Under the Affordable Care Act (ACA), plans and insurers are required to offer dependent coverage up until a child turns 26 years old – but with certain exceptions.
Dependency eligibility depends on a number of different criteria, including if an adult is married, has children of their own, or lives away from the parents’ house.
Marital Status
In the US, marital status is defined by state law and is a legal status that impacts many aspects of an individual’s life, including accessing health insurance coverage. Married individuals typically have greater access to coverage due to having higher incomes which make securing health insurance through an employer easier.
One’s marital status may change throughout their lives. For instance, should they become widowed or divorced, their marital status will change to reflect that. This will have an immediate impact on obtaining health insurance coverage as well as any benefits related to being single.
Factors that may influence one’s marital status include age, duration of relationship and whether or not there are children involved. Furthermore, current financial status plays a part in one’s marital status: for instance if someone is struggling financially they may opt to remain unmarried or separate so as to ensure affordable health insurance coverage.
Modern society is witnessing a gradual evolution of marriage definition. More women are opting not to marry or have children, which has significantly altered how we see and treat marriages; with many states now legally recognising cohabitating relationships as marriages resulting in an intricate web of rules regarding married and unmarried statuses.
Marriage status can have an impactful influence on health insurance availability for families with children, particularly for married parents with jobs who work both part time and full time. This research brief presents rates of health coverage by family structure using nationally representative data from the Current Population Survey and compares coverage rates for households where both employed and unemployed parents work, exploring differences by both income level and racial/ethnic group membership.
Students applying for financial aid must provide information about the marital status of both of their parents. This should be indicated on Question 55 of the Free Application for Federal Student Aid (FAFSA). An answer should indicate either “Married or Remarried” if both are married and living together or “Single” otherwise; grandparent, foster parents, older brothers/sisters and stepparents do not count as parents unless legally adopted as such by a student.
Age
Under the Affordable Care Act, plans and issuers that offer dependent coverage must extend it until an adult child reaches age 26. This rule applies equally to both individual and family health plans.
To qualify as your dependent, they must live with you and receive over half their financial support from you (or have an order from court), although some states and plans have more specific rules – for instance New York allows individuals who meet specific criteria (biological children of insured, spouse/domestic partner’s children or legal guardianship arrangements) to be claimed as dependents.
Age requirements also apply to supplemental insurance plans like accident and disability plans; most require individuals be at least 19 years old in order to be covered as dependents under their parents’ plans.
Age limits for dependents may differ by state and insurer, with eHealth only covering people up to the age of 26 in its individual medical policies, while its supplemental accident and disability policies cover them up until age 50.
As children age, they will eventually need to find their own insurance policies on their own and plan accordingly. Understanding any age restrictions applicable to dependents will assist them with making this transition as smoothly as possible.
For instance, if your child is approaching 26 they should start exploring their options for new coverage before their birthday so that if their parent’s coverage changes they have a plan in place should it ever lapse.
If a married child becomes ineligible for their parents’ plan due to age, they can still gain coverage through either the marketplace or employer-sponsored plans. In certain situations, they might even qualify for Medicaid or COBRA depending on their personal situation – check with a local representative for details.
Relationship to You
If you are trying to decide between staying on your parents’ health insurance or purchasing it through the marketplace, there are a number of factors you should take into account. Some include understanding deductibles and in-network doctors/hospitals as well as cost. You could contact a licensed insurance agent who can discuss all your coverage options and assist in making comparisons between plans.
The Affordable Care Act permits children up to 26 years old to remain covered under their parent’s health plan; the specifics vary by state. To qualify, individuals must fulfill certain criteria:
These individuals must share a close relationship with you and meet your definition of dependent, typically including being your biological or step children, step children, legally adopted children or legally fostered children. Furthermore, they must reside with you and have established residency (having lived there more than six months) while not being able to obtain or afford health insurance on their own.
Relationship requirements do not have to be strictly limited to spouses and children; you can include in-laws and other relatives if they satisfy certain criteria. However, these individuals must be close relatives living with you, be eligible for health insurance through their job, claim tax dependent status from you as their taxpayer and cannot access coverage elsewhere – but rather be close relatives without accessing coverage from elsewhere or being claimed by tax dependent status from someone else in their family or having another relative provide them similar coverage.
One exception may apply if your ex-spouse has custody of the children; then, depending on your health insurance plan and contract(s), coverage could continue up until their 26th birthday or they can obtain coverage through COBRA or Marketplace plans.
Length of Residency
Residency programs provide advanced medical training over three to seven years and are an integral part of becoming a doctor, providing hands-on experience and guidance needed for independent practice of medicine. When selecting your medical school, ensure they have an exceptional record for placing graduates into residencies at prominent hospitals across the nation.
Under the Affordable Care Act, children can remain on their parents’ health insurance up until age 26. Once that point arrives, they must choose their own plan from either employer, university, or the insurance marketplace – loss of coverage from either your parent’s policy counts as a qualifying life event and thus opens a special enrollment period wherein you can enroll directly into one.
As soon as you turn 26 and remain on your parent’s plan, be sure to pay all monthly premiums on time. Understand how these payments impact the cost of health insurance in the future and remember if you’re married or living outside your parent’s home that submitting proof of both relationship and residency is required of both of you – this may involve providing copies of marriage certificate(s), lease agreements or proof of financial dependence such as joint bank accounts, credit card statements or auto registration as necessary.
Consider offering to chip in for yourself as well, particularly if being charged more for being an adult child is going to be difficult for you. Doing this could ease the transition into having your own health insurance while showing that you can financially cover this coverage yourself.