DETAILS ON DEPENDENT COVERAGE TO AGE 26 UNDER REFORM

On Monday, May 10, 2010, the Employee Benefits Security Administration (EBSA) of the Department of Labor, along with the Departments of the Treasury and Health and Human Services released Interim Final Rules (available at http://www.dol.gov/ebsa/pdf/dependentcoverage.pdf ) implementing the extension of dependent coverage for children up to age 26 as part of the requirements under the Patient Protection and Affordable Care Act (referred to as The Affordable Care Act).  The EBSA also released a Fact Sheet (available at http://www.dol.gov/ebsa/newsroom/fsdependentcoverage.html) and FAQs (http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html) describing the extension of dependent coverage.

Under the Act, all plans and insurance issuers that offer dependent coverage must offer coverage to an enrollee’s adult children whether married or unmarried until the child reaches age 26, even if the adult child no longer lives with the parents, is not a dependent on a parent’s tax return or is no longer a student.  (Plans that do not provide dependent coverage are not required to do so under the Act.)  However, this extended eligibility does not apply to the adult child’s spouse or children.  This expansion of eligibility is effective for plan or policy years beginning on or after September 23, 2010. Calendar year plans will have to comply as of January 1, 2011.  Under a transition rule, if the adult child has another offer of employer-based coverage other than a parent’s coverage, plans would generally not have to provide extended dependent coverage to that child until 2014.

For plan or policy years beginning on or after September 23, 2010, plans and issuers are required to give adult children who qualify a special enrollment opportunity that continues for at least 30 days even if the plan offers a periodic open enrollment period.  Plans and issuers must provide a written notice of this special enrollment opportunity no later than the first day of the first plan or policy year beginning on or after September 23, 2010.  The rules provide that any qualified adult child must be offered all of the benefit packages on the same terms as are available to similarly-situated individuals who did not lose coverage due to a cessation of student status.

HHS Secretary Kathleen Sebelius has asked leading insurance companies to begin covering adult dependent children voluntarily before the Act’s implementation date.  Over 65 companies have agreed to cover adult dependent children who graduate from school or age off of their parent’s coverage before the Act’s implementation date, including Aetna, Blue Shield of California, CIGNA, Kaiser and Wellpoint (parent of Anthem). 

Regulations relating to grandfathered health are expected to be published in the very near future. The regulations released on May 10 included a statement that the Departments anticipate that the regulations on grandfathered plans will make clear that a plan will not lose its grandfathered status if it voluntarily complies with the age 26 rules before being required to do so.

327 Responses to DETAILS ON DEPENDENT COVERAGE TO AGE 26 UNDER REFORM

  1. jill says:

    our son is 24 and will turn 25 on 7-29-2010. he is currently covered under my husbands employers health insurance plan. the company, suncor energy, is a self insured plan administered by cigna. suncor energy has determined my sons insurance will terminate when he turns 25 in july 2010 and he will not be allowed to re-enroll until 1-1-2011 when the plan year starts over. i understand many companies including cigna have chosen to retro back to 1/1/2011 but because suncor is a self insured plan they do not have to comply with this decision. this is an extreme injustice. my son will be terminated 7/2010 and will not be able to re-enroll until 1-1-2011. is there anything being done to mandate self insured plans to retro the dependent age back to 1/1/2010? my son works fulltime, graduated from cu boulder in 12-2008, he lives at home and cannot afford health inurance thru cobra. my husband and i are unable to help him with the high cost of health coverage as i have multiple sclerosis and am disabled. is there anything at all being done to close this “hole” in the dependent coverage? Thank you.

    • johngarner says:

      I’m afraid that Suncor is within its rights to wait until legally required to cover children up to age 26. COBRA is the best option and I understand it can be expensive.

    • KIM CRUDO says:

      Family has been on COBRA for 18 months.
      One of the children is over 18 and a full time student is he allowed to cobra on his own?

      • johngarner says:

        Each qualified beneficiary is allowed to take COBRA on their own; however, if the family is only entitled to 18 months of COBRA due to termination of employment or a reduction in hours, no family member can extend COBRA beyond that, unless the family member is disabled or there is a second qualifying event, such as the child reaching age 26.

    • Al says:

      I’m on cobra as a result of leaving my job, and my family is covered under my cobra. My son will turn 26 soon. Can he remain on my cobra post 26? Does he have the right to elect cobra for 18 months from his birthday even though he’s on my cobra coverage now?

      • johngarner says:

        When your son turns 26 that will be a second COBRA qualifying event, which will entitle him to up to COBRA coverage until 36 months from your date of termination.

  2. Debbie Nance says:

    My son turned 22 Oct of 2009, at this time his health insurance thru FEHP BlueCros/Blue shield ended. With this new bill, will I be able to put him back on my insurance come Jan 1 2011? He currently has insurance, but it is only for medical cost, doesen’t even cover perscriptions, dental or vision.

    • johngarner says:

      You should receive a notice when your son can be added back to your plan. In the case of the FEHP, I believe he can be added on October 1. Employers need to notify employees of the right to add children. The notice should be provided no later than the first day of the plan year beginning on or after 9/23. Employees will then have 30 days in which to add the child.

  3. Jenn says:

    I have read that dependant adult children are eligible up to their 27th birthday, but many articles say simply ‘until age 26′.

    Are they eligible up to their 26th birthday or 27th birthday? I cannot find a clear answer.

  4. Paul says:

    My daughter has finished University and is losing coverage without possibility of COBRA because it is a SHIP plan . She turns 25 on 8/8/10 and loses her SHIP coverage on 9/19/10
    She has been declined for an individual plan due to pr-existing conditions.
    I have small business plan w/ Kaiser and was going to put her on as a new hire commencing 10/1/2010 and plan to employ her thru 12/31/10 and then terminate her .
    I have been told by Kaiser that she we will be eligible as dependent child on 1/1/11 the renewal date of my plan ”’ I am concerned that she lose her eligibility as a dependent child if CAL COBRA is offered to her at termination date .
    I do not feel comfortable letting the insurance simply lapse without coverage whatsoever …

    • johngarner says:

      I agree that you should not feel comfortable about your daugheter going without insurance. There is a new alternative under health care reform, which will be available in California in September. It is called a Pre-Existing Condition Insurance Plan (PCIP) and is designed for people like your daughter who have been declined insurance due to a pre-existing condition.

      To request an application for the PCIP when it becomes available, send name, address, telephone number & email address to PCIP@mrmib.ca.gov

  5. RMSmithJr.SPHR says:

    What if a covered dependent becomes eligible for his/her own policy through employment?

    • John Garner says:

      If a plan is grandfathered, it can refuse to cover an adult child who is eligible for employer-sponsored coverage. That could be, for example, through their own employment or the child’s spouse’s employment. If a plan is not grandfathered, they cannot refuse to cover any child up to age 26.

  6. Nadeem says:

    Does the Dependent Coverage to Age 26 under the haelth care reform apply to group dental insurance too or not?

    • John Garner says:

      Generally, health care reform does not apply to dental plans. Most dental plans are what is referred to as “limited scope” plans and are not subject to the law. If a plan combines medical and dental, such as by having a common deductible, it would not qualify as a separate “limited scope” plan.

  7. Melanie Zierer says:

    How do you know if a plan is grandfathered?

  8. John Garner says:

    Please see my posting of June 25 regarding details of when a plan loses its grandfathered status:

    http://dmeclegal.wordpress.com/2010/06/25/regulations-released-on-grandfathered-status-under-reform/

  9. tina says:

    I work for an organization which our benefits are provided through our union.we are currently in open enrollment period, our employee is telling us to contact our union regarding any benefit changes.we’ve contacted our union regarding dependants over 18 but under 26 years of age.they are telling us we can not add them untill the year 2012 because we are in a contract.can they legally do this to us?

    • John Garner says:

      The law itself is not as clear as I would like on this point, but I think the clearest explanation comes from the preamble to the regulations (75 Fed. Reg. 34542-43):

      “…collectively bargained plans (both insured and self-insured) that are grandfathered health plans are subject to the same requirements as other grandfathered health plans, and are not provided with a delayed effective date for PHS [Public Health Service] Act provisions with which other grandfathered health plans must comply. Thus, the provisions that apply to grandfathered health plans apply to collectively bargained plans before and after termination of the last of the applicable collective bargaining agreement.

      I suggest you point out this language to the plan sponsor.

  10. Sandra Bunch says:

    My son lost his coverage under my plan the day he turned 19 which was 8/31/2010. Open enrollment for for insurance at my place of work is 11/15/10. Will he be eligible for benefits at that time or no? Same for my daughter who lost coverage on her 19th birthday 5/22/2009.

  11. John Garner says:

    Your children (up to age 26) will be eligible for coverage under your plan on the first day of the first plan year beginning on or after 9/23/2010. For most plans that will be 1/1/2011. If your plan is a grandfathered plan, there is an exception: if your child is eligible for coverage other than through a parent (such as through the child’s employer or, if the child is married, through the child’s spouse’s employer) the grandfathered plan does not have to cover the child.

  12. Deidre B says:

    Taxable income for the State of California?

    • johngarner says:

      Unfortunately, California did not pass legislation to conform its tax laws to the new federal laws. Therefore, even though both state and federal law now require employers to allow employees to cover children up to age 26, employers will have to treat children over age 19 who are not students and any child over age 24 the same way they treat domestic partners–that is, withhold taxes on the fair market value of the coverage.

      • Jay says:

        When do we have to start withhold taxes for the fair market value of the coverage of children up to age 26 for the State who are not in conform with the federal Laws?
        We started new enrollment on December 1, 2010.
        Thanks.

      • johngarner says:

        Withholding should begin when coverage begins.

      • Jay says:

        Another question, are there distinction between dependent who are full time student vs. dependents who are not?
        One of our employee’s dependent has been her dependent, and covered under her health plan before this new law passed. He is still a full time student. Will his re-enrollment for next year be subject to CA taxes?

      • johngarner says:

        The California tax laws have not changed with regard to student status and employer-sponsored health coverage. My understanding (remember, I am not a lawyer or accountant and cannot give legal or tax advice) is that if the child is a full-time student and under age 23, no taxes would apply at either the federal or state level.

  13. Tony D says:

    Is it accurate to say the “dependent” in the title of this article doesn’t really mean dependent in any traditional sense? I no longer declare my 24 year old son as a dependent on my taxes, he therefore doesn’t qualify for coverage on my Health Savings Account. But he could be covered on my employers plan under reform. Isn’t adult children a better term than dependent?

    • johngarner says:

      The law itself uses the word “dependent”, although you are correct that an adult child does not need to be a dependent for tax purposes in order to qualify for coverage.

  14. Mary says:

    Hi John,
    My daughter turned 24 10/10 – FT student. Just found out by having elig verified for a medical visit on 11/8 that she was dropped by United Pacificare w/o notification. Is there any recourse other than Cobra until 1/1/11?

    Appreciate your assistance.

  15. johngarner says:

    You certainly should have been notified of the termination. It sounds like your plan year begins 1/1, so at least you do not have a long gap to worry about. COBRA may be your best option. If your daughter is in good health, you could get an individual policy, but by the time it is approved, the gap would be very short, whereas COBRA should be retroactive to the date of termination. Let me know if you have any other questions.

    • maria says:

      I have a question for you. My child was covered by Kaiser insurance all these years. At the age of 18 she was dropped from the insurance, we were never notified or anything, found a month and a half later when my child needed to see the Dr. She was told was no longer covered as of July 1 2013. Can this legally be done could he just drop the child without us being given notice? Is there recourse can she be added back on. She is 18. The new law states they are covered until 26. Help.

      • johngarner says:

        It sounds like a mistake was made. I encourage you to contact Kaiser and/or the employer group through which you may be enrolled. It may not be too late to correct the error.

  16. Sherry says:

    Husband employer which is Mo. but we live in IL. My son 22 was on lost status for health ins. when the employer offerend open enrollement to implement the new healthcare reform husband enrolled him at work. After the fact we assumed it was for all our supplemented family plan of medical, dental and eyecare plan which we are on a family plan. Now employer says it was stated medical only and they are only required by law to offer medical and not the other eye and dental. He was on all 3 before lost status and all other dependents will have all 3, Just like me I am a dependent and get all 3 medical , eye and dental plans. Is this true? do they only have to offer medical?

    • johngarner says:

      The health care reform law only requires employers to extend coverage to age 26 for medical, not for dental and vision. Some employers have voluntarily extended coverage for dental and vision, some dental and vision insurers are offering coverage to age 26 and states may require it.

