If a plan covers children, they can be added to or kept on a parent’s health insurance policy until they turn 26 years old. Children can join or remain on a parent’s plan even if they are:
Not living with their parents
Not financially dependent on their parents
Eligible to enroll in their employer’s plan
These rules apply to both job-based plans and individual plans bought inside or outside the Marketplace.
What happens when my child turns 26?
Under-26 coverage ends on a child’s 26th birthday.
When a child loses coverage on their 26th birthday, they qualify for an SEP – special enrollment period. This lets them enroll in a health plan outside open enrollment.
They may qualify for tax credits and other savings based on their income.
They can enroll up to 60 days before their 26th birthday. Their special enrollment period ends 60 days after their birthday.
If they enroll before their birthday, coverage can start as soon the first day of the month they lose coverage. If they enroll during the 60 days after their birthday, coverage can start the first day of the month after picking a plan.
If they don’t enroll in health coverage within 60 days of their birthday, they may not be able to get coverage until the next Open Enrollment period.
If they aren’t insured, they may have to pay the fee that some uninsured people pay. If they’re uncovered for less than 3 months of the calendar year, they don’t have to pay the fee.
State based legislation that existed long before Obamacare
Long before the “Patient Protection and Affordable Care Act” (a.k.a. “Obamacare”) was signed in to law on March 23rd, 2010. There were Federal & State laws that were already in force around the country that provide protection for dependent children regardless of their college student attendance status.
In fact, the PPACA legislation does NOT include protection for dependent children regardless of student eligibility status until 2014. Neither does it guarantee access to health insurance coverage regardless of pre-existing conditions until the year 2014. Even though, the President stated repeatedly that “within 6 months of the signing of this legislation, dependent adults will be able to stay on their parent’s policies until 26 years of age and children will no longer be denied coverage for a pre-existing condition“.
Thanks to America’s Health Insurance Plans (who had already suggested such legislation in 2008) children did not have to wait until 2014 to obtain guaranteed access to health insurance coverage for pre-existing conditions so long as they are insured on a parent’s policy. This is true because America’s Health Insurance plans voluntarily agreed to do in 2010 instead of waiting until 2014.
Thanks to this agreement, as of 9/23/2010 all dependent “adult children” can now remain on their parent’s health insurance policies until the age of 26 without the need to be attending college. Blue Cross Blue Shield lists all of the other mandates that were added to health insurance policies as of 9/23/2010 under the PPACA as well.
In addition, more than 80 new Preventative Care mandates have also been added to all “non grandfathered” health insurance plans (plans purchased after March 23rd, 2010).
Another law that was passed by Congress in 2008 also protects college students. Such as Michelle’s Law (H.R. 2851) which requires insurance plans that use student status to determine dependent eligibility to allow dependents to take up to 12 months of medical leave without jeopardizing their eligibility. More than 20 percent of states had enacted similar laws prior to federal action.
Then there are COBRA Continuation Coverage Rights which were passed more than 14 years ago in 1996. Under these laws, a dependent child will become qualified for COBRA benefits if they lose coverage under their parent’s employer-sponsored insurance (20 employees or more) if:
1. the parent/employee dies;
2. the parent/employee’s hours of employment are reduced;
3. the parent-employee’s employment ends for any reason other than his/her gross misconduct;
4. the parent/employee becomes enrolled in Medicare;
5. the parents become divorced or legally separated; or
6. the child stops being eligible for coverage under the plan as a “dependent child.”
Below are the States that already had laws on the books before the PPACA that provide continuation of coverage for adult dependents regardless of their college attendance.
