Health Care Reform: Dependent coverage to Age 26

Remember President Obama’s push for health care reform? I pretty much forgot about it until I received an ‘Important Special Enrollment Notice’ from my health insurance company. And now that most company’s enrollment periods are coming in November, I think its a good time to bring it up for discussion.

On March 23, 2010, President Obama signed into the law the Affordable Care Act. It’s a law that will hold insurance companies more accountable and lower health care costs, offer more health care choices and increase the quality of health care for all of us. Its explained the act will take place in portions and that some of them have already taken effect. Further changes will not be implemented until 2014 and beyond.

The most current change to take place is Extending Coverage for Young Adults . If you are renewing your health care coverage on or after September 23, 2010 this is how the law affects you and your dependents.

Children can remain on their partents’ health insurance policy until they are 26 years old and related special enrollment right

The health care reform law allows you to keep your children on your health plan until they turn 26 years old regardless of their student status, marital status, whether they live with their parents, or are claimed as a dependent on their parents’ tax return, as long as the dependent is not eligible to enroll in other employer provided coverage. “Children” includes natural childrend, legally adopted children, stepchildren, and children who are dependent on you during the waiting period before adoption. Unfortunately, grandchildren are not eligible. If the state you live in provides a higher maximum dependent age, then that requirement will continue to apply.

  • If you want to add dependents to you health plan who are younger than 26 years of age, you have a one-time special enrollment right under the law. If your adult children under 26 was previously denied in the past or lost coverage because they exceeded the maximum dependent age, then they will fall under this enrollment right. The ‘enrollment period’ takes place no later than the first 30 days of your plan year.
  • If you currently have single or employee/spouse coverage and you want to add children, you need to change your enrollment status to one that allows dependents to be added to your contract, such as family or employee/children coverage.
  • If ou are not currently enrolled, but wish to do so to take advantage of the dependent coverage right, you and your adult chilren may both enroll during the special enrollment period if you meet eligibility requirements
  • If you want your children to stay on the plan, you don’t need to do anything
  • If you don’t want to keep your children on your plan until age 26, you will need to contact your employer’s benefits administrator to remove them as dependents under your policy

No more lifetime dollar limits on benefits and related special enrollment right
The Affordable Care Act requires health insurance companies to remove lifetime dollar limits on benefits from all plans. This applies to medical and pharmacy benefits only; not dental or vision.

  • If your coverage was previously canceled because you reached the lifetime dollar limit under your plan, you have a one-time special enrollment right under the law. You can enroll again and be covered without any lifetime dollar limit on benefits. Again, the special enrollment period will take no later than the first 30 days of your plan year.
  • If you are covered by your employer’s health plan now, you do not need to do anything
  • If you are not covered by your employer’s health plan now and are not eligible to enroll during the special enrollment period, contact your employer’s benefits administrator for more information on when you can enroll

I embrace this current change because as we know, many adult children are moving back home due to the collapse in the financial world. I for one, would feel secure knowing my children are still covered if something ill was to take place; not that I embrace them moving back home. ;)

There are other changes that have taken place that I am for in this health care reform. There is Expanding Coverage for Early Retirees for Americans who retire without employer-sponsered insurance, but are not yet eligible for Medicare. Or there is relief for four million seniors hit by a gap in Medicare prescription drug coverage known as the ‘donut hole’ (each senior will receive a $250 rebate). And pretty soon you can obtain free preventive care services such as mammograms and colonoscopies with being charged. To see more of the changes, go to HealthCare.gov. It’s quite interesting.

Photo credit: {FederalTimes.com}

108 thoughts on “Health Care Reform: Dependent coverage to Age 26

  1. LoveBeingRetired

    This piece of the health care reform came at just the right time for me with my 22 year old daughter graduating from college in June. It really helps with fresh graduates who cannot find a job right now as well as those who will move through numerous jobs over the coming years until they reach 26. We all know how the economy can be unpredictable and jobs transitory, so it is good to know that the kids will be covered from a health perspective as they get their lives figured out.

    Reply
    1. Money Funk Post author

      You could not have said it any better. I completely agree. It is nice to know that my kids will be covered during such transitional periods in life.

      Reply
    2. Nuvopor

      My daughter is in Grad school and needs coverage, too. Thanks to the Democrats and a few Republicans, she will not be without insurance. I hope you vote this coming Tuesday and support the political party that has a social conscience.

      Reply
  2. Wellescent Health Blog

    The provisions to cover children up to age 26 are important because they eliminate the disincentive for children with medical conditions to get a higher education. At the same time, they allow young people to take some calculated risks in terms of their career when they may not be sure what they want to do.

    Reply
  3. DKH

    Well folks – Here’s the bad news. There is no free lunch or healthcare for that matter. As your employers’ renewal comes up, the monthly premiums to expand all of this coverage will likely increase by 10% to 20%. If you contribute to your coverage, your contribution will either go up proportionately or you will be forced to pay the entire increase. With small businesses barely getting by, being forced to pay higher healthcare premiums will result in possible layoffs or a slowdown in new hiring. So in the end, you are going to pay for all this “free” stuff that our congress is “giving away”. Good luck!

    Reply
    1. Money Funk Post author

      Hi DKH, I don’t know why I didn’t think about premiums going up at my work. Mine went up last year, but just slightly. It will be interesting to see what the future holds in terms of premium costs. But being self-employed with needing to cover health insurance premiums did cross my mind. Its almost kind of a hold your breath to see what happens. Thank you for bringing up those great points! Hopefully, it won’t be too bad.

      Reply
      1. Rob C.

