer Health Insurance

Many colleges and universities offer health insurance plans for students. If your school has a student health plan, you may still be eligible for coverage through the Health Insurance Marketplace, which may be less expensive.

Insurance Can Vary Depending on Your Employment

Many full-time jobs offer employee-sponsored health insurance (ESHI). If you lose your job, you may be able to keep your ESHI for a limited period of time through COBRA, a federal law that allows workers to maintain health coverage in some circumstances. However, you would be responsible for as much as 102 percent of the cost of an insurance plan.

If you can’t get health insurance through an employer, or you’re self-employed, work as a freelancer, work part-time, or lose your job, you can apply for coverage through the Health Insurance Marketplace. Health insurance through the Marketplace is often more affordable than COBRA.

If your income is low or you’re unemployed, you may be eligible for free or low-cost health insurance through Medicaid, a program that is operated in partnership between states and the federal government. Eligibility for Medicaid varies between states.

Medicare Is Available for People With Kidney Failure

Medicare is government health insurance that is usually available to people age 65 and older. However, you may qualify at any age if you have kidney failure, also called end-stage renal disease, and need dialysis or a kidney transplant.

You Can Only Enroll in Health Insurance at Certain Times

Health insurance plans generally have open enrollment months when you can sign up for health insurance or make changes to your health insurance policy. If you have health insurance through an employer, they can advise you about open enrollment for the policies they support, which can be different in every state.

Health Insurance Marketplace plans usually have open enrollment from November 1 through January 15 in most states. Medicaid and CHIP are different because you can apply for them at any time of year if you qualify.

Certain life events may allow you to enroll in a health insurance plan outside of open enrollment dates, such as:

• Loss of an existing health insurance plan
• Marriage, divorce, having a child, or death
• Some changes in residence
• Changes in income that affect eligibility for some types of insurance coverage
• New U.S. citizenship

It’s Essential To Understand How Your Policy Works

It’s important to review the details of a health insurance plan before you enroll. You want to be sure that a policy will cover office visits, specialized care, tests, medications, and other healthcare you may need for C3G or IC-MPGN. Each health insurance plan will have a benefits package that describes what is covered.

Many plans only cover certain doctors and nephrology specialists who are in their network. Many health insurance plans also require prior authorization for some types of care. This means you need to talk to someone at the insurance company before you have a test or procedure.

It’s also important to understand the costs associated with your plan. Depending on where you get coverage, there’s usually a monthly premium, and there may be additional out-of-pocket costs that you’ll be responsible for.

Out-of-pocket costs may include:

• Copays — Extra costs for prescription drugs, in-person doctor visits, blood tests, or other medical services
• Deductibles — The amount you pay before insurance starts covering costs
• Coinsurance — The percentage of costs you pay after you meet your deductible

You Can Get Help With Navigating Health Insurance Policies

If you need help understanding your health insurance options or have questions about the health insurance coverage you already have, there are professionals you can reach out to, including:

• Social workers or benefits coordinators who work at clinics or hospitals
• Human resources personnel where you work
• Insurance company representatives
• Marketplace navigators

Your healthcare team may be able to help you find someone who can provide health insurance advice. Importantly, your condition or life events may require you to change health insurance at various times. Staying organized and getting professional advice are key to maintaining your healthcare needs.

Steps To Take if You’re Denied Coverage

If your insurance company denies a claim and refuses to pay a medical bill, you may want to appeal the decision. Your doctor can help you with an appeal if you need evidence that medical care was needed.

You may also be eligible for financial assistance for your medical care if you’re having trouble paying despite having health insurance. Organizations that provide financial assistance include:

• American Kidney Fund
• Patient Advocate Foundation

You may be able to get help with paying for medications through a drug discount program. Some drug companies offer prescription assistance programs for people with kidney disease.

Join the Conversation

On MyKidneyDiseaseTeam, people share their experiences with kidney disease, get advice, and find support from others who understand.

Are you a young adult with C3G or IC-MPGN who has had problems with health insurance? Let others know in the comments below.