Table of State Laws (Updated August 20, 2009)
|Colorado||Colo. Rev. Stat. § 10-16-104.3 states that a child is considered a dependent for insurance purposes up to age 25 (even if they are not enrolled in an educational institution) as long as they are unmarried and are financially dependent or share the same permanent address as the insurance provider.|
|Connecticut||C.G.S.A. § 38a-497 requires that group comprehensive and health insurance policies extend coverage to unwed children until the age of 26 provided they remain residents of Connecticut or are full-time students.|
|Delaware||Del. Code Ann. Tit. 18, § 3354 requires insurance providers to cover policyholder’s dependent children until age 24. Dependents must be unmarried and a resident of Delaware or, if living outside the state, a full-time students. Insurance companies may charge more for dependent coverage past age 18, but it may not exceed 102 percent of the policyholder’s cost before the child turned 18.|
|Florida||Florida 627.6562 allows for dependent children up to 25, who live with their parent or are a student, and up to 30 years old, who are also unmarried and have no dependent child of their own, to remain on their parents’ insurance.|
|Georgia||Ga. Code § 33-30-4 allows dependent children up to age 25 who are enrolled as a full-time student at least five months during the year or are eligible to enroll but are prevented due to illness or injury to remain on their parents’ insurance.Ga. Code § 33-24-28 requires that a health services plan or health insurer exempt dependent children incapable of self-sustaining employment due to disability from dependent age limits.|
|Idaho||Idaho Stat. § 41-2103 allows for any unmarried dependents to remain on their parents’ health insurance until age 21; any full-time, unmarried student until age 25; or a dependent with a disability without regard to age.|
|Illinois||215 ILCS 5/356z.12 provides parents with the option of keeping unmarried dependents on their health care insurance up to age 26. Parents with dependents who are veterans can keep them on their plans up to age 30.|
|Indiana||IC 27-8-5-2,28 and IC 27-13-7-3 require commercial health insurers and health maintenance organizations to cover children until age of 24 or without regard to age if they are incapable of self-sustaining employment due to disability.|
|Iowa||Iowa Code § 509.3 and Iowa Code § 514E.7 requires that health insurance providers continue to cover unmarried children under their parents’ coverage provided that the child 1) is under the age of 25 and a current resident of Iowa, 2) is a full-time student, or 3) has a disability.|
|Kentucky||Ky. Rev. Stat. § 304.17A-256 allows parents to keep their unmarried children on their health plans until the age of 25. Parents may have to pay extra for their adult children.|
|Louisiana||La. Rev. Stat. Ann. § 22:1003 allows an unmarried, dependent child to remain on parent’s insurance up to age 24 if they are a full-time student.|
|Maine||24-A MRSA § 2742-B requires individual and group health insurance policies to continue coverage for a dependent child up to 25 years of age if the child is dependent upon the policyholder and the child has no dependents of the his/her own.|
|Maryland||MD Code, Insurance § 15-418 requires that health insurance be extended to, at the request of the policy holder, unmarried dependents under the age of 25.|
|Massachusetts||Mass. Gen. Laws Ann. Ch. 175 § 108 allows dependents to stay on their parent’s coverage for two years past the age of dependency or until age 26, whichever occurs first, or without regard to age if they are incapable of self-sustaining employment due to disability.Young adults ages 19-26 are eligible for lower-cost insurance coverage, tailored to meet their needs, offered through the Commonwealth Health Insurance Connector. Reform summary and fact sheet, PowerPoint presentation; More information.|
|Minnesota||Minnesota Chapter 62E.02 Defines “dependent” as a spouse or unmarried child under age 25, or a dependent child of any age who is disabled.|
|Missouri||Mo. Rev. Stat. § 354-536 defines dependent as an unmarried child up to age 26. If a health maintenance organization plan provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children, such coverage shall continue while the child is and continues to be both incapable of self-sustaining employment by reason of mental or physical handicap and chiefly dependent upon the enrollee for support and maintenance.|
|Montana||MCA 33-22-140 provides insurance coverage under a parent’s policy for unmarried children up to age 25.|
|Nevada||NRS 689C.055 allows an unmarried, dependent child who is a full-time student to remain on his or her parent’s insurance up to age 24 if parent is covered by small group policy.NRS 689B.035 requires that dependents retain coverage beyond age of policy termination if they are incapable of self-sustaining employment due to disability.|