  17. Smith says:

    Is my self-insured employer required to offer primary coverage to our dependent under the new law, or can they get by with offering secondary if my spouse’s plan will cover our son? My employer is requiring that the employee’s dependent be placed on the spouse’s employer’s plan if:
    A) The spouse has sponsored coverage available through their employer
    B) The spouse’s birthday comes before the employee’s in the calendar year (similar to COB)

    Since my wife has coverage through her employer and her birthday comes earlier in the year than mine, they are saying that our son has to go on her plan before they’ll offer (secondary) coverage under my plan.

    • johngarner says:

      There is a “uniformity” clause in the regulations regarding coverage of adult children. It says “The terms of the plan or health insurance coverage providing dependent coverage of children cannot vary based on age (except for children who are age 26 or older).” I interpret this to mean that your employer can impose the requirement you described only if the same requirement applies to all children.

  18. Barbara says:

    My son is 21 and lost insurance under our independent (non-employer) family plan when he turned 19. He has been on his school group plan since then without a gap in coverage. He will graduate in June 2011 and has a pre-existing condition. Can he be denied coverage in the state of California. From what I have read it sounds like the state laws rule and I cannot figure that part out. Kaiser has said that he must pass medical review.

    Any guidance would be helpful

    • johngarner says:

      Under the federal regulations, if your son lost coverage under this policy because of his age, he can be covered under your family plan as of the first day of the first policy year beginning on or after 9/23/2010.

      • Barbara says:

        So Kaiser cannot force him into medical review and deny him coverage due to pre-existing condition? that is what they are trying to do.

  19. johngarner says:

    According to http://www.healthcare.gov, your plan is required to provide a 30-day period beginning no later than the first day of your plan’s first policy year beginning on or after 9/23/2010 to allow you to enroll your adult child. Your plan must notify you of this enrollment opportunity in writing. If you enroll your adult child during this 30-day enrollment period, your plan must cover your adult child from the first day of that policy year. What is the first day of your policy year?

  20. Denise says:

    does the health reform cover dependants pregnancies? My insurance says no..But what if your child got raped? And was pregnant….It should cover all maternity bo matter what..

    • johngarner says:

      My understanding of the health care reform law is that it requries employers who cover dependent children to change the definition of eligibility to include adult children up to age 26, but that it does not affect the definition of covered expenses. In 2014, plans will need to cover all “essential benefits” in order to avoid penalties. Until regulations are issued, we will not know the details of what constitutes essential benefits.

  21. CKDunlap says:

    My son (24) started working for a temp agency in June 2010. They offered medical insurance but the cost was very expensive for the coverage provided vs what he’s being paid so he declined. He was covered under my plan until age 23. Can I add him back on or since they offered him coverage he’s on his own??

    • johngarner says:

      If your employer’s plan is grandfathered, the plan has the right to deny coverage for an adult child who is eligible for other group health coverage. If your plan is not grandfathered, you have the right to enroll your child. You should receive a notice if your plan is grandfathered. You also should receive notice of the deadline for enrolling your son. Depending on the plan year, the coverage may not be available yet or the deadline may have already passed.

  22. Deebbie Price says:

    My daughter age 25 lost coverage for insurance at the end of Nov 2010. My husband’s open enrollment was oct 2010 and at that time she had insurance and did not need to be placed on his. He is trying to place her on his insurance now and his employer is telling him that he can’t add her because it is longer than 30 days since she had coverage. Does this matter with the new health care law? Isn’t this what it is supposed to prevent?

    • johngarner says:

      There are two different 30-day periods that may apply to your daughter. One is the 30 days after she lost coverage, which has now ended. The other is the 30 days related to the change in definition to allow coverage of adult children. This varies by employer and may have been concurrent with open enrollment or may still be available. I encourage you to review the open enrollment materials to see if a time period was specified during which adult children could be enrolled or to ask the employer for documentation of the period of time.

  23. LMWhite says:

    Does Interim Final Rule implementing the extension of dependent coverage for children up to age 26 as part of the requirements under the Patient Protection and Affordable Care Act also include those of us who have Tricare prime witht he military? My son is a full time student (21 years) and just got married. Is he covered under us or not?

    • johngarner says:

      The following information is from the Tricare web site:

      TRICARE Young Adult Coverage up to Age 26

      The recently-signed National Defense Authorization Act for fiscal year 2011 includes a provision to extend premium-based health coverage to eligible dependent children until age 26, similar to the provision in the 2010 Patient Protection and Affordable Care Act.

      TRICARE Young Adult Program

      The new program, TRICARE Young Adult, will be available to eligible dependents who age out of TRICARE at age 21 (or 23, if full-time college students) who are not married or eligible for their own employer-sponsored coverage.

      TRICARE is fast-tracking implementation. Beginning later this spring, qualified, unmarried dependents up to age 26 will be able to purchase TRICARE coverage on a month-to-month basis.

      Upon implementation later this spring, eligible dependents will have an option to purchase TRICARE Standard/Extra health coverage on a month-to-month basis.

      Those who are eligible to purchase coverage should save their receipts after the first of the year, as the benefit will be retroactive to January 1, 2011, provided premiums are also paid back to January 1.
      After purchasing coverage, enrollees will be issued a new ID card as verification.

      Discussions are currently underway on how TRICARE Prime will be affected by this legislation.

      You can find more information at:

      http://www.tricare.mil/downloads/what%20does%20this%20mean%20to%20me.pdf

  24. MLHeslop says:

    I didnt know I could add my 20 year old daughter in October and living in another state looking for work. I thought she had to be in school full time. She is now back, can I add her. She has no insurance. I didnt add her in the open enrollment period because they turned me down the year before for not being a full time student, she was part. Are their exceptions? My insurance is with Cigna. Thank You. Mrs.M Heslop

    • johngarner says:

      The rule about covering adult children up to age 26 is effective for employer-sponsored plans as of the first plan year beginning on or after 9/23/2010. For individual policies it applies for policy years beginning on or after that date. It is possible that this provision does not yet apply to you and your daughter. If it does apply, your employer and/or insurer should have notified you and informed you of the dates of a 30-day enrollment period during which you could enroll your daughter. I suggest you call CIGNA and ask them about enrolling your daughter. They may tell you when you can do so. If they tell you that you missed the enrollment period you can tell them you were not notified (which sounds like the case) and ask what you can do.

  25. JoeMatters says:

    Joe,

    I work in the state of Florida where Health dependent care coverage is available up to age 30. Does my vison and dental plans fall under the same rules as the health plan, dependent care coverage until age 30? My health coverage is through BCBS of FL, my vision through VSP and dental through Assurant.

    Thanks

    • johngarner says:

      The 2008 Florida law requiring insured plans in that state to cover dependent children up to age 30 applies to medical, but not to dental or vision insurance.

  26. kim says:

    I work for the State of Indiana and need to know who determines eligibility for full time student. Who sets the guidelines for the amount of credit hrs. needed to qualify, the insurance company or the college? This question concerns the years 2009 and 2010.
    Thank you for your help, kim

    • johngarner says:

      Prior to the health care reform legislation, it was generally the plan sponsor (typically an employer) that set the eligibility rules for students. Some insurers would set the rules and others would allow plan sponsors to do so. In some cases, the plan sponsor would set the rules and the insurer or administrator would interpret them. For example, an employer might say they wanted to cover full-time students up to age 23 and the administrator might interpret that to mean 12 credit hours per term. In some cases the interpretation of full-time would be left to a college or university. In other words, there were no hard and fast rules.

  27. Sandra says:

    Our 23 year old dependent daughter who lives with us is unemployed, married, and pregnant. She is unable to join her husband who is in the British military and deployed because her visa has not been approved as of yet. She has no health coverage from the UK while here in the USA and won’t be covered there until her visa is approved and she is able to relocate to be with him.

    Her pregnancy expenses have been covered to date by our BCBS policy. When the baby is born here in the USA, will the baby have the mandatory irrevocable 30 day coverage like all newborns are entitled to? Or because the Health care Reform Act says it only covers dependents and not dependent’s children is this a problem? I am unable to find an answer anywhere and frankly I am worried about the hospital baby’s bills.

    Just in case people are wondering, she has a BA and an MA but has not been able to find a job in this economy. This is very difficult on her with her student loans coming due and we are hoping she will be able to find employment in the UK. Thank You.

    • johngarner says:

      The health care reform act does not require group health plans to cover grandchildren. Your daughter’s delivery should be covered, but you will need to find other coverage for her baby. Quite often the nursery charges are covered as part of the mother’s hospital bill, but if the baby is sick, you will need other coverage.

  28. Sherri says:

    Does the new law pertain to dental insurance as well as medical? I was just advised by MetLife that in the state of California that the Employer can determine a termination age if not a full time student. I was not aware of this.

    • johngarner says:

      Generally speaking, the requirement that plans cover children up to age 26 does not apply to dental and vision coverage. If the dental and vision coverages are “stand-alone” coverages, they are exempt from health care reform requirements. If the dental or vision coverages are not “stand-alone” coverages, then the health care reform requirements, such as coverage to age 26, do apply. An example of a situation where the coverage would not be considered “stand-alone” coverage would be if there is one deductible that applies to both medical and dental services.

      • James Bangar says:

        Mr Garner, it appears that my health coverage through Anthem Blue Cross of California ( HMO) requires me to designate a dental coverage either PPO or HMO through Delta Dental to determine my monthly deduction from my payroll check.
        We also have options for Vision.
        Just received a letter from my employer regarding my 20 year old son requesting me to make an election (among others) that includes: Being a dependent, living at home, Unmarried and full time student. Is his an ALL OR NOTHING type of requirement?? It is legal for my employer to do??

      • johngarner says:

        Employers can choose to bundle plans together and require employees to take any combination of benefits the employer chooses. Some employers allow separate choices for medical, dental and vision and others put them into one package.

  29. kiley says:

    HI my 24 yr old daughter is covered under my insurance and planning to get married before the baby is born. If she does get married, will she still be covered on my insurance?

  30. Andrea says:

    My brother enrolled his son (now 24) in his self-insured health plan with the city where he works. His son had a pre-existing chemical dependency condiiton. The son has now completed detox and inpatient treatment. We have received lots of requests for information regarding prior health coverage (none) and doctor visits prior to his enrollment date (July 1, 2011) from the insurance company. We’re getting nervous that they are building a case to deny coverage. What do you think?

  31. johngarner says:

    It sounds as if the plan has a pre-existing conditions exclusion. The exclusion would not apply (or would apply for a shorter period of time) if the son had prior coverage. If not, the plan needs to know about treatment during the 6 months prior to the enrollment date.

  32. Andrea says:

    ok, thanks for the information.

  33. ANNE says:

    I am 25 and currently pregnant. I am on my fathers plan now. I turn 26 in March does this mean I need to find other insurance in March for the remainder of my pregnancy?

    • johngarner says:

      Anne,

      Yes, you will need to find other insurance for the remainder of your pregnancy. It is unlikely you will be able to get an individual policy that will cover your pregnancy, so taking COBRA on your father’s plan will probably be your best choice.

  34. Blue Cross Blue Shield…

    [...]DETAILS ON DEPENDENT COVERAGE TO AGE 26 UNDER REFORM « DMEC Legislative Updates[...]…

  35. Pregnant and need help says:

    I am 22, pregnant, and on my moms insurance policy. Just found out that I am pregnant. Will her insurance plan kick me off? I know that I will need to find insurance for my baby once born however will it cover my pregnancy, and delivery?

    • johngarner says:

      Your mother’s insurance plan cannot kick you off until you are 26, unless it is what is known as a “grandfathered plan”, in which case you could only be terminated if you become eligible for another group health plan, such as through your own employer. Your mother’s plan should cover your pregnancy and delivery. As you know, you will need to find insurance for your baby, unless your mother’s plan is unusually generous in its eligibility provisions.

  36. Cyndie Taylor says:

    My son was put back on my AT&T plan for 1/2011. He was 25 (turned 26 in March). In February he went to the emergency room & we found out he was dropped from coverage. I called & they claimed I had to send a birth certificate to prove he was mine (he had been born under the plan & was on it until he reached 19). I faxed the birth certificate and United Health paid his claims. Now 8 months later we get a bill from one of the Dr. They claim United asked for the money back & we are now responsible. Per ATT benefits they didn’t start coverage until 3/1/11 because they didn’t have his birth certificate. I am filing an appeal. Any suggestions on what I should do. THANKS in advance

    • johngarner says:

      Filing the appeal was the right thing to do. It sounds as if they are basing the gap in coverage on the lack of a birth certificate. Did they notify you of this requirement? If not, your case will be stronger.

  37. Bonnie says:

    My 23 year old son will be joining the military. He has been covered under my employer’s plan (a grandfathered plan). When he gets his coverage through the military, will he still be eligible for coverage under my employer’s plan? I wasn’t sure if the military is looked at as an employer plan.

