Maggie Walmsley was heading home from class at Cabrini College recently when her stepmother called with some graduation advice.
"She told me, 'You can't mess with your future, because our insurance company has your information, and once you graduate, you're off,' " says Walmsley, 21, of Drexel Hill.
Walmsley, who will graduate Sunday with a psychology degree, could stay on her parents' health insurance if she went for a master's degree. "My parents said I better get into graduate school. I'm covered by their insurance if I stay in school."
As commencement ceremonies get under way, graduates have more to worry about than a lousy job market. Graduation often marks the end of insurance coverage for young adults under their parents' employer-sponsored plans. Even graduates lucky enough to find jobs could end up in positions that don't provide health benefits.
Stefanie Swanson, 21, of Doylestown, who is graduating from Villanova University, recently caught up on her medical checkups in advance of her graduation - and loss of coverage - later this month. "I won't be covered by the end of May," she says. "Hopefully, nothing will happen between now and when I get a job."
Adults between the ages of 19 to 29 are among the largest and fastest-growing groups of uninsured people in the country, totaling 13.2 million in 2007, according to the Commonwealth Fund, a nonprofit research group.
Many young people lose coverage at 19 or when they graduate from high school. That's when they become ineligible for their parents' plans or for government programs, such as Medicaid and the Children's Health Insurance Program. Lower-income young people are hit especially hard.
The next big coverage drop occurs at college graduation.
"With the downturn in the economy, young people may now be even more vulnerable," says Sara Collins, an assistant vice president at the Commonwealth Fund. The unemployment rate for 20- to 24-year-olds reached 14.7 percent last month, up from 9 percent the year before, and "we know that when unemployment goes up, the number of uninsured goes up."
Young people can buy individual policies for $40 to $100 a month, but even a low-cost policy may be a stretch for someone who is working an entry-level job and has student loans. And some young people simply don't see the need for health insurance.
While young adults are generally healthy, they're at risk for serious problems, including accidents that land them in emergency rooms, and HIV and other sexually transmitted diseases. Chronic health problems, including obesity, high blood pressure, and diabetes, are on the increase among young people.
Lateefah Holder, 23, a Temple University senior and theater major, knows firsthand the steep cost of living without insurance. She lost coverage under her parents' plan three years ago after she became a part-time student. When she got the flu last year, she passed out, hit her head, and was hospitalized with a concussion. She's graduating this month with $5,000 in medical bills, along with $80,000 in college loans.
"At this age, you never think something is going to happen to you," says Holder, who is from Bloomfield, N.J., "but you're wrong."
Courtney Hope, 22, an aspiring screenwriter who graduated from New York University last year, has had no health insurance since August. She earns $400 to $500 a week working as a waitress and doing freelance work, but pays $750 a month in rent and has little money left after buying food and other necessities. She knows many other young people in the same situation.
"They don't go to the doctor, they use herbal supplements, they use the Internet as their doctor," she says. After losing her insurance, Hope, who is from Allentown, stopped getting acupuncture treatment for headaches.
Some states are trying to help young adults stay insured. About half the states have enacted legislation that requires insurers to extend coverage to young adults under their parents' or guardians' plans, even if they don't attend past high school.
"Since 2006, we've seen an exponential increase in the number of states that have passed these types of laws," says Laura Tobler, a health-policy analyst at the National Conference of State Legislatures, which tracks legislation.
Tobler says the state laws typically allow for coverage of unmarried dependents up to age 25, though the age extension rises to 30 in a few states. The laws apply to group plans that are subject to state regulation, as well as to individual policies in some states. It's up to parents to decide whether to keep an adult child on their policy, she says.
New Jersey has had a law since 2006 that extends coverage to age 30, and recently raised the limit to 31. About 15,000 young adults have benefited from the extended coverage (which also applies to the benefit plan for state employees), including 10,000 who are currently getting coverage, says Edward Rogan, spokesman for the state Department of Banking and Insurance.
In Pennsylvania, a bill to extend coverage for dependents to age 30 passed the House in March and is in a Senate committee.
"This is one of these commonsense measures that doesn't solve the health-care crisis, but it does provide a solution for some of the uninsured," says Rep. Mark Longietti (D., Mercer), who is sponsoring the bill.
But Ross Schriftman, an employee-benefits consultant at Kistler Tiffany Benefits in Berwyn, which sells group and individual insurance, says the laws, while broadening coverage, may shift the cost to employers or parents, who could end up paying higher premiums.
In any case, he says, young people should learn how to take care of themselves.
"Some parents have never taught their children to be self-reliant," Schriftman says. He says it's far better for young people to buy low-cost plans and learn how to manage health-savings accounts, allowing parents to save for their own health problems in old age.
Many insurers are targeting new graduates by marketing to their parents or by advertising on the Internet. Their message: Insurance can be affordable.
Independence Blue Cross, for instance, offers its Keystone HMO program starting at $76 per month.
Aetna offers individual plans to people ages 25 to 29 for as little as $41 a month, but prices can vary based on many factors.
Low-cost products can protect against a catastophe but may come with large deductibles. Consumers need to understand what they're buying, experts say.
Some parents may also be caught off guard when they realize their child is going to lose coverage. Kathy Staller, an executive secretary in the Philadelphia Law Department, says she panicked when she received notice from Independence Blue Cross that her son, Nicholas, who turned 23 in March, would be cut off from coverage May 1.
"God forbid if he got into a car accident," Staller says. She says her son, a business-finance major at Temple who recently lost his part-time painting job, could not afford a policy on his own. So she applied to enroll him in a basic Keystone HMO plan.
Temple senior Kevin Paris, 22, of Blakely, near Scranton, says his parents are insisting he get an interim policy to cover the few months when he's off their insurance plan but not yet covered through his teaching job with Teach for America in Mississippi.
"Both my parents are very adamant about me signing up for a private plan, while I'd be more willing to risk it," says Paris. He says he'll probably take his parents' advice. "As they put it, it's better to have it than not have it."