When Autumn Greene was 21, her mother died. Without warning, the young woman also lost her health insurance.
Greene, now 22 and a student at the University of Maryland Global Campus, had been covered under her mother’s state plan. No one told her that when her mother died, the coverage would end. Her father, who lives out of state and is disabled, could not add her to his insurance.
“I remember feeling complete dread,” Greene said. “As if losing my mother wasn’t enough, I now had to navigate life’s complex systems without much guidance.”
Greene’s experience illustrates a broader challenge. For many young adults, the transition to independent health insurance involves navigating extensive processes with limited support.
“There’s a lot of financial education that young people need to stay on top of,” said Shlomo Rosenstein, a health insurance broker based in Columbia, Maryland. “So many little details that could really play a big part of their lives down the road.”
A sudden loss
At the time of her mother’s death, Greene was in weekly therapy and under psychiatric care for bipolar II disorder and other mental health conditions. After losing coverage, she could no longer afford treatment. Her therapy office temporarily continued care during a short grace period, but it didn’t last long.
She said she enrolled in insurance through a job, but quit months later after experiencing workplace bullying, thereby losing coverage again. She earned too much to qualify for Medicaid, leaving her uninsured.
Without access to care or medication, Greene’s mental health deteriorated. She attempted suicide and was hospitalized, later receiving a $14,000 bill after being incorrectly told her treatment would be covered.
“It felt like I was being punished for losing my mother,” she said.
How the system works
Under the Affordable Care Act, young adults can remain on a parent’s health plan until age 26, with a 120-day window — 60 days before and after their birthday — to serve as a safeguard intended to ease the transition.
But the age 26 cutoff is just one of many moments when young adults find themselves thrust into the health insurance system with little preparation. For some, the disruption comes earlier: finishing school, losing a parent, or leaving the foster care system.
For others, it’s leaving a job or navigating the gap between temporary and permanent employment. These transitions often overlap with other major life changes — moving, completing a degree, starting a career — making an already complex process feel overwhelming.
The stakes rose in 2026, when pandemic-era tax credits expired and premiums climbed nationwide.
So, with the help of the Maryland Citizens’ Health Initiative, Maryland responded by making its Young Adult Subsidy permanent, offering additional state support for residents under 37.
Interviews with young Marylanders suggest that even with these protections, the system still fails them.
Betting on healthy
Insurance works by spreading risk. Most people pay premiums and use little care. A few get very sick or injured, costing far more than they pay. The healthy people’s premiums cover the sick people’s bills.
But not all healthy people get health insurance.
“It can be really easy to think ‘I’m young, I’m healthy, I don’t need it,’” said Dr. Kyle Fischer, a clinical associate professor of emergency medicine at the University of Maryland School of Medicine. “But at the same time, we forget that diseases like testicular cancer is a disease of young men. You might be perfectly healthy at 25 and then get cancer at 27. It’s just not worth it to take that risk.”
Faith Dew was working a contract job without benefits when she turned 26 and had to find her own insurance. After seeing plans that charged $500 a month, Dew settled on a limited-coverage plan offered by the Washington, D.C., government.
“I was like, I’m not trying to pay that,” she said.
Six months later, Dew felt her face being pulled in one direction. After going to the urgent care, she was referred to another doctor — but her insurance didn’t work in the doctor’s D.C. office so she traveled to Silver Spring instead and was told that she had a facial tremor and needed to see a specialist.
Months later, Dew was able to see a neurologist who confirmed that she had multiple sclerosis.
“I was overwhelmed,” she said. “I had seen people like (actress) Selma Blair with a cane and I warped that aspect of it.”
When Dew asked about starting treatment, her doctor warned her that nine times out of 10, people with her insurance are denied Kesimpta, the medication she needed for treatment.
So she had to wait until the following year to take Kesimpta after her new job’s benefits kicked in.
“The thing I would have done differently is gotten a job with benefits,” Dew said.
Lost in translation
The price tag of insurance plans is not the only barrier to being in control of the system.
For many, understanding insurance terms and rules presents a separate challenge.
Brokers who work with young adults say the biggest barrier is not cost — it’s confusion.
Wenxi Yu, a first-year UMD PhD student from China, thought she had an advantage. Before coming to the U.S., she worked in a hospital and her mother works in China’s insurance system. If anyone should understand coverage, it would be her.
But the American health care system shocked her. “Every time I want to see a doctor, I need to first check if they are in my network,” Yu said. “That was so weird to me.”
When she tried to find a dermatologist near her College Park apartment, the CareFirst portal returned zero results. Then came an unexpected $40 bill from a nutritionist she’d confirmed was in-network — a charge stemming from a mismatch between her online insurance card and her physical card.
Yu eventually sorted out her billing issue, but the experience left her wary.
“The first thing in my mind was that there must have been something wrong with my health insurance,” she said. “I can’t wait for something more urgent or serious to happen.”
Lydia Neidlinger, a 23-year-old former UMD graduate student, turned to ChatGPT for help in understanding insurance terms when her parents could no longer keep her on their small business plan.
“I literally asked, ‘What does HSA mean? What does deductible mean?’” she said. “The fact sheets are not that easy to understand.”
Neidlinger selected the plan with the lowest monthly premiums offered by her employer.
“If I got in a car wreck, it probably wouldn’t be very good,” she said. “But I took the cheapest plan.”
Turning 26
For many young adults, the 26th birthday marks a hard deadline — a sudden loss of coverage that can feel arbitrary and unforgiving.
Asli McCullers, a behavioral and community health doctoral student with the School of Public Health at UMD, studies how young people transition into adult systems. But, she has seen the consequences up close. Her older brother turned 26 and didn’t enroll in time.
“My parents were shocked when his name got crossed out immediately,” she said. “He was uninsured for a full year.”
His mistake became a family lesson. McCullers urges others to start early.
“Have a plan when you’re 24 — 25 is too late,” she said. “Start investigating and getting your options together.”
McCullers decided to do things differently. She worked as an as-needed employee at MedStar Health, which didn’t qualify her to receive benefits. She asked the company’s human resources department if she could transition to part-time status and subsequently received a promotion.
Others found success through different paths.
For 26-year-old Devin Gardner, who works at Capital One, insurance came through his job — a solid plan with reasonable premiums.
“I feel really lucky,” Gardner said. “My company takes really good care of me, but I know that’s not the reality for most.”
On the other hand, 26-year-old Petra Bauman used Medicaid as a bridge between jobs.
“I was quite unemployed, which made me a great candidate,” Bauman said.
The network
Maryland has resources for residents seeking health coverage: a permanent Young Adult Subsidy, an Easy Enrollment program accessible through state tax returns, the Maryland Insurance Administration, and a network of free brokers and navigators available through MarylandHealthConnection.gov.
Ruth Getachew oversees consumer assistance at the insurance administration and her team helps residents navigate denials and billing disputes for free.
“Health insurance is incredibly complicated,” Getachew said. “That’s why my team exists — to walk you through the process.”
She encourages people to take time understanding basic insurance terms like copay and deductible, and to shop only through regulated sources like state-based marketplaces or employer-sponsored plans. She also recommends calling providers before enrolling to confirm they accept the insurance.
For Autumn Greene, whose mother’s death left her uninsured at 21, navigating the health insurance system meant long hold times, multiple transfers, and sometimes being told that the person on the phone didn’t have the proper tools to help her.
Today, she has coverage through a part-time job at Amazon and financial assistance from the state marketplace.
But Greene lives with the lasting impact of losing access to consistent mental health care at a critical moment.
“The consequences of being uninsured almost cost my life,” she said.