  38. Dental Dam says:

    Dental Dam…

    [...]DETAILS ON DEPENDENT COVERAGE TO AGE 26 UNDER REFORM « DMEC Legislative Updates[...]…

  39. Thomas says:

    My new employee probation period ended during the open enrollment period. I was given the forms to complete for medical insurance. All information given to me stated only dependents up to the age of 19 are eligible for coverage if not a college student.

    As of November 7, 2011 my BCBS of Alabama employer website benefits manual states only dependents up to the age of 19 are eligible for coverage if not a college student. It does state that this manual may be out of date but we did not a receive a manual and were referred to the website.

    HR says everyone was notified but I was not and worry many employees are still unaware of the new law. Is there any recourse for not complying with the new law? I can’t notify everyone myself as this is a tough economy and can’t afford to lose my job due to “causing trouble.” (I live in Florida so they can fire me for not liking the way blink.)

    • johngarner says:

      I would say that your employer would have a hard time denying you the right to add your adult child if they did not properly notify you. As I understand it, the penalty for employers who do not comply is $100 per day per affected individual.

  40. Thomas says:

    Wow great, except adding my son now will give him a very long pre-existing exclusion period because he doesn’t have proof of creditable coverage like he had back in January 2011 when he should have been enrolled.

    How are employers suppose to notify employees and how are they suppose to prove it. If it’s a notice in your paystub envelope than it will be a “he said, she said” situation. Because we were not notified.
    I want them to backdate my son’s enrollment to January 2011 to avoid a long exclusion period. It was their fault and I will fight them to fix it.
    Really appreciate your assistance.

    • johngarner says:

      Thomas,

      The regulations required that a written notice be given to either the child or the employee. The regulations said that the notice could be included with other enrollment materials, provided the statement is prominent.

      Either the employer should be able to provide documentation that they provided proper notice, or not. It should not just be a “he said, she said” situation.

      Good luck,

      John

  41. Shelley says:

    My daughter cannot be covered by Tricare because she is married. Even though she and her husband is still supported by myself and her father who is an active duty service member, while attending college. Can you please explain to me that a law/act made by the commander in chief can be exempt by the DOD.

    • johngarner says:

      Shelley,

      Unfortunately, the way the health care reform law was written, it does not apply to TRICARE.

      John

      • johngarner says:

        Shellye,

        The health care reform law does not apply to TRICARE; however, the Ike Skelton National Defense Authorization Act for Fiscal Year 2011 extended coverage under TRICARE to qualifed dependent children through age 26. To be qualified, a dependent must be unmarried and not have access to employer-provided health care.

        John

  42. Just had an unusual situation regarding the dependent coverage to age 26 law. I received a Student Dependent Certification that I had to fill out yearly, to provide my insurance company that my dependent child was a full time college student. I called my insurance provider BlueCross BlueShield of Texas, because I was confused about the Certification, that it would be a duplicate of the one I filled out July 1st. Previously, they would send Student Dependent Certifications in September and would ask how many credit hours that my daughter was enrolled in school, her current semester dates, her previous semester dates, and upcoming semester dates. When calling my insurance provider, they said that due to the new law enacted that I should not have to fill out that form. I was confused since the timing that these recertification’s had been sent out had changed and caused a duplication of the dates that my daughter attends school. While on the phone with the provider, who said they would no longer be necessary due to the change in the law, I asked her about another daughter who had been cancelled off that same medical plan in March 2011, when she turned 23 years old, I was confused why they cancelled her since that new law had been in place since Sept. 23, 2010, but they said that it didn’t pertain to my medical coverage since it was a Retiree plan…(that was back in March 2011)but while waiting on hold today, I decided to get more information on what the law entailed, and found that any plan that covers dependents would abide by this extended dependent age 26 and that my plan does cover dependents. The insurance provider couldn’t explain why my daughter was cancelled other than the old rule of when a dependent turned 23 they would cancel them off the insurance policy. At that time my daughter was a full-time student, and up until March 14, 2011 (when she turned 23) she was covered by my insurance policy. The customer service agent for BlueCross/BlueSheild of Texas said something about the exception of the insurance policy being in place on March 23, 2010…she said it wasn’t grandfathered, so that’s why it was cancelled, which in reading information not being grandfathered in meant they did have to provide coverage?? Also, even if they were grandfathered in, that if they did have access to another employer provided insurance, (which she didn’t, she was a full time student working part time) that they would have to extend coverage to her under my
    plan until age 26. They referred me to my companies Human Resource and I spoke to someone there who first said no she wasn’t’ covered, then looking further said she would send the insurance company something to have her reinstated. I had a medical bill that was denied in March 2011 due to her being cancelled, would they have to reimburse me for that cost? What kind of recourse do I have since it seems that they totally have cancelled her without any basis, and gave me bad information when I challenged them in the first place back in March 2011? Would appreciate any help on this, and so challenging to get a straight answer from companies who do not want to comply with this new law. Also, concerned about the Student Dependent Certification, that I should send it, even though it’s technically not required, it’s like some computer is running rogue on it’s own, sending this stuff out and then canceling dependents regardless of this new law!

    • johngarner says:

      Maria,

      This is a confusing situation and it sounds like you have been given some incorrect information. Based on what you have written, it appears that grandfathered status has nothing to do with your daughter’s eligibility. Your coverage as a retiree may or may not be an issue. Plans that cover only retirees are exempt from the requirement to provide coverage to adult children up to age 26; however, there is a lack of clarity in determining the definition of a “plan”. If your former employer files a single government report for both active and retiree plans, it may be considered one plan and they would have to allow retirees to cover adult children up to age 26. They could also choose to allow coverage (and it sounds like they have). Furthermore, the coverage up to age 26 only applies to medical plans, not stand-alone dental and vision plans, so those plans could continue to require student verifications. Also complicating matters is the effective date. Coverage up to age 26 was required for plan years beginning on or after September 23, 2010. For example, if your plan’s plan year begins on July 1, your daughter could be reinstated, but only back to July 1, 2011. You should have been given a notice of your right to continue or reinstate your daughter’s coverage. It sounds like your HR department is taking the appropriate steps to reinstate your daughter and you are entitled to be reimbursed for all payable claims retroactively.

      John

      • Thanks so much for the info…our plan year always starts on Jan. 1st of each year and that year Jan 1, 2011 my daughter was covered, they had only cancelled her coverage after her birthday which was on March 14, 2011… which she turned 23 which was after the plan year started. I do have a dental plan as well, and the dental plan actually still has her covered to age 26, and without student verification…so you can see how challenging it is trying to sort out what is right and if this just was a medical plan computer glitch. They said they would get back to me tomorrow so I will hopefully have more information then, and have her back with medical coverage.

      • Well, I never heard back from HR…so I decided to call today…now I have another HR person tell me since the company self funded the medical plan, is why they don’t have to comply with the the new age requirement to extend coverage for dependents to age 26. She said they had a choice to follow the new law…they do comply with it for active employees…which is why I asked her if that was self funded as well, she said it was. Is it true that they could have denied dependent coverage for active employees if the medical plan was self funded? Also she said if the medical plan wasn’t funded by the government they they didn’t have to comply. So crazy, it doesn’t make sense…are other companies limiting their medical insurance to those up to age 22 as well, I don’t get the point of the law then, if companies don’t have to comply?? I told the agent who I’m sure is just reading off a benefit info sheet, why didn’t they ever address that law with Retirees…I’m on hold while she tries to find somewhere that they addressed it. Which they didn’t or I wouldn’t be calling in the first place. I guess I just accepted their explanation when they denied my daughters claim in March. They also said they didn’t have any info showing that I had called on Nov. 29th, very challenging. Where can one go to get assistance on these issues? Obviously, companies would rather not cover dependents until age 26…it’s just annoying when a law gets passed and companies look for every way not to comply. What do people have as recourse for such challenges? Any help on this would be appreciated.

      • johngarner says:

        Maria,

        Being self-funded is totally irrelevant and not a reason for them to deny eligibility. As I mentioned before, if the plan is truly a separate retiree plan, they may have a reason. You may want to contact the Department of Labor. You can go to http://www.dol.gov
        and click on “contact us”.

  43. Elliot says:

    My wife is 25 and currently on her fathers plan. She turns 26 in the beginning of March 2012. Does she lose coverage on the exact day of her birthday or is she still covered until the end of the month in which she turns 26 – meaning up until and including March 31?

  44. Diane says:

    First of all I think it is ridiculous that a parent is responsible for a child that is not in school over the age of 18. If you can vote and go into the military at 18 you can get your own insurance. And at 21 if you can drink alcohol you certainly don’t need mommy and daddy to provide you with insurance. This is such violation on the insurance companies.
    Next, I have a friend who is divorced, paying child support, and carrying insurance through Catapiler Co. on his children. His daughter of 18 is pregnant with her second child, getting state aid in Texas for this and is also getting insurance from her mothers and step fathers insurance. My husband says this is “double dipping” and against the law. Now our friend has been taken to court to pay and extra $110 a month to cover extra insurance costs. How can this be ok? Pregnant, 18, two babies, two insurances and state aid? I am appauled at all this insurance mess

    • johngarner says:

      Having two medical plans is not against the law. Virtually all group insurance plans include coordination of benefits provisions that limit reimbursement to 100% of allowable expenses in order to prevent people from profiting from having duplication of coverages.

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  49. Jeff says:

    My daughter is 21 years old and recently married. Last year she was on my insurance but now I am being told she cannot be covered because she is married. Her husbands insurance does not cover dependents.

    My understanding of PPACA makes me feel my work should cover her, how can they deny her that coverage because she is married under the new rules? My policy does include coverage for dependents. Blue Cross Blue Shield of Illinois is the provider for our national business.I work for a large manufacturing company with over 2000 employees.

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  51. Kathleen Ammerman says:

    My question is a little different. What if the parents of the adult child do not want them on their policy? Example: Son, age 24, has a high cost medical condition. Is not living at home and doesn’t really have a good relationship with parent. Has no insurance coverage, but mother (who carries the insurance for the rest of their family) says she does not want him on the plan. Can the adult child go to the employer on their own to request coverage or does it need to be added to parent’s plan?

    • johngarner says:

      There is nothing in the law that forces parents to cover adult children and the adult children have no right to enroll–only the employee can enroll a dependent. The exception would be if the employer pays 100% of the premium for dependents, in which case all eligible dependents would be covered automatically.

  52. Tina says:

    I recently started a new job on November 7th. At the time I did not know my son could be included on our insurance, so when they asked for names for coverage, I only provided my husband.

    I recently found out that my son is eligible to be on our insurance (under 26, doesn’t live with us, and not a student). I thought he had to go to school to be covered.

    My employer did not realize I had a child that old (stepson) so they never asked about children for coverage and never told me he could be covered.

    I requested that they allow me to add him now, but they say I am out of the 30 day enrollment period. I told them they failed to inform me that my adult children could be covered. BCBS denied my exception request and won’t let me add him.

    Is there any recourse to getting him added to my BCBS insurance?

  53. Dolores says:

    Does a employer have to cover your child as secondary insurance if your child is under 26 and has her own insurance through her employer.

    • johngarner says:

      A “grandfathered” plan does not have to allow employees to cover adult children if they have access to employer-sponsored coverage (other than through a parent). Grandfathered plans need to notify participants of grandfathered status. Non-grandfathered plans cannot refuse to enroll children under age 26 for any reason.

  54. tom says:

    I have been covered as a dependent of a surviving spouse through gm salaried retiree healthcare via blue cross blue shield my entire life (age 24, born 11/17/87). I am a full time student and accordingly, I was under the assumption that I would be covered until age 26, under the Affordable care act. I received notification that my coverage is no longer available and I would have to purchase a cobra plan at nearly 550 per month. My mother is still being covered, but I have received the boot. I have no issues paying for my own healthcare if this is true, but I do not want to be taken advantage of either. Also I am in NY State, but the plan is out of Michigan I presume, if that even matters.

    • johngarner says:

      I cannot think of any reason, based on the facts you describe, why they could legitimately terminate your coverage. I encourage you to push back and ask for justification. If you have other employer-sponsored coverage available to you and this is a grandfathered plan, they could terminate your benefits.

      • tom says:

        Thanks for the quick response, it is highly appreciated. I am not currently employed and will remain a full time graduate student until may 2012, when I graduate.

  55. tom says:

    This is what concerns me, http://www.aetna.com/health-reform-connection/reform-explained/retiree-only-plans.html

    This is saying that retiree only plans are exempt from ACA…is this no longer true?

    • johngarner says:

      It is correct that retiree-only plans are exempt from health care reform and that may be the basis of their action. I encourage my clients to be very cautious in attempting to apply this exemption. We have no guidance on how to determine what is or is not a retiree-only plan. If the plan sponsor has created an entirely separate plan number for purposes for filings with the federal government and summary plan descriptions, then the exemption would clearly apply. On the other hand, if the retiree plan is a separate plan of benefits that is filed under the same plan number as the plan for active employees, there is a good chance that the federal regulators may not consider it to be a retiree-only plan.

  56. Marcia Reinhardt says:

    I want to know if my son turning 18 is a qualifying event to have him taken off of my insurance? Open enrollment is this month which means that the new year will start in March. My son turns 18 in May and I do not want to have to pay for medical insurance for him for the next year if I do not have to.

  57. Marcia Reinhardt says:

    The problem is that he will be 18 after open enrollment. I want to know if it is a qualifying event so that I can drop him in May because open enrollment is in February.

    • johngarner says:

      There is no law that says you must cover a child until age 18, although there might be a court order that says so in specific cases, such as divorce. If your plan has pre-tax contributions, a child turning 18 is not a reason to drop coverage for the child. If you are not subject to a court order, your plan probably would allow you to drop coverage during open enrollment.

  58. Colleen says:

    My daughter is 17 on my husbands insurance, just found out she is pregnant.(will be 18 in March) I looked up the insurance it said maternity is only for employee and spouse. Can they do that?
    She is still in high school and planning to go to a local college in the fall.

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  60. Concerned says:

    Our insurance does not cover 100% of all medical expenses. If 22 year old goes to Dr and has medical expenses who gets stuck with the medical bill? Would it be the parent that has the 22yr old on their insurance? We got a bill and it came in our name?

    • johngarner says:

      Dear Concerned,

      Health care reform allows parents to cover adult children, but does not change anything with regard to legal responsibility for unpaid bills. Unless you signed something saying you are responsible, your adult child would be responsible for anything not covered by your insurance.

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  62. Kaitlin Nevels says:

    Hello. I am 22 years old preparing to graduate from college. Recently, I learned my Father’s insurance (blue cross blue shield of Michigan) has taken me off. I’ve went through all of the necessary steps to get back on my Dad’s insurance and they are taking all of the steps to keep me off of it. I just received a 1400 dollar bill in the mail for a doctor appointment I recently had. I wouldn’t have went if they had not made me believe that I was back on his insurance (they sent me an email stating the dependent has been verified, or something to that nature). However, they have no record of it. They even told me they would reimburse me for all of the times I had paid full price for medications. This is because they have not had me in their system since 2009 and admitted it was their mistake and apologized, but to get back on I would have to reapply during the special enrollment period. So, I did. They first tried to say that they never received my information, however, I sent it twice and have documents to prove that (including reply emails from them) Now, they are saying that because my Father did not claim me on his taxes this year, (my Mom did, they’re divorced) that they are going to deny my right to have health insurance. My Mom has no way of putting me on hers and my job does not offer health insurance. My Dad is a delphi retiree, I’m not sure if that makes a difference, but after reading details about the health care reform, this seems illegal? Oh, I might also add, they make you discuss your health care concerns with his union. I thought the Union was there to help? I am so irritated. Please help, its driving me nuts. I just want to resolve this problem. I’m starting to feel helpless and I think my Dad is to. We’ve been trying to resolve this problem for nearly 4 months now.

    • johngarner says:

      Kaitlin,

      I’m so sorry to hear of your problems. It is situations like this that give the insurance industry a bad name. Based on what you have written I cannot say for sure whether you are entitled to coverage or not. This is because your father is covered as a retiree. Plans that only cover retirees are not subject to the rule requiring them to allow adult children up to age 26 to be covered. Even if the retiree plan is different than any plan for active employees, it is not necessarily a ‘retiree-only” plan for legal purposes. Your father should have a summary plan description that should indicate whether it is a plan only for retirees. If it is, you are out of luck. If there are active employees covered under the plan, then you should be entitled to coverage. Good luck.

  63. Alan says:

    My daughter turned 26 almost 2 years ago. My employer left her on the plan until this month when they did an age 26 audit. Her coverage is now being terminated. Do they have to offer her COBRA now? HR said it was my responsibility to have notified them when she turned 26 and without the notification she lost her opportunity for COBRA. Is this true?

    • johngarner says:

      You should have notified your employer; however, you have 60 days to do so. Since they seem to have discovered this within the 60 days I do not believe they can deny her COBRA. Your employer should have known the date and many employers automatically send COBRA notices when children reach age 26.

      • Alan says:

        I did not notify my employer within the 60 days of her turning age 26. She was left on the plan. If they terminate her now, is that a qualifying event for COBRA. The employer says “no” and that the initial COBRA letter clearly stated it was my responsibility to notify them. Is this true or do I have a case to push back?

      • johngarner says:

        Your employer is correct. It would have been nice of them to notify you and/or your daughter of COBRA rights when she turned 26, but the legal obligation was on you.

      • Alan says:

        Thanks. Your help keeps me from possibly digging a deeper hole.

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  65. Keith says:

    My 24 yr old daughter’s overseas job is ending soon, along with her medical insurance. Should I be able to add her onto my company’s policy at that time or will I have to wait until the annual open enrollment period in December?

    • johngarner says:

      Keith,

      If your daughter’s change in residence makes her eligible for a plan she was not eligible for previously, then she has special enrollment rights. Your company should be able to give you details.

  66. huda says:

    Hi
    It mentions in this article above that “this extended eligibility does not apply to the adult child’s spouse or children”. Does this refer to when a child is born or even before the child is born? When I called my insurance they mentioned to me that I can not be covered as a dependent for ob-gyn visits to my doctor. (but everything else I am covered) Is this what the article means when it mentions that children can not be included? Does this apply only when the child is born or even before the child is born? Are they allowed to cover me for everything except ob-gyn visits?
    Thanks

    • johngarner says:

      I do not have enough information to state anything with authority, but for most plans what you were told is not correct. If you are the adult child, your child would not be covered, but your ob-gyn visits would be covered under most plans. The exception is that plans can cover maternity expenses only for employees and spouses and not children. Most plans do not take this approach, but some do.

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  68. Kelsey says:

    I am 24, no longer in school and working. I am on my parents health insurance plan right now, CIGNA, and they tell me that they have to claim me as a dependent for taxes because I am on their insurance? is this true?

    • johngarner says:

      Kelsey,

      If your plan is an individual or family plan, what you have been told is not true. If your plan is a group plan covering active employees, what you have been told is not true. If your plan is a group plan that covers only retirees, what you have been told may be true, depending on the terms of the plan. For dental and vision plans, what you have been told may be true, depending on the terms of the plan.

  69. Okey says:

    I will be losing private insurance in April becuase of retirement. I am receiving a SSI disability do to illness. I carry my two adult children ages 24 years old. I will be offered Cobra through my previous employer. Am I required to carry my married adult children on my plan? Since I have very limited income a single cobra is a lot cheaper than an family.

  70. Liz says:

    My employer has not followed the required format in notifying employees of a supposed “grandfathered status.” They simply wrote in our renewal packet, “that dependents under age 26 are not eligible to be insured if they are offered group health insurance through their own employer.” Is this considered sufficient notification of a “grandfathered status?” I had read somewhere that the notification should include a letter which includes a specific format for grandfathered status. Am I wrong to assume that my employer does not have this status since no such letter was ever furnished to employees?

    • johngarner says:

      Whenever distributing materials, group health plans are required to disclose to members if a plan believes it is grandfathered. There is model wording that should be followed.

  71. tracie says:

    My 20 year old daughter does not live with me and is pregnant. She is covered under my insurance. My insurance company is refusing to pay for her pregnancy. Is this legal?

  72. Miranda says:

    I am 23 years old and married and have coverage through both my husband’s employer and my father’s employer. Both insurance companies are arguing over who is my primary coverage. My husband’s insurance is claiming the “birthday rule” saying that sense my father’s birthday falls before my husband’s birthday, my father’s insurance is my primary. My father’s insurance is claiming that the “birthday rule” is just for determining primary insurance between two parents and that a spouse’s insurance takes precedence over a parent’s. Which one is right?

    • johngarner says:

      Miranda,

      Your father’s insurance plan is correct that the birthday rule is for children covered under more than one plan and you are not covered as a child under your husband’s plan. Based on what you have written, it appears to me that the applicable rule would be the “longer or shorter length of coverage” rule, which says that the plan that covered the person longer is the primary plan.

  73. Jen says:

    My husband has a 19 year old that is on his plan however would like to drop her. We are getting mixed messages on whether or not this can be done. From reading your above post it seems to me the insurance carrier must offer coverage but not that the parent must elect it. Also, the last sentence about if the dependent has the option to elect coverage through their employer, seems that not even the insurance issuer has to offer if that is the case so I am guessing then a parent shouldn’t have to cover either? Also, if during the time an adult dependent is covered under their parents coverage is the parent ultimately responsible for their co payments? We have started to receive bills from this dependent going to the doctor and then telling them to bill her. Which she knows our address is who they will be.

    • johngarner says:

      Jen,

      Sorry about the mixed messages–this can be a complex topic. The health plan must offer coverage for adult children (unless the plan is grandfathered and the child has employer-sponsored coverage available, other than through a parent). The employee is not obligated to cover the adult children; however, if coverage is elected, Internal Revenue Code rules may restrict when coverage can be dropped, so you will need to check with the employer about the rules that apply to this plan. I am not an attorney, but I would not think that covering an adult child would make the parent liable for the copayments.

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  75. Lisa says:

    My step daughter is 21 and going to school . Her mother has every benefit known to man given by the state. She asked us if we could add her to our insurance plan that my husband ( her dad) has through work. We have Aetna – and my husband said they were fine with adding her.
    She doesnt live with us, so I am unsure if that makes a difference

    • johngarner says:

      I have never seen a plan that required a child to live with a natural parent to be eligible for coverage. I have seen plans that require a child to live with a step-parent in order to be eligible for coverage under the step-parent’s plan.

  76. johngarner says:

    The health care reform law merely requires health plans to allow adult children to be covered until age 26, it does not require coverage. Your husband’s plan may prohibit changes in coverage during the plan year, unless certain criteria are met, such as a change in your step-son’s employment.

  77. L King says:

    Can a self funded Health Plan specifically exclude coverage for a dependent’s pregnancy when under age 26 even though the plan covers prenancy for covered adults on the plan?

  78. jbubbly says:

    My son who is 24 and lives in another state now has health care coverage through his employer. I live in NY and he is also covered under my health care insurance until age 26. Can he use his as primary and my insurance as secondary, to cover costs he cannot afford to cover such as co-pays?

    • johngarner says:

      The rules of each plan or policy dictate which plan pays first. If both plans follow the industry standard rules, then his plan would pay first and your plan would be secondary.

  79. My daughter is 22 and in college. She is getting married on July 27 and TRICARE young adult told me today that she will be dropped from that insurance we’re paying for her when she marries. Is that legal? (We have TRICARE Standard, also.)

  80. Carol Leedy says:

    I am a retiree from a large company. My son has been under my plan for the past year. He just turned 24 in May. My company says he will be dropped as f 7/13/22 because he is not a full-time student. They also say he would also be dropped at the age of 25. can u explain this to me? i thought all kids under 26, regardless of school status, could be covered. (???)

    • johngarner says:

      A plan that covers only retirees is not subject to most of the health care reform rules, such as the requirement to cover adult children until age 26.

  81. christina says:

    Our 19 yr old son is currently on my husbands BCBS insurance, he has been living on his own for over 6 mo, but was recently injured in an accident. After the health insurance pays their portion, who is liable for the balance of the bills? Our son or us?

    • johngarner says:

      There is nothing in health care reform that changes liability for debts. It sounds like he would be liable for anything the insurance does not pay. You might want to check with an attorney.

  82. Angela says:

    I was a dependent on my father’s member plan until I turned 26. I live in a different state than my parents. Every time I went to the doctor, in MY local area, the insurance company would deny my claims as out of network. They stated that I could only go to a doctor in the area where my parents live in order for it to be in-network. It does not seem right that the law can require coverage for dependents until age 26 but then make it really difficult for them to actually be seen by a doctor without traveling hundreds of miles, or having to pay full price for the doctor as if they did not have coverage.

  83. carlene dzierzynski says:

    i am a 25 year old employee with my own dental insurance. i am also a full time student and covered under my stepfathers dental insurance until i reach 26. which one would be considered primary?

    • johngarner says:

      Under standard coordination of benefits provisions, the plan that covers a person as an employee is primary and the plan that covers that person as a dependent is secondary.

  84. Maria Mercado says:

    I have a question on my sons elegibility. My son turn 26 on March 24th,2012, being that he turn 26 this year is he cover through the end of 2012 or is he no longer covered according to the insurance he is only cover 30 days after his birthday.
    Please confirm.
    Thank you,
    Maria

    • johngarner says:

      That depends on the terms of the plan. He might lose coverage as of his birthday. Most plans extend coverage until the end of the month, which would be 3/31. Tax-free benefits can only be extended until the end of the year, but not many plans extend coverage that long.

  85. Chastity Vickery says:

    I’m currently enrolled in my dads insurance plan thru Humana. My work offers insurance but I only want vision by taking the vision will I get kicked off my dads plan?

  86. Melinda says:

    I am currently a student and have been covered for years under my dad’s family plan with UnitedHealth. When I turned 24 they terminated the vision coverage, and have recently terminated my dental coverage, six months before I turn 26. I presume my medical coverage continues until I turn 26. I nor my parents were aware of these termination dates. There were no emails or letters notifying us of termination, so that I can better prepare to get replacement insurance. I require dental work and expected to be covered for another few months. Did UnitedHealth properly terminate my vision and dental plans? What recourse do I have with UnitedHealth? Thank you.

    • johngarner says:

      It is OK for an insurer to terminate dental and/or vision coverage before age 26; however, if your plan is subject to COBRA you should have received a COBRA notice and been given the opportunity to elect to pay for continued coverage.

  87. Juley says:

    Hi, I’m 25yrs old, lives in TX, just got married last may 2012 and is under my stepdad insurance BCBS. Im 5months pregnant and turning 26 on March 24. I have been going to docs visit and already had ultrasounds done. Will I still be covered until my baby comes? Or will I have to find another insurance for the remaining of my pregnancy? If so what insurance comp would take me right now and when will I have to apply? Thanks

    • johngarner says:

      It depends on the terms of the plan. You will probably lose coverage either on your birthday or the end of that month. If your plan is subject to COBRA, you should receive a notice of your right to continue coverage.

  88. Amanda says:

    Does any of the new laws on healthcare change the eligibility of grandchildren as a dependent? What are the current requirements for a grandchild to be eligible for coverage through blue cross blue shield?

    • johngarner says:

      Nothing in health care reform changes rules regarding grandchildren. Each Blue Cross Blue Shield plan sets its own rules regarding grandchildren. I have found that most that I deal with require legal guardianship in order for a grandparent to cover a grandchild.

      • Amanda says:

        As a parent of a child that is listed on someone else’s insurance-why do I not have a right to obtain insurance information regarding my child through the insurance company? Where can I find the laws regarding Federal Insurance pertaining to this. I was told by the agent that they cannot give me any information on the insurance of my child because it is someone else’s policy, nor can I have them removed from that insurance. It just doesn’t make any sense to me considering it is my child and they live with me. Any help would be appreciated.

      • johngarner says:

        Here is a link to a frequently asked question on this subject:

        http://www.hhs.gov/ocr/privacy/hipaa/faq/smaller_providers_and_businesses/227.html

        For your convenience, I have copied the 1st paragraph here and left out the exceptions:

        Does the HIPAA Privacy Rule allow parents the right to see their children’s medical records?
        Answer:
        Yes, the Privacy Rule generally allows a parent to have access to the medical records about his or her child, as his or her minor child’s personal representative when such access is not inconsistent with State or other law.

        While this question pertains to medical records, I believe the same answer applies to protected health information held by an insurance company.

        If you are not the policyholder or covered employee, it makes sense to me that you could not remove someone.

  89. Lisa says:

    I have ??s my daughter age 21, married and 5 months pregnant previously insured through her step mom has been removed from the policy without warming, she has no insurance now and doesn’t know what to do. Her husbands job doesn’t offer ins. Did what her step mom do, was that right? Or can she be put back on that policy? Help? Thank you Lisa Ritenour

    • johngarner says:

      I am not aware of any laws that would require the step mother to inform your daughter in advance of a loss of coverage. If you or her father have a group health plan, and if you are acting within 30 days of her loss of coverage, you should be able to add her to the group health plan. Depending on the circumstances, such as if the step mother lost her job, your daughter may be entitled to COBRA coverage. If COBRA does not apply and if no more than 62 days have gone by without coverage, she should be able to obtain an individual health insurance policy. It will be expensive, but possibly less expensive than paying for the delivery and probably less expensive than what complications would cost.

  90. cynthia says:

    i just turned 26 on jan 4th, and just broke my wrist today, jan 27. do i get cut off on my exact birthdate?… or by chance might i be covered for the full month?

  91. Kristin says:

    My friend who has been divorced for 12 years. Has paid child support all along, and his now grown son,18 apparently was on Medicaid, along with his 2 stepbrothers, by his mom. (this was a bombshell when she announced the medicaid) My friend had always assumed his son was covered by his stepfathers coverage. She has now informed my friend that he must now put his son on his insurance plan, because they will be dropping him in the next few months. His son has never been a dependent…his mother has always made all the decisions for their son, and had sole custody, with only visitation for my friend. The grown son is currntly living with his girlfriend, and Im sure his mother is still writing him off as a dependent. Being that the son has never been a dependent, never joint custody, and is currently considered still living with his mother. What is my friends responsibility under these circumstances with the health care law?

    • johngarner says:

      Health care reform allows parents (including non-custodial parents) to cover adult children up to age 26, but does not require them to do so. Qualified Medical Child Support Orders can require children to be covered, but I have never seen such an order for an adult child who is not disabled.

      • Kristin says:

        If the new law requires the parents to cover the child until 26, is the sole resposibility on the custodial parent, or is my friend obligated because the mothers choice of medicaid coverage is no longer available for the child? If so, can he ask the exe to pick up half the tab for the additional coverage he will now have to pay for? My friend had fulfilled all his obligations for child support etc. according to the divorce decree, now out of nowhere this has been thrown in his lap,without being aware what his childs coverage was. Also, will this send up red flags over the fact that the childs mother chose to put him on medicaid, when for the last couple of years, the father had health care coverage available. His HR dept. has stated that the child must be from adoption, just born, marriage, or custodial change…non of those options fit, and like I said earlier, she is still claiming him as a dependent, and sole custodian.

      • johngarner says:

        The health care reform law does not require parents to cover adult children, it just allows them to do so. There is an older law that requires plans to allow children to be enrolled within 60 days of losing Medicaid. Again, the law does not require enrollment, it just requires plans to allow it. Your friend can tell his ex that he expects her to pay for the coverage. There is probably no mechanism by which Medicaid would be notified if he does enroll the child.

  92. Al says:

    We have a separate medical and dental both under Aetna…does my daughter time out on the dental at 23 even if she is a student?

  93. My granddaughter is a stepchild, she completed 4 years of college but is now going for her masters and her stepmother, who has family coverage with her employer has refused to put her on her medical insurance. Does my granddaughter have any rights

  94. Kathleen Haa says:

    Without advance notice, my ex-husband cancelled our three sons, ages 25, 24 and 21 as his dependents from AT&T’s health insurance coverage. None have other health insurance available to them, 2 are still in college, oldest holds down 3 part time jobs.They recently received a “Certificate of Group Health Insurance” that my ex forwarded to my address, originally from AT&T and mailed to ex which showed the cancellation of coverage date of 3/22/13 -This is how we found out.The Marital Settlement Agreement stated ex and I each pay 50% of the insurance premiums for our sons and since the entire amount was being deducted from ex’s paychecks, I reimbursed him every month. All payments were up to date. My 21 year old plays for his college hockey team. He is required to have health insurance coverage to remain on his team but his college does not offer student health insurance. I contacted ex, asked for COBRA information and enrollment materials so my 21 year old can keep all of his health insurance coverage including dental and vision. Ex told me that none of our sons including 21 year old are eligible for any COBRA coverage at all including COBRA dental or vision. Ex has all of the AT&T health insurance materials and enrollment materials sent to his own address only, he only sends our sons insurance cards every year, including for 2013. Now ex says the 2013 cards are not valid. Shouldn’t COBRA coverage and COBRA dental and vision coverage be available from AT&T to my 21 year old? How can I find out? My 21 year old needs to immediately enroll in COBRA if it is available to him so his health insurance coverage including dental and vision remain uninterrupted and/or retroactive to the 3/22/13 cancellation date. Thank you in advance for your answer.

    • johngarner says:

      COBRA only applies when certain qualifying events occur and an employee dropping coverage for dependents is not a qualifying event. Most employers only allow coverage to be dropped in the middle of a plan year because of certain status changes, but that is only required if an employee pays for coverage on a pre-tax basis. I suggest you contact an attorney for assistance. AT&T probably will not talk to you, but may speak to one of your sons. There is probably a number to call on the ID card or other plan information. They could verify that losing coverage is OK in the middle of a month under the plan rules. If coverage has been lost and cannot be restored, your sons can get what is known as a HIPAA guaranteed issue policy, but that does take some time to be issued. A health insurance agent should be able to help you with that.

      • Kathleen Haa says:

        Thank you very much for your quick response since the time frame for my 21 year old to prove his coverage for his college hockey team is very short. Is my 21 year old son too young, in other words, to qualify for COBRA continuation of his coverage? If he had been 23 when my ex dropped him as a dependent, would COBRA have been available to him? My 24 yr old son has been allowed to continue his dental and vision after age 23 through AT&T using COBRA to do so, and is covered by it now. For my 21 year old to not be able to have the same ability to continue any coverage through COBRA because he is 21, not 23, makes no sense. I also have COBRA health insurance coverage including dental and vision through AT&T since the divorce. Can my 21 year old be added as a dependent on my own COBRA insurance since he was dropped from my ex’s list of dependents, to ensure he will have continuation of coverage for his last year of college? Please, explain what a HIPAA guaranteed issue policy is. Is it a continuation of coverage for the gap between ages 21 and 23 if the dependent coverage has been dropped, or a new policy for coverage that will extend past age 23?

      • johngarner says:

        Since you have coverage you can add your children since they have lost coverage. You should contact them right away to add them.

  95. Hello Mr. Garner,
    Our son recently lost dental & vision coverage under my husband’s employer sponsored plan because of a loss of student status. He also lost medical coverage under Medicaid because of turning 19. He has medical coverage through my husband’s employer sponsored health plan, but Medicaid paid his deductibles and co-insurance, so the loss is a significant increase in health care expenses for us.

    We thought that either the loss of dependent/ student status, or the loss of medicaid coverage, would be a qualified family status change, allowing us to make a mid-year election change to our health FSA. (We wanted to increase the contribution amount, to cover the additional expense of our son’s dental & vision needs and to compensate for the loss of medicaid coverage). HR informed us that based on the Health Insurance Answer book, loss of student status doesn’t allow mid-year changes to health FSA’s, and that the loss of medicaid coverage is irrelevant to the employer, and is not a qualifying event that would allow permit changes to the health FSA contributions.

    I would greatly appreciate your opinion as to whether or not this is accurate….especially since HR says they are basing it on your book. :)
    Thank you for your time.

    • johngarner says:

      The IRS regulations that allow mid-year plan changes to health plans are much more restrictive when it comes to flexible spending accounts and certain changes do not apply to FSAs. Under the FSA, your son did not experience a status change that would allow a mid-year change in elections.

  96. Nicole says:

    I’m 24 and have the opportunity to get on my stepfathers health insurance through his new job but my question is will he have any access to my medical records? Or access to knowing any of the doctors I see? Or any medication I pick up from the pharmacy?Or basically anything? .. what does he have access to (specifically)?

    • johngarner says:

      If you do not take any action, the employee will typically get copies of Explanations of Benefits, which usually show the doctor (or facility) name, date of service, amount charged and sometimes will have a brief description of the service, e.g., office visit. Privacy regulations under a law known as HIPAA (the Health Insurance Portability and Accountability Act) give patients the right to restrict access to this information. You shold be able to instruct that nothing be sent to your stepfather.

  97. ebrandy says:

    when covered under your parents plan and turning 26. do you have until the end of the calender yr that you turn 26 to be on the insurance or does coverage end the day you turn 26 in most cases?

    • johngarner says:

      The answer depends on the terms of the plan. Most plans terminate coverage at the end of the month in which the 26th birthday occurs. Some plans terminate coverage on the birthday. Few plans extend coverage to the end of the year; however, if they do, it is still tax-free.

  98. jeff says:

    hi, my mother dropped me from her insurance because she didn’t want to pay the family rate, is there any way to get back on her insurance, im 24, and her plan does offer coverage until 26.

    • johngarner says:

      Health care reform only requires employers and insurers to offer coverage until age 26, it does not require parents to elect the coverage for adult children. I suggest you contact an insurance agent as soon as possible. If you are in good health you should be able to obtain catastrophic protection at a reasonably low premium. If you are not in good health, you may have coverage options available, depending on the type of coverage you had, how long you had it and how much time has gone by since you lost the coverage. An agent should be able to guide you through the process, which varies by state. Good luck.

  99. Monica says:

    I am on my mom’s insurance through Kaiser. 22 and pregnant. I want to get married before the baby comes, I’ve read and seen that marriage won’t get me kicked off of her health insurance but just want to make sure. And also… I started a new job in January that offers benefits but I didn’t know that I could be kicked off for that too.. I haven’t applied for my work’s benefit plan and kaiser has said nothing to me… what do I do? And I will need to find different insurance for the baby right?

    • johngarner says:

      You are correct that getting married is not a reason to lose coverage through your mother’s plan. I have never encountered an employer-sponsored plan that would terminate coverage due to a marriage, so I doubt that would be a problem. It is highly unlikely that you would be able to add your baby to your current plan through your mother. Getting married triggers a special enrollment period, which would allow you to enroll yourself and your husband in your plan at work. Having a baby also triggers a special enrollment period, which would allow you to enroll yourself and your baby.

      • Monica says:

        I want to remain on my mom’s policy. I do not want my employer’s offered health plan. I read somewhere that I may not qualify for my moms policy if my job offers a plan, is this true?

      • johngarner says:

        If your mother’s plan is a grandfathered plan, you may not be able to stay on it if you have other coverage available to you.

  100. Monica says:

    By the way, you are an amazing person for keeping up with this thread and answering all of our questions. :):)

  101. tonie kuchar says:

    I work in a doctor’s office in illinois, we are trying to figure out when a child is 23 and is working has insurance threw his work, but also is on his parents insurance, who is prime?

  102. Chuck Taylor says:

    My son is almost 26 and suffers from crohn’s disease and needs constant treatment for this disease. He’s not working and won’t be able to afford health coverage after he is no longer covered on my plan. Does he lose coverage on his 26th birthday or is actually his 27th birthday. I’ve been reading conflicting reports, some say he’s covered through the age of 26. Also, and more importantly Is there anything I can do to keep his coverage after 26 do to a disease or disability? Any loopholes?

    • johngarner says:

      Plans are required to offer coverage to age 26; however, if they choose to extend coverage, it is tax-free to age 27. Effective January 1, 2014, your son will be able to have health insurance without providing evidence of good health and without any pre-existing conditions exclusions. If he loses group coverage before that time, his only option will probably be COBRA continuation coverage, if your plan is subject to COBRA.

  103. Tammy Bartelli says:

    My daughter got married in December 2012, turned 25 in January 2013, and learned in May 2013 she was pregnant. Our insurance is with Blue Cross and Blue Shield of Alabama. This morning they informed us that her pregnancy is not covered. Any suggestions?

    • johngarner says:

      When is her due date? What type of policy does she have (individual, small group, large group)? What is the policy or plan year? Individual policies and small group policies (except grandfathered plans and small group plans) will have to cover maternity expenses for all policy and plan years beginning 1/1/2014 and later.

      • Tammy Bartelli says:

        Her due date is January 23, 2014…two days after she turns 26. She is on my husband-her step fathers policy with Blue Cross Blue Shield of Alabama the 320 Plan Group Health. The company my husband works for is a relatively small company with about 50 employees. What’s really crazy, she called last week about a claim and to give permission for them to discuss things with me…she told them she was pregnant (which they should have noticed because of the claims being submitted) and they never said anything about her pregnancy not being covered. The person she spoke to yesterday called her a co-dependent. We are really confused to why they have paid for a few things, but now she’s not covered.

      • johngarner says:

        Your husband should have been given a summary plan description (SPD). If you do not have it, he should ask for one. The SPD should say what the plan year is and whether the plan is grandfathered (if the SPD was issued in the last 3 years). If the plan year starts January 1 and the plan is not grandfathered, he should call Blue Cross Blue Shield and ask if his plan is a small group plan. If the plan year starts January 1, it is not a grandfathered plan and is a small group plan, the delivery should be covered, as long as it happens before she loses coverage due to turning age 26. The SPD should say if coverage terminates on her birthday or at the end of the month. If coverage terminates before the date of birth, COBRA continuation coverage would be an option. It will be worthwhile to explore an individual policy. As of October 1, the new Health Insurance Exchange (Marketplace) will be taking applications for coverage, which will be effective January1. An insurance agent should be able to help you find a policy, either through the Exchange or outside the Exchange. If she gets a policy through the Exchange, she may qualify for a subsidy, based on her income.

  104. Dylan says:

    My wife does not have health insurance through her employer, so we opted to add her as a dependent under her father’s HI plan instead of mine, primarily because it was significantly cheaper. Her last coverage date was 7/15/13 because he quit his job and we recently found out that she is pregnant! This would be the perfect opportunity to add her to my health insurance plan so that pre-natal care visits would be covered. But MY employer is giving me a hard time about defining this event as a “qualified life event.” Two examples of life events are: (1) Spouse loses coverage due to employment status change, and (2) employee [not spouse] lost dependent status with Parent’s employer’s plan. It would seem that because she is now without insurance, that reason would be a sufficient “Qualified Life Event.” After informing me that it wouldn’t qualify, the human resources department vaguely justified their response by pointing to the IRS tax code. Can you tell me any more about Qualified Life Events which would make my wife eligible to join under my health care plan? Are there any resources to which you can refer me?

    • johngarner says:

      With regard to employment status changes, the regulations are not as clear as I would like on this point. Even if they were clear in your favor, plans are not required to allow everything the IRS would allow.

      Regardless of whether your father-in-law’s job loss would count as an employment status change, the important thing is that your wife lost coverage. Almost any loss of coverage should allow you to enroll her.

      • Dylan says:

        Thanks for your response. As an update, after I petitioned the HR officer to look into the matter further, Human Resources has decided to allow this as a life event. They didn’t give their reasoning, but I’m satisfied at the outcome.

  105. Drie says:

    I am under my dads health insurance (humana) he has had it on me all my life. I recently just found out I was pregnant. Will his insurance cover my appointments and delivery? I know I will have to get insurance for the baby once born. I still haven’t gone to the appointment to confirm of my pregnancy but still just don’t know what to do if they “kick me off” or whatever. I am a fulltime student and I do work and we are in the open enrollment period to add insurance, but I don’t believe they will add me because I am pregnant.

    • johngarner says:

      An insurance company cannot cancel your coverage because you are pregnant. A group insurance plan cannot refuse to cover you because you are pregnant. You should have coverage for your prenatal visits and delivery. You will have to get coverage for your baby, which will probably not be possible through your father’s plan. If the baby is born in 2014, getting coverage for the baby will not be a problem and you may be able to get a subsidy through the new Exchange (marketplace) in your state.

      • Dylan says:

        My wife was under her father’s plan, but prenatal and delivery expenses are specifically excluded under the plan for “covered dependents.” Be sure you read the Summary of Benefits pages for your father’s health insurance at Humana.

      • johngarner says:

        Dylan, thanks for sharing, you are correct, plans have been able to exclude maternity expenses for children. Otherwise, they must treat maternity the same as any other illness, and most plans do not exclude children. Effective in 2014, individual policies and small group policies will not be able to exclude maternity expenses for children.

  106. […] designed for individuals and families who don’t have the option to purchase … details on dependent coverage to age 26 under reform – DMEC … May 17, 2010 … You can leave a response, or trackback from your own site. … She has […]

  107. […] details on dependent coverage to age 26 under reform – DMEC … May 17, 2010… the Act’s implementation date, including Aetna, Blue Shield of California, CIGNA, … You can leave a response, or trackback from your own site. ….. Blue Cross of California ( HMO) requires me to designate a dental coverage … […]

  108. […] mental health and substance …. You can leave a response, or trackback from your own site. details on dependent coverage to age 26 under reform – DMEC … May 17, 2010 … You can leave a response, or trackback from your own site. …. If a plan […]

  109. […] details on dependent coverage to age 26 under reform – DMEC … May 17, 2010 … (Plans that do not provide dependent coverage are not required to do so … You can leave a response, or trackback from your own site. ….. I work in the state of Florida where Health dependent care coverage is available up to age 30. … me to designate a dental coverage either PPO or HMO through Delta … […]

  110. Matt Baldwin says:

    I am 23 years old, currently covered under my parents “family plan” insurance. Unique situation, I am slotted Active Duty Military, but am not scheduled to start until November-December (No tricare until then).

    The catch is, I am getting married in three weeks – and am not sure what to expect in coverage (Bluecrossblueshield – Florida) Will my wife to be and I need to find coverage for ourselves until I am able to start Tricare, or are we still able to be covered under our parents as we’re both under age 26?

    Any help would be great!

    • johngarner says:

      Prior to health care reform, things like becoming active-duty military and getting married would cause most plans to terminate coverage for children; however, now the only reason a plan can terminate coverage for a child is when the child reaches age 26 (parents can also voluntarily drop coverage). You will not be able to add your wife to your plan when you get married, but if she has coverage under a parent’s plan, she can keep it.

  111. I have a child who I insure thru my employer as I have done all her life. Since she is over 18, what financial obligations do I have since she is not paying her medical bills, I have random benefits explanations show up and we do not speak. I currently plan to drop her coverage since she owes 5k etc… I guess said differently whats my financial responsibilty since she is an adult,. can they turn me over to collection or damage my credit.

  112. Chery Hardy says:

    My friends minor child is pregnant she is 15. She’s covered under her fathers insurance. Since she’s a minor will the baby be covered under her fathers insurance?

    • johngarner says:

      That depends on the terms of the plan. Many plans or policies do cover maternity expenses for dependent children; however, some do not. For policy years beginning in 2014, individual and small group policies will have to cover maternity expenses.

      • Chery Hardy says:

        Ok Thank you….being she is a minor child herself she can not retain her own health care will the baby be covered?

      • johngarner says:

        Policies almost never cover grandchildren. Under health care reform the child can get coverage effective January 1, 2014, or later if born after the first of the year. If the child is born before the first of the year, it may be possible to get coverage through a government program, such as Medicaid or the Children’s Health Insurance Program. It may also be possible to get an individual health insurance policy–you can ask an agent in your community.

  113. Elizabeth says:

    I am 25 years old and on my parents healthcare. My company is doing open enrollment for coverage to start on 10/1/13. My dad has said since I turn 26 next year he does not want to renew my coverage when his coverage renews 1/1/14. I know my age is a qualifying event but not sure if I could get my company insurance starting 1/1/14 under a qualifying event since I do not actually turn 26 until part way through the year. Or if the qualifying event only applies on my birthday.

    • johngarner says:

      Losing other coverage creates a special enrollment period, so you should be able to sign up for insurance at your company whenever you lose coverage under your parent’s coverage.

  114. PJ Lee says:

    My daughter is 22, married and 8 months pregnant. She is still covered under my company insurance. My question is that her husband has just accepted a job where they will be offered insurance coverage. If he puts her on the policy before she delivers will the new insurance pick up her remaining two months of pregnancy or will mine continue or do I have an option? My concern is that I am switching jobs and in this switch it would obviously be best for her to go with the new coverage- how will that work for her remaiing pregnancy?

    • johngarner says:

      Her husband’s insurance should pick up her pregnancy expenses. You could also keep her on your coverage and the two plans would coordinate coverage to pay 100% of the bill, if you both have PPOs (if one or both are HMOs, it is more complicated). Also, if your plan is a grandfathered plan, she could lose eligibility under your plan once she becomes eligible for other coverage.

  115. Kate garrison says:

    I am 25 I am covered on my fathers plan as a dependent until October 19th of this year being I turn 26 my concern is I found out that I am pregnant 2 days ago after 2 years of infertility. I am self employed had planned to get an individual plan but now I’m not sure being pregnancy is considered a pre existing condition What are my options for coverage if any ?

    • johngarner says:

      You may want to get COBRA continuation coverage for the rest of this year, then get an individual policy, effective January 1, 2014. You can apply for coverage from October 1 through December 14 and have it effective January 1. For policies effective January 1 and later, pre-existing condition exclusions are prohibited.

  116. Pat Doner says:

    My niece is22 years old,she does not get along with her parents,(especially her Mother) they took her off thier health Ins. beause of this. Is this legal, can they do that? Her Dad works for Ford Motor company in Michigan.

    • johngarner says:

      Yes, this is legal. Employers are required to allow employees to keep adult children on their plans until at least age 26; however, there is no requirement that employees elect the coverage for their children.

  117. My daughter is on my husbands health insurance (her step-dad).
    She graduated college in May & is working part-time at the moment. Today I was informed by my husband’s company that a step child is not included until 01-01-2014 & that they are dropping her coverage.
    My husband can re-apply in 2 weeks during open enrollment for her coverage starting January…. go figure! Is it true that step children are not included in the affordable health care act once they have graduated college?

    • johngarner says:

      I wish I could give you a clear answer. In defining which children under age 26 are eligible for coverage, the interim final regulations prohibit a plan from requiring a child to satisfy any conditions other than “a relationship between a child and the participant.” No further guidance was offered as to the nature of the relationship that would support the characterization as a “child.” Prior to health care reform, in order to avoid imputing income, employer plans commonly offered dependent coverage to some subset of an employee’s Code § 105(b) dependents, a term that includes certain “qualifying children” of the employee, as that term is defined by Code § 152. Under Code § 152,the term “child” means “a son, daughter, stepson, or stepdaughter . . . of the taxpayer.” I would not advise an employer to exclude stepchildren, but it is not absolutely clear that they cannot.

  118. GiGi says:

    My daughter is married to a military man. They have Tricare right now. She is 4 months pregnant. But they will be losing the Tricare insurance 2 months before the baby is due. She is 23 years old. Can I put her on my insurance (BCBS through my employer) so that the delivery will be covered?

    • johngarner says:

      That depends on the terms of your employer’s plan with BCBS. She will have the right to sign up for an individual health insurance policy, either through one of the new Exchanges or directly with an insurance company.

      • GiGi says:

        So I found out that yes, she can be covered under my insurance. Even with her being pregnant and married. However, she has to be NOT covered by any other insurance. So the day that she loses her husband’s coverage, I will have 30 days to add her to my policy. The “life event” reason for adding her to my policy is that her husband is losing coverage and so will she.

        But I do want to advise. The Benefits counselor that I saw was reading the policy wrong. And at first told me that my daughter would not be covered. So I insisted that she dig further into what the policy meant. The policy states that the spouse and “child” would not be covered. She thought “child” was the adult child, my daughter. In fact, “child” meant the baby that would be born. I disagreed with her and when she made a few phone calls, she discovered she was giving out the wrong info.

  119. Cathy Lawless says:

    I understood that some health plans continued coverage of a 26 year old until the end of the 26th year. I also understood that if the 26 year old was dropped from the family plan they were on, notification would be given by the insurance company so the 26 year old could obtain cobra benefits. We just found out our daughter was dropped after her 26th birthday in June. We just found out when a claim was denied in late October that she hasn’t been covered since June. Is it legal for her to have been dropped without any notice?

  120. Dreama Lutz says:

    My daughter is teaching English as a second language in Thailand. She is currently on my husband’s health insurance plan. She cannot use the plan in Thailand. If we take her off our plan for the 1-2 years she will be in Thailand, can we add her when she returns to the states? She will still be under 26.

    • johngarner says:

      Your husband’s plan would be required to allow her to come back onto the plan; however, enrollment may be limited to during the open enrollment period (if any). I suggest that you check with the plan administrator.

  121. Maria Schneider says:

    My daughter just turned 23 today…she has been on my retiree insurance benefit for 4 years…without any problem..she is a full time student who will be graduating from college next June…she has been dropped from my coverage as of today…I just found out she was being dropped when I received a Cobra package…with a charge to keep the insurance for her one individual at $471 and change per month. I am confused…I read that grandfathered plans could drop coverage, but with the ACA coming into existence in January 2014 I thought all health insurance plans would have to abide by the 26 year old age rule…and they would no longer have the grandfathered status to keep peoples dependents from coverage? It is my open enrollment at this time even as a retiree…and every year prior we were able to put in our choices…when speaking with HR…they have advised that the type of retiree that I am I have no alternate choices…but I still could not print out what I would be getting for 2014…My concern is, that if they must abide by the 26 year old age requirement…shouldn’t my daughter be kept on my insurance…or will she be taken off until 2014 and then we have to re add her on…they aren’t being very helpful with this…I’m sure if they have a choice they won’t want to allow her on the insurance plan…but if it’s the law..I sure want to make sure she isn’t having to pay for private insurance which would cost a lot more than what she has had being on my plan.
    It isn’t very clear, and there are no Q & A’s about this situation…please explain the law as how it will be when it goes into full effect in January 2014…thank-you for your time and consideration…

    • johngarner says:

      You have a complex situation. Grandfathered plans will be required to cover children up to age 26, even if they have access to other insurance, starting with plan years beginning on or after January 1, 2014. Retiree-only health plans are exempt from many of the requirements of health care reform.

  122. Sara Lowry says:

    I was covered on my father’s insurance until my 26th birthday in October and then I was dropped. My new employer offers insurance but won’t pick me up until the first of year, so am I supposed to go without coverage?

    • johngarner says:

      I never recommend going without coverage. You should have been offered COBRA. You have 60 days from the date you were notified of your COBRA rights (or the date of termination of coverage, if later) to elect COBRA. After electing COBRA, you have another 45 days to pay the premiums. That means if you wait until close to the 60th day to elect COBRA, you would not have to pay anything until after the first of the year. At that time, you can determine if your claims would exceed the premiums due and, if so, pay the premiums.

  123. Renee says:

    I currently cover my 23 year old son on my medical insurance plan through my employer. He recently married and his wife is in the USAF making him eligible for benefits as a spouse. If he signs up for coverage, would the new plan be secondary? Also could it interfere with the benefits of his primary plan?

    • johngarner says:

      TRICARE (the plan for military dependents) pays second after any other health insurance plan. If your plan is a grandfathered plan and if it has chosen to do so, it could terminate his coverage if he becomes covered by TRICARE before the end of 2013.

  124. Steve says:

    What a great site! Are there any provisions for AFTER age 26 if my son is dependent on me, cannot work, has emotional issues?

    I live/work in CA.

    Thank you

    • johngarner says:

      COBRA continuation coverage will be available after your son reaches age 26. Under health care reform, insurance companies will have to offer individual health insurance policies regardless of a person’s health history. That coverage can be purchased through Covered California (the new Exchange in California) or directly from an insurance company through an insurance agent.

      • Steve says:

        Thank you. I contacted Kaiser and they told me my son could be added back to my policy if he is “legally disabled”, but not sure which / whose definiation they use.

      • johngarner says:

        When your son approaches age 26, you can ask Kaiser for details on how to continue his coverage. They would determine if he meets their definition of a disabled child.

  125. Amik says:

    My daughter just turned 24. She’s a grad school student, living out of state, and she will probably not be making any money in 2014, or very little.

    From what I was told, as far as the IRS she can’t be our dependent beyond the age of 24, but as far as the ObamaCare we can include her on our insurance till the age of 26…

    When I applied thru HealthCare.gov the system would drop her name as an applicant, ’cause when asked if my daughter “will be claimed as a dependent” I answered “no”…. Once I changed it to “yes” (had to go thru a new application all over again) then the system added her name as an applicant, eligible under our coverage.

    Something makes no sense here…. HealthCare.gov and the IRS need to sit down, have a little talk…. Or am I missing something here?

    • johngarner says:

      Different rules are frustrating. Since you won’t be claiming your daughter on your tax return, that could cause problems later if you are getting a subsidy. Since she has virtually no income, she might be able to get Medicaid, if she lives in a state that is expanding Medicaid.

      • Amik says:

        But that’s what I’m saying, “different rules”… This is a Catch 22… if the government allows parents to provide health insurance for their kids till 26, then the government should make it available till the age of 26… Or else I can only interpret it as deception, or ineptness at best.

        Why would a young American start her life under Medicaid? Why is it better for the American people to pay for my daughter’s health coverage, when her own parents are willing to pay for that cost?!?!

      • johngarner says:

        If you are supporting your daughter, she may still qualify as your dependent. I suggest you speak with a tax professional.

  126. Michelle Getz says:

    My daughter is 23. Lives dependently in her own apartment in another state. Do I have to cover her?

  127. Paige says:

    My dad got remarried in 2013 and moved out of state. We are now on Anthem Blue cross. They live in Indiana and I Michigan. I am 22, turning 23 and took the 2013-2013 school year off to find somewhere to live and get settled. Am I still covered under their insurance? I will resume school in fall of 2014.

    • johngarner says:

      Check with your Dad. As long as you are under age 26, any parent or step-parent can cover you under an employer-sponsored plan (although an HMO network may not help you in another state).

  128. Claudia Meza says:

    My parents have medi-cal and I am claimed as a dependent. Am I still covered until the age of 26? Someone from the medi-cal office told me my coverage ended when I turned 21 (and I am now 22 and still a dependent.)

  129. SHARON MARQUEZ says:

    My grand daughter, age 19 and pregnant, is covered by Kaiser on her father’s union medical coverage. We have just been told that the baby has a cleft lip, which they say can be repaired between the ages of 6-8 weeks. Will the baby be covered by Kaiser, or will my grand daughter have to find other insurance to cover the surgery?

    • johngarner says:

      You can check with Kaiser; however, it would be highly unusual for them to cover the new baby, which means you probably need to get new insurance for the baby. Fortunately, health care reform means the baby cannot be denied coverage and pre-existing conditions cannot be excluded.

  130. Linda says:

    my niece is 28 years old, lives at home, does not work and will continue to live at home. both parents are working and insured. she lives in Texas which did not extend Medicaid

    • johngarner says:

      Because she is under age 30, she can buy a catastrophic policy through the Exchange. It will be the least expensive option and will still cover preventive services, plus 3 office visits, without a deductible. It will also provide protection from very large expenses.

  131. godmother says:

    My godson is 18, still in high school, but hopefully graduating in June. He has left home and is couch surfing, as he does not get along with his (single) dad. It’s unlikely he’ll get a job with healthcare benefits soon. He may not enroll in college for quite a while as he has to get on his feet financially first. If his father chooses to take him off his Kaiser plan in CA, what are his options for affordable coverage
    ? Affordable Care Act (which package?), Medical? Other? Thank you in advance.

    • johngarner says:

      It sounds like he would probably qualify for Medi-Cal (California’s version of Medicaid). If he loses coverage, he can go http://www.coveredca.com and complete information about his income and they he will probably get a message that he qualifies for Medi-Cal. It will then take some time for them to get back in touch with him, but they eventually will do so.

  132. Julian says:

    My daughter changed her last name, different from mine. She’s going to be 23 this year. Can she be still covered under my health and dental insurance even if she changed her last name to her stepfather

  133. Julian says:

    Sorry, another question my daughter is 22, turning 23 this July. By law, do I have to have her under my medical and dental insurance.

  134. Charity says:

    My daughter is turning 18. By law do I have to have her covered on my medical and dental insurance after she turns 18. Can I legally drop her from my insurance after she turns 18.

    • johngarner says:

      You can drop her coverage at open enrollment or if there is another status change; however, turning 18 would not allow you to change payroll deductions if you have pre-tax contributions. Your employer may not allow all the mid-year changes that are allowed under the IRS rules, so you should check with them.

  135. Charity says:

    Another question, by law, does my husband have to cover medical and dental vision insurance for his 22 year old adult child

  136. Charity says:

    When my child turns 18, she’s going to need dental implants for her molars, because she was born without any molars. Can my ex husband take her off his insurance when she turns 18 and graduates high school.

    • johngarner says:

      Unless you have a court order (which in unlikely once a child reaches age 18), your ex husband can take her off his insurance whenever that plan’s rules allow doing so. If it is an employer-sponsored plan, he may have to wait until the next open enrollment period to drop her coverage. If it is an individual policy, he can probably drop her coverage at any time.

      • Charity says:

        It says in the divorce decree that my ex husband shall provide medical support for the parties’ child for as long as child support is payable under the terms of this decree. So does that mean when my daughter turns 18 and graduates high school, he can without notice take her off his dental insurance, even though she needs these molar implants. Is that legal?

      • johngarner says:

        It would seem to be legal.

  137. Rose says:

    I know by law my ex husband needs to provide health insurance when my child turns 18 and graduates high school, but does he have to by law also provide dental and vision insurance before my child turns 18.

  138. Julian says:

    I just got talking to BCBS. They said since the affordable care act took in effect as of this year, or as we call, “Obama Care” BCBS said I need to cover my child for health and dental even after my child turns 18.Can my child get insurance for herself after she turns 18. I don’t want to be penalized if I take her off my insurance. Is my daughter responsible to get health and dental after she turns 18, or is it the parents responsibility. You tell one thing and the Obama care tells me another.

    • johngarner says:

      There is a lot of confusion & misinformation about health care reform, even within the insurance industry, where people work with the rules every day. There are other, older rules that may apply to you. If you have pre-tax contributions for an employer-sponsored plan, you can only remove a dependent if certain status changes occur. If your child loses coverage, he or she should be able to get coverage through the new exchange in your area.

      • Julian says:

        My company doesn’t pay for insurance . I pay for my health and dental Insurance. since I’m a sole proprietor. Can I take her off my health and dental after she turns 18. Will my daughter be responsible for herself or my ex wife. I just don’t want to get in trouble if I remove her. I’m sorry for bombarding you with so many questions.

      • johngarner says:

        Whether you can remove her may depend on the insurance company’s rules. If your ex-wife has employer-sponsored coverage, she could add her if she loses coverage with you, as long as she does it within 30 days. She would have 60 days to get coverage in an exchange.

  139. Sally Cooper says:

    For NJ-My son graduates college in May at 22 yrs old. He is covered under my health insurance through work. My X pays half of what they take out of my check for his part. Which he pays $53 a week full BCBS health ins. My divorce decree was finalized in 2009. My question is: He is graduating and most likely due to economy will not find a job ASAP w/ health insurance. I would like to keep him on mine, but don’t know if I can afford too. Would I be able to revisit the divorce decree since this wasn’t an option to leave children on to age 26 in 2009, to see if he is entitled for his father to still pay the $53 until he finds a job or maybe give him one year to leave him on my insurance.

  140. hmmm says:

    Are the children of union members exempt from this? Meaning at age 18 they are kicked off their parent’s policy?

    • johngarner says:

      Generally speaking, union plans are subject to the requirement to offer coverage to children up to age 26. If a plan does not cover any dependent children, health care reform does not require them to cover adult children. Grandfathered plans with plan years beginning before 2014 are not required to offer coverage to adult children who are eligible for other employer-sponsored coverage. Union members are not required to enroll their children, even if they are eligible and children have no independent right to enroll.

  141. Julian says:

    My daughter turns 18 in January, but doesn’t graduate until the end of May. I know in the state of texas I have to pay child support up until she graduates, but can I take her off my health insurance once she turns 18, or do I have to wait until she graduates, just like the child support.

    • johngarner says:

      If you have employer-sponsored coverage, you will probably have to wait until open enrollment to drop her coverage. Check with your employer. If you have an individual health insurance policy, check with your insurance company. Be sure to follow anything spelled out in a court order.

  142. Michael Drayer says:

    My girlfriend just found out recently that the father of her daughter who is 21 yrs. old was dropped from her father’s insurance coverage as of 12/31/13. She was never notified, apparently the insurance company sent the notice to the father who never forwarded the notice on to his daughter (whom he hasn’t seen since she was 3). Here lies the problem; her mother (my girlfriend) tried to put her on her health insurance plan which she has because she is self employed through Highmark. They said she couldn’t because it was out of the 60 day grace period and not time for open enrollment. So she tried looking at the market: the market said the mother couldn’t get an insurance plan that would cover her daughter because her daughter files her own taxes, even though it is as a dependent of her mother, because she makes earned income of about $4000 from a PT job while she attends college FT. Then they said because she makes less than $11,000/year she doesn’t qualify for her own insurance plan. WTH? And they wonder why more under 26 and under haven’t signed up, this is most of them! This just doesn’t even sound right at all. I am a tax accountant and because her daughter has earned income she should be filing her own tax return. Why does this disqualify her from getting insurance on the market place that I thought was supposed to be there to make sure everyone gets minimal coverage!?! I’m at a loss on all of this!

    • johngarner says:

      Does she live in a state that expanded Medicaid eligibility? If so, there is no open enrollment period for Medicaid–people can enroll at any time if they are eligible (and it sounds like she should be).

      • Michael Drayer says:

        No, we live in PA so there isn’t any expanded Medicaid eligibility. The people on the Marketplace Phone line have said she doesn’t qualify as dependent on her mom’s insurance if her mom got insurance on the marketplace because her daughter files her own tax return (as a dependent of her mother’s). So since her mother claims her as a dependent her mom is the one that would get the fine for her daughter not covered by an acceptable plan, but her they won’t let her cover her on a marketplace plan. And then looking at her separately she doesn’t qualify because she makes less than $11,000. This makes no sense at all and would explain why under 26 yr. olds aren’t signing up like Obama thought they would. She only makes $4k a year working PT while going to college FT, so her mom claims her as a dependent and rightfully so. She lives at home with her mom and her mom clearly provides over 50% of her financial support. The only reason they are giving her mother that she can’t cover her under a market plan is that her daughter files her own tax return (but she doesn’t claim the dependent exemption, the mother does). That’s what is keeping her from getting on her mother’s plan and the fact that she doesn’t make over $11,000 disqualifies her from getting one on her own. Does any of this make any sense!?! Its the typical tax filing scenario for college students. They file a tax return because they have earned income from a PT job but the parent who is paying for college, is still providing them a home and feeding them is claiming their adult child as a dependent.

      • johngarner says:

        I can’t say that it makes sense and I can’t think of a way around this. Normally someone knows when they lose insurance and they would have 60 days to apply for coverage through the Exchange (usually 30 days for an employer-sponsored plan). Since she lost coverage without knowing about it, she is an unfortunate victim of all these complex rules.

      • Michael Drayer says:

        Thanks for reviewing my questions. My girlfriend may be consulting with an attorney for failure to forward her daughter’s mail which, although rarely enforced, is a federal offense! Since he did this they will likely be subject to the penalty of 1% of Household AGI (which will be more than the $95) Unfortunately her daughter is not only a victim of the complex rules but of having a buffoon for a father (keeping it clean for the sake of the blog, lol).

  143. Charity says:

    Does my husband have to notify his ex wife, that he’s taking their daughter off his insurance once she is 18 and graduates high school. Can the ex wife get an attorney for him to put her back on the insurance or sue him for not notifying her in the state of texas

    • johngarner says:

      I am not aware of any state or federal laws that would require him to notify his ex-wife. Unless someone over 18 is incapacitated, it is unlikely a court would issue an order.

  144. Raven Ludy says:

    I have a different complaint. I am a 20 year old women in the state of Texas going to college with no children and currently not married with no health insurance. I have tried with multiple places and I have been denied a total of 6 times. I am not crippled in any way but I have a long history of ADHD, and a low immune system from birth. I was kicked off my mother’s CHIPS plan the day i turned 19 and no matter what I tried I haven’t been able to get on any other type of insurance. Everything says I need to be pregnant, a mother, 26, or disabled. I am currently in need of a tonsillectomy and have no way of affording it with out digging my own debt hole. I even got denied the Texas Women’s Health Program insurance. Even the low monthly cost but ridiculously high deductible denied me. And I also heard that anyone with out insurance will be billed $500 on taxed the first year they don’t have anything and that it’ll keep rising each year you don;’t have any on you taxes. I also heard that if you don’t pay that bill then it will roll over onto next years taxes. Does anyone have any advise for me because I’ve literally tried everything that I could and nothing worked. And if anything happens to me and I need to go to a hospital, there will be no way I can afford it. Please I really need help on this matter.

    • johngarner says:

      Unfortunately, you missed the open enrollment period for this year and Texas has not expanded Medicaid. The penalty for not having health insurance is the greater of $95 or 1% of income. If you make $50,000, the penalty will be $500. There are a number of categories of people who are exempt from the penalty, including anyone who would have to pay more than 8% of their income for a policy and anyone who tried to get coverage during the open enrollment period and could not, because of all the technological problems. There are also circumstances that arise between open enrollments that allow people to obtain insurance, such as getting married, having a baby, moving to a new area with different insurance options. It doesn’t sound like any of these apply to you and you may have to wait until the next open enrollment period, which starts November 15 for coverage effective January 1. You might check with college to see if they have anything available before that time.

      • Raven Ludy says:

        I have checked with the college and they said that there is nothing available for me. Right now do to my unemployment I am not able to afford to pay taxes at all and I am in no position to marry or have children so that is out of the question. I have tried getting jobs with benefits but they all require experience that I don’t have and almost none are willing to train and the ones that are won’t work around a college schedule. I can’t drop out because the loans I’m receiving right now are my only source of income and I unfortunately have no other choice but to live off of them. I can’t qualify for STAMPS because my roommates don’t want on the case and I have no income to qualify myself. Am I the only one in this bind of not having insurance and not being able to get a job? And as for open enrollment I think my mother tried to get me on something last year but unfortunately I was denied coverage the same as every other time I’ve tried. They all say I don’t meet any of the requirements to receive the coverage that they offer. We tried again this year as well, with the same results. No matter what I’ve tried I get denied.

      • johngarner says:

        If your mother tried to sign you up during open enrollment and was not able to do so, you should be exempt from the penalty.

    • Michael Drayer says:

      You can see I had some questions about this process as well. I am presuming that for whatever reason your parents can’t cover you under their health insurance?

      We did find that there is Short-Term Health Insurance available that is fairly reasonable from what I’ve seen that can get you through to the next open enrollment period but usually it doesn’t include pre-existing conditions which is why it doesn’t qualify under the AHA. But at least you have coverage.

      As far as the penalty for not having a qualified health insurance plan is concerned here are some clarifications on this:

      For 2014 it is $95 or 1% of household modified adjusted gross income. Now this excludes the first $10,150 so for most FT college students you will not have to pay the penalty, but if you are claimed as a dependent on your parent’s tax return they may be subject to the penalty and your income and their income will be combined to determine the penalty (that’s where that 1% of household income comes into play and can get pretty hefty!). However if you claim your own dependent exemption for 2014 and make less than $10,150 you won’t have to pay any penalty. If you make more than $10,150 take your total income and subtract $10,150 from it and then multiply it by 1%, your penalty will be the greater of $95 or the 1% calculation. For you penalty to be $500 in 2014 your income would have to $60,150 ($60,150 – $10,150 = $50,000 x 1% = $500.00).

      Hopefully this gives you some clarification for this. The media and politicians have overblown this a bit but I understand it still stinks, lol!

    • Michael Drayer says:

      Given what your saying Raven then you won’t have to worry about the penalty you will just have to deal with paying for medical costs out of pocket. Your mother’s insurance can’t deny you coverage if its during their open enrollment period, but your mother doesn’t have to cover you either, the AHA just makes the option for parents to cover their children till their 26 it doesn’t require them to. However if your mother is claiming you as a dependent on her taxes while you are going to college (which if she is likely doing, especially if she is helping you pay for college, to get a tax break), then she is the one that will face getting the penalty for you not having health insurance. If you claim your own exemption on your taxes and your mother doesn’t claim you and your income falls below $10,150 you technically don’t need to file a Federal Tax Return and you will also not be subject to the penalty. However, if you worked at all doing a PT job and still earned less than $10,150 and no one claims you as a dependent I would recommend filing because you will likely be due a tax refund.

  145. Michael Compton says:

    My medical insurance cost has continued to increase to a point where it is no longer affordable. I would like to change to my wife’s employers insurance. Which is about $300 cheaper per month. The problem is my open enrollment date and hers are at different times and her HR director said it is too late. My question is…..if the enrollment dates are different how would I ever be able to change from my insurance to hers? We live in Texas.

    • johngarner says:

      Some employers allow people to add or drop coverage to coincide with another employer’s open enrollment period. If your wife’s plan does not do that one way to switch from one plan to the other without losing protection is to have duplicate coverage for a period of time, which can be very expensive. Another approach would be to drop coverage with your employer, get individual coverage so you do not have a gap, then drop the individual coverage when coverage under your wife’s plan becomes effective. This would be easiest if your open enrollment coincides with the annual enrollment periods for the Exchanges.

  146. Kathleen says:

    My son is 20 years old and we live in TX. He receives straight Medicaid (not as a dependent or party to my plan) as I was his foster mother and adopted him as a young child. He receives Medicaid because of serious medical and surgical issues he has had since birth. His Medicaid was extended to age 21 (instead of the normal 18) as former wards of the state are eligible for this if they have needs. He will turn 21 in November. I called the TX Medicaid adoption liaison (there are less than 10 for the whole state!) who had no possible new information, and told me that I needed to apply for medicare for him, as has been the process as former wards of the state age out for the last 20+ years.

    My reason for wanting to get his Medicaid extended until age 26 (and not switch to medicare at this time) is that he requires approximately 3 more major surgeries in the next 2 years. His surgeons practice at a children’s hospital and he will continue to have these last surgeries done by the pediatric surgeons as they have seen him since he was a child, and these are surgeries that are performed by pediatric surgeons: not general surgeons.

    Do you have any information on whether he can continue to receive his Medicaid and how do I access this? Thank you.

    • johngarner says:

      I wish I knew more about Medicaid in Texas. I do know that the Health and Human Services Commission (HHSC) determines Medicaid eligibility in Texas. People who receive Temporary Assistance for Needy Families (TANF) automatically qualify for Medicaid. Other people also may qualify based on their income and resources.Call 2-1-1 or visit http://www.211texas.org/211/ for information about qualifying for Medicaid.

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