Updated Sept. 9, 2019: More than 2 million people ages 19 through 25 gained health insurance in the years following the passage of former President Barack Obama's health care law, which allows young adults to stay on their parents' plans until age 26.
Post-Obamacare, these young adults had access to health care, but it also risked exposing their private health information to the policyholders — their parents.
How privacy affects health care
People are less likely to seek health care if they're concerned about confidentiality, especially when it comes to sexual or reproductive health, said Lauren Wisk, assistant professor of pediatrics at Harvard Medical School. People seeking mental health care like drug treatment might also not want their parents to know.
"Even something that isn't necessarily a sensitive service, people might want to keep that private for whatever reason," Wisk said.
People might be more likely to skip care if they're worried about confidentiality. But that can be risky and sometimes unnecessary. Young adults on their parents' plans have ways to keep their health information private.
Federal health privacy laws require providers and health plans to let people ask for confidential communications if they feel revealing their health information to the policyholder will put them in danger. Federal law also prevents insurers from revealing patients' HIV status.
States adopted similar regulations even before Obamacare, but the issue gained more visibility after the law put many more adults on their parents' plans, said Abigail English, director of the Center for Adolescent Health and the Law, a research organization.
Even if no danger exists, you can always talk to your provider about how services get billed and how they communicate with patients, Wisk said. Providers will often comply with a request for confidential communications even if there's no strict legal requirement as long as the request is reasonable.
When dealing with insurance companies, read your policy to learn how the plan communicates with policyholders. You can contact the insurer before any sensitive services to make sure billing or other information is only sent to the people you want.
Remember: Providers and insurance companies aren't required to do this under federal law. It's up to them whether they comply with requests from dependents. But some states are filling the void to provide more privacy protection for young adults.
Massachusetts passed a law this year that would give patients control over how and where insurers send payment information. California has a similar law, and a handful of other states offer similar protections, English said.
There's not only variation in state laws, but also how insurers comply with those laws, English said, so it's best to contact your insurance company to learn exactly how they handle privacy issues. (Learn who exactly controls your health data.)
What to do if there's a privacy breach
Given this inconsistency, it's possible parents may find out about their dependents' private health information. If this happens, contact the provider and insurance company to get ahead of further breaches, Wisk said.
"I would pursue it very assertively with the company and ask to speak to supervisors," she said.
If the company has violated federal law, you may want to file a complaint with Office of Civil Rights at the Department of Health and Human Services. You may also contact your state insurance commissioner. But once your confidentiality is breached, there's not much you can do to put the cat back in the bag. That's why it's important to take steps to keep information from getting leaked in the first place, Wisk said.
"Young people really need to be proactive and seek information from their health plan about what measures are available to protect their privacy, and then take action to make use of whatever protective measures are available," she said.