        DKH probably is right, but you’re too quick to point out the rise in health care cost and forget that if a young adult is disqualified from coverage because of age, the cost for him/her to get coverage would be a lot more than a 10-20% increase. It’s nothing in comparison, and the way the job market is, people who have the education and experience are not getting jobs and companies are not willing to take chances on students since they would have to spend their resources on training them. We have to resort to, in many cases, taking up a job with a job placement agency, whom as you may know don’t usually offer benefits.

        Reply
  4. Jenna

    As a college grad who’s been paying for her own health insurance for 2 years, I’m a little jealous that this is just happening now. But lucky for all the future kiddos who can’t get health insurance. Definitely a step up.

    Reply
    1. Money Funk Post author

      Wow, one in the few people paying for her own health insurance. I tried to remember how I was covered in my younger years and I can’t recall. I know my parents were not covering me. Must of just winged it. *woosh* lucky nothing major happened. Well, if its any consolation… I am jealous I can’t claim baby bonding time with my two kids (that would be 12 weeks off!) ;)

      Reply
      1. Jenna

        I know a ton of people my age who are paying for their own insurance. It sucks. I play too many sports and to risk winging it.

        Reply
  5. Forest

    It really saddens me that the health insurance companies will not budge on their profit margins…. They make way to much from peoples health… I think this is a great policy but somehow it should have written law to say the health insurance companies could not raise premiums to incorporate this…. Not like they would not be in profit!

    It is scary the amount of young adult friends I have in USA with undergrad and masters degree’s, no job and no insurance….. Very scary stuff!

    Reply
  6. DKH

    Forest, The healthcare companies make an average of about 3% on their premium dollars collected. That is a very skinny margin of profit by anybody’s standard. Your local grocery store does much better than that. So nobody should be saying that it’s the health insurance companies causing the problem. You can’t just pile on new cost and expect no increase in premium. You are drinking the cool aid of the “big bad company” rhetoric of Obama.

    Try talking to a healthcare provider and see where their costs are. Some 50% of healthcare provider costs today are tied up in government regulatory requirements and legal liability expenses. I’m not promoting total deregulation but every time some law adds paperwork the cost goes up. And frivolous lawsuits cost all of us not just the doctors. Congress is so uninformed that they are addressing the entire problem from the wrong end.

    The vast majority of college educated jobs include healthcare programs. Almost all union jobs include a healthcare program. So the answer to the uninsured young college grads is jobs not “free” handouts from government restrictions on private industry. Job creation in the private sector is an entirely different and long discussion.

    The purpose of the healthcare reform plan is to run up costs so high with the private insurance providers that the government will have to step in with a single payer system. It’s already working. Call the IRS to ask a question, or even better call the INS. Then after a day or two of phone calls and voice mail heck, decide whether or not you want government drones running your healthcare. Good luck.

    Reply
  7. Forest

    Hey DKH, 3% is still a lot of money…. You can’t tell me the health industry is scraping by now? When it comes to the health of a nation I can’t believe profit is even something people agree too. 3% going towards yachts or 3% back into the system? Sure wages for individuals is fine and doctors should be paid high but from the UK standpoint (agreed not the finest healthcare system but has stood me well) doctors are well paid and we get treatment no matter how ill we are or what our situation is.

    So while jobs are being created, if you get laid off etc etc and you can’t afford it and something happens….. You could well end up disabled for your whole life either literally or financially from the bill you foot…. It’s a disgusting situation as far as I am concerned.

    Everyone should be covered. You can’t expect anyone to live in a nation and pay tax and then be left to die if something horrific happens to them.

    So many people have had good insurance for years and suddenly they get sick…. Then they find out some silly little loophole like “Oh you had a yeast infection once, we can’t treat you for this you will have to pay out of pocket!”. Also the drugs companies must be making a much bigger margin than 3%…. Way way bigger and they get to charge extortionate prices because the insurance companies cough up the bills but then they are all inter twinned anyway…..

    I’m not an American but from the other side of the fence for once the grass does not look greener for me. Japan and Germany are great social models to look too.

    Imagine if the police would not come to your house to stop a burglary because you wasn’t insured or a fire engine would not put out flames from the next door house for the same reason…. To me private and health spells trouble and that, I think, is one of the main reasons why America is not even in the top 10 for life expectancy. Sure the rich get the finest health (sometimes) but the poor end up even more marginalised and the gap widens and widens.

    Privatise anything you want but I think health should be for the benefit of everyone, not just those that can afford it…. America and it’s economy would benefit a million ways from having better health.

    …… Now I need Kevin @Invest it Wisely to come and crush my socialist rant :).

    Reply
  8. DKH

    Forest, If you don’t live in this great country you could not possibly understand how we value freedom. “Give me freedom or give me death”.

    Your rant is just that – With no substantiating facts whatsoever. Maybe some day you may want to get down off the lap of your government wet nurse and make your own way.

    Reply
  9. Joe Plemon

    Thanks for drawing our attention to these aspects of the health bill. Good post and lively ensuing conversation (between DKH and Forest). I would enter the fray but DKH has more than capably voiced my thoughts.

    Reply
  10. DKH

    Correction – Patrick Henry said, “Give me liberty or give me death”. Maybe it was Joe the plumber who said, “Give me freedom or give be death.”

    Reply
  11. Jimmy1920

    I like your straightforward approach to this subject.
    There is much that is good in health care reform.
    For those of us deeply immersed in its implementation, we may take a jaded view. For my slant on the age-26 issue, I invite you to read my own blog post at http://thehealthcaremaze