Help! My Child Is Turning 26 And Will Lose My Employer Insurance. What Now?

One of the popular provisions of the Affordable Care Act is the piece that says that children can stay on their parents' employer-sponsored insurance up until they turn 26. Of course, many youth ages 18-26 have already gotten offers of employer-sponsored insurance--and taken them. But in other cases, youth turning 26 are working part-time jobs and/or going to school and/or parenting themselves. Parents who have spent their whole lives with employer-sponsored insurance are often confused and worried.

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Don't Panic. 

Part of the Affordable Care Act means that there *are* options, even if your child has Type 1 Diabetes or a history of asthma.  

Help your child evaluate their options and make sure to include them in all discussions.  They are over 18 and in most cases you will not be able to make healthcare decisions for them, even if you still take them as a dependent. 

Household?

Take a look at who is in their household.  Are they married?  Are they single?  Do they have children of their own?  Do they claim any dependents on their tax return?  In most cases, your child is a household of one until they have dependents to claim or file jointly with a spouse.

Income?

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Take a look at their expected household income.  Is their job seasonal?  Do they work part-time or full-time?  Take a look a the Federal Poverty Guidelines (FPL) and figure out where your child falls. What is your child's income?

Healthcare Options

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Their choices for healthcare are Medicaid, Marketplace or Employer Sponsored Insurance.  If their job offers insurance, they will be able to enroll when their current insurance ends (read about special enrollment periods below).  If your child's last 30 days of income is below 138% of the FPL ($1396/month gross in 2018  for a single person), they will qualify for Medicaid.  Applying online is easy at MI Bridges.  If their income is above 138% FPL and their employer does not offer insurance, the Marketplace is where they will get their healthcare coverage.   

Plan Ahead! 

When your child turns 26, your employer may terminate their coverage on their actual birthday, at the end of their birthday month, or--rarely--at the end of the calendar year.  It is important to find out what the exact date is for the loss of coverage because they have a limited time to enroll in other coverage.  It is also a good idea to get a letter from the insurance company showing the date coverage ends for your child.

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The loss of the parents' insurance creates a special enrollment period which enables your child to enroll in health care outside of open enrollment.  Medicaid enrollment is always open and your child can apply anytime. 

For employer insurance, the special enrollment is 30 days from the date of insurance ending.  Occasionally employers are not aware that loss of coverage creates a special enrollment period for an employee.  If the employer is unaware, please direct them to this explanation from the US Department of Labor.  The Marketplace special enrollment period is 60 days from the loss of coverage.  You can apply online at healthcare.gov

Start Early!

To avoid a gap in healthcare coverage, you should start this conversation before the coverage ends.  For Medicaid, employer and Marketplace insurance, you can complete the application or submission of paperwork before coverage ends.  

If you have any questions about eligibility or timing, please ask in the comments below or call us 734-544-3030.  We are always happy to help. 

Washtenaw Health Plan - We Help People!

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