|New Hampshire||N.H. Rev. Stat § 420-B:8-aa defines dependent as those who are unmarried up to age 26 and either a full-time student or resident of New Hampshire for purposes of health insurance coverage.2009 SB 115 allows those up to age 26 to buy-in to coverage through the state’s CHIP program, Healthy Kids.|
|New Jersey||N.J.S.A. 17B:27-30.5 states that, at the option of the insured person, a dependent may be covered up to the age of 31, as long as they are unmarried and have no dependents of their own.|
|New Mexico||NM Stat. Ann. § 13-7-8 states that health insurance for dependents may not be terminated based on age up to age 25.|
|New York||2009 AB 9038 allows an unmarried child to remain on parent’s insurance up to age 30 if they are a resident of New York.|
|North Dakota||N.D. Cent. Code § 26.1-36-22 allows an unmarried, dependent child to remain on parent’s insurance up to age 22 if they live with parents. If they are a full-time student, they can remain on parent’s insurance from age 22 up to age 26.|
|Ohio||Ohio Rev. Code § 1751.14, as amended by 2009 OH H 1 allows an unmarried, dependent child that is an Ohio resident or a full-time student to remain on parent’s insurance up to age 28, or without regard to age if they are incapable of self-sustaining employment due to disability.|
|Oregon||O.R.S. § 735.720 defines dependent as an unmarried child up to 23, elderly parents and disabled adult children for the purpose of insurance coverage.|
|Pennsylvania||2009 SB 189 states that an unmarried child may remain on parent’s insurance up to age 30 if they have no dependents and are residents of PA or are enrolled as full-time students.51 Pa.C.S.A. § 7309 states that full-time students whose studies are interrupted by service in the reserves or the National Guard must be extended health care benefits as a dependent of their parent beyond the terminating age equal to the length of their deployment..|
|Rhode Island||R.I. Gen. Laws § 27-20-45 and Gen. Laws § 27-41-61 requires insurance plans which cover dependent children to cover unmarried dependent children until age 19 or, if a student, until age 25. If the dependent child is mentally or physically impaired, the plan must continue their coverage after the specified age.|
|South Carolina||S.C. Code Ann. § 38-71-1330 allows an unmarried, dependent child who is a full-time student to remain on parent’s insurance up to age 22 if parent is covered by small group policy.S.C. Code Ann. § 38-71-350 requires that a dependent child who is not capable of self-sustaining employment be allowed to remain on his or her parent’s insurance, without regard to age.|
|South Dakota||SD Codified Laws Ann. § 3-12A-1 states that any insurance provider offering benefits to a dependent may not terminate those benefits by reason of age before the dependent’s 19th birthday. If the dependent is enrolled in an educational institution, they are not to be terminated until they reach age 24 and not terminated if unable to seek self-support due to disability.SD Codified Laws § 58-17-2.3 states that if the dependent remains a full-time student upon attaining age 24 but not exceeding age 29, the insurer shall provide for the continuation of coverage for that dependent at the insured’s option.|
|Tennessee||Tennessee Code Ann. § 56-7-2302 allows for dependent coverage for children under their parents’ health insurance plan up to age 24 provided the child is unmarried and financially dependent on the parents.|
|Texas||V.T.C.A. Insurance Code § 846.260 and V.T.C.A. Insurance Code § 1201.059 make dependent status available for an unmarried child up to age 25 for insurance purposes.|
|Utah||Utah Code Ann. tit. 31A § 22-610.5 requires that coverage for unmarried dependents continue up to age 26, regardless of whether or not the dependent is enrolled in higher education.|
|Virginia||Va. Code Ann. § 38.2-3525 makes dependent status available to any child up to age 19 or who is a dependent up to age 25 who resides with the parent or is a full-time student.|
|Washington||West’s RCWA 48.44.215 states that, at the option of the insured person, an unmarried dependent may be covered up to age 25.|
|West Virginia||W. Va. Code § 33-16-1a defines dependent for health insurance coverage as a child or stepchild up to age 25.|
|Wisconsin||Wis. Stat. § 632.885 requires that coverage for unmarried dependents through a parent’s insurance be offered up to age 27 if they are not offered insurance through an employer. Full-time students called to active duty in the armed forces can be covered beyond age 26 depending on various factors.|
|Wyoming||Wyo. Stat. § 26-19-302 states that if child is unmarried and a full-time student, they can remain on parent’s insurance up to age 23 if parent is covered by small group policy.|
Source: State Health Facts and NCSL, 2009. Back to Access to Health Care Overview Page