Kate Morgan, 25, hasn't seen a doctor for a checkup since before she went to college, when she saw her pediatrician at age 18.
"Nothing's bothering me, I don't have any symptoms, why go see a doctor?" reasoned Morgan, who recently moved from Voorhees, N.J. to Hummelstown, Pa. When she has needed medical care, she either went to the emergency department or visited an urgent care clinic.
For now she has insurance under her dad's policy, but that's ending with her 26th birthday next week. She works multiple part-time jobs, so she can't get employer-based insurance.
"I have no idea how the health insurance marketplace works or if I can afford it," she said. "I haven't looked into it because it's kind of daunting."
Morgan is not alone. According to the 2015 Investing in the Health and Well-Being of Young Adults report, only 55 percent of Americans ages 18 to 25 visited a doctor's office in 2009 and only 34 percent visited a dentist.
There are lots of reasons: feeling invincible, difficulty navigating the health care system, concerns about costs and co-pays, and the inconvenience of making an appointment and seeing a doctor or dentist. Under the Affordable Care America Act (also known as Obamacare), everyone who can afford it is legally obligated to get health insurance or pay a penalty. One of the main reasons some major insurers have cited for leaving the exchanges is the lack of young, healthy people signing up, leaving the exchanges full of older and less healthy people who cost more to cover.
How often a person should get a physical exam depends on whom you ask, said Janice Hillman, an adolescent-medicine physician at Penn Medicine.
"A medical provider will say once a year for an annual physical," she said. "But if you ask insurance, they'll say 18-34 year olds are your ideal patient population because they're never sick, so well-checks should be every two years and three years with some insurance plans."
But it's about more than an insurance quagmire. The millennials (19-35 year-olds) are a lost generation for health care, Hillman said. They hate to, as they see it, waste time and money; they don't place as much store as their elders on having a personal relationships with a provider; and they go to the internet for answers. When they do get sick, they choose retail clinics and emergency rooms for the convenience.
"Most millennials cannot believe that our outdated, inefficient system says, 'You're sick today, come in two weeks when I have an appointment for you,'" Hillman said. "So they go where they can be seen at the time and place of their choosing."
The health care system is taking notice. Online apps such as DocASAP and Zocdoc; telemedicine, where doctors work with patients via phone and web; and an increase in physician assistants who can examine, diagnose and treat patients, are gaining popularity. ERs are developing parallel tracks so they can accommodate true emergencies as well as patients who use the ER as a primary care office. Many doctors and hospital systems are communicating with patients through text messages, the favorite tool of the tech-savvy generation.
"The millennials want efficiency, value, to be treated with respect, and customer service, and we have to listen," said Hillman.
For some young adults, that means sticking with their pediatrician. The National Ambulatory Medical Care Survey analysis estimates that there were 700,000 visits to pediatricians by 19-28 year olds in 2002, 1.4 million in 2007 and 2.4 million in 2012.
The fact that they are seeing any doctor is good news, said Patience White, director at the Center for Health Care Transition Improvement, a group that studies the transition from pediatric to adult health care.
Karly O'Toole, 24, doesn't feel regular checkups are worth the trouble. "The doctor that I had is in West Chester and it's not easy to get there," said the Center City resident. An account executive still on her parents' insurance, she doesn't want to take time off from work or lay out the co-pay.
"It's more of a chore to me than it is a benefit. If I'm feeling okay, I don't feel the need to get a checkup."
O'Toole does see a specialist for a recurring heart issue and sees the gynecologist for birth control. But for anything else she'll consult her mom or the pharmacist, and if necessary, go to an urgent care facility. She eschews dentists.
Dental care recommendations include a cleaning every six months, four basic x-rays once a year and a full set of x-rays every four to five years, said dentist Jeff Cabot, owner of Queen Village Family Dentistry. But there's an obvious gap in the millennial age group, he said.
"Dentistry is best done on a routine basis," he said, noting that by the time there's pain, what could have been a simple filling might turn into a root canal or crown - or even systemic health problems.
"Gum disease increases your risk for heart disease, diabetes, low-birth-weight babies of pregnant mothers, and there's a connection with Alzheimer's disease because it's literally an infection that can travel through your entire body," he said.
Cabot chalks up the reluctance to young people feeling invincible, and also fear of the cost of dentistry.
"A lot of people think it's expensive but if you do it properly it can actually reduce your overall costs," he said.
That's what happened to Morgan. Though she was cavity-prone as a kid, until last year, she hadn't seen a dentist in seven years. When she finally did go, she needed extensive work. "Now I go regularly and am very much committed to dental care," she said.