What to know about health coverage for young adults and disabled dependents
Health coverage for children doesn’t end when they turn 18. In fact, many plans let young adults and certain dependents with disabilities stay on a parent’s plan longer than you might expect. Here’s what to know about eligibility, benefits and steps to keep your loved ones covered.
Who is eligible for dependent health insurance coverage?
If a health plan offers dependent coverage, it must extend that coverage to adult children until age 26. This includes biological children, stepchildren, adopted children and, in many cases, foster children. Grandchildren and other relatives aren’t typically included unless formally adopted.1,2
Your adult child can stay on your health insurance plan until they turn 26 whether they are:
- Married or unmarried
- Living with you or somewhere else
- Disabled or not
- In college or working
- A dependent on your taxes or file separately
- Adopted or biological2
Generally, if the child could be on your plan as a child, they can stay on that plan until they are 26. Check your plan details if you’re not sure.
If your child is aging off your insurance, a short term health insurance plan may provide basic coverage for a limited time (up to 12 months in some states) while you decide your next step.3
How long can a dependent stay on a parent's health insurance plan?
If your family has an ACA Marketplace plan, your child can stay through December 31 of the year they turn 26.1 For other plans, your child may be ineligible the day of their birthday or the end of that month. After the age of 26, a child can stay on the parent’s health insurance plan if they have a documented disability and approval from the insurer.
How does coverage work for married or working dependents?
A common question is whether marriage or having a job changes things. The answer is no. Even if your adult child:
- Gets married
- Has a child of their own
- Is offered health insurance through an employer
They may still stay on your plan until they turn 26. The coverage does not extend to their spouse or children, though — just to the adult child themselves.1
Can a disabled dependent stay on health insurance after age 26?
Some dependents with disabilities may qualify to stay on a parent’s health plan after age 26. This may provide ongoing access to important care and medications.
Each plan may have its own rules. Typically, coverage can continue if:
- The disability began before age 26
- The person cannot be self-supporting
- The disability meets the plan’s requirements
- The family provides documentation and gets certification
Not all plans must extend coverage to disabled adult dependents after the age of 26. Whether your plan will extend this coverage depends on your state, how you get coverage and your plan specifics.4
Steps to take to keep a disabled adult dependent on your health plan
If you’re caring for an adult dependent with a disability and you want to keep them on your health insurance after they turn 26, take action as soon as possible. Notify your insurance company as soon as possible, ideally years before the dependent’s 26th birthday.
Each plan and insurer will have a unique process, but there are some steps that most families need to take:
- Notify the insurer and ask for the plan requirements
- Submit any required forms and medical documentation
- Receive certification from the insurer that they consider the dependent disabled
- Redo the process in regular intervals, as requested by the insurer
Recertification may need to happen with every plan year or less often.
Who qualifies as disabled to stay on parent’s insurance?
Your plan will have its own requirements for considering an adult dependent disabled. It’s important to get the requirements from the insurer, but there are some possibilities you can expect.
Many use the same definition as the Internal Revenue Service (IRS) uses for tax purposes. The IRS considers someone “permanently and totally disabled” if that person is, “unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
Some plans may also require you to submit financial documentation that shows that the dependent relies on you and does not work. State laws may apply when considering whether your adult dependent can stay on your insurance after the age of 26.
How does the Affordable Care Act (ACA) offer support for families with adult dependents?
The ACA made it easier for young adults to keep coverage during a time of transition. It requires most plans that offer dependent coverage to include children up to age 26, no matter their personal circumstances. It also protects dependents with disabilities, so they may continue to receive coverage past 26, when eligible.2
If a dependent ages out and doesn’t qualify for disabled coverage, the ACA also offers options through the Health Insurance Marketplace, Medicaid or an employer’s plan.5
Bottom line
Whether your child is heading to college, starting a new job or living with a disability, understanding dependent coverage can help you make confident choices about health insurance. Knowing the rules may help your family avoid gaps and stay connected to the care they need.
Share
More articles
More articles
Shopping for a plan?
Find what you’re looking for, from individual plans to Medicare and more. Learn about your options and get online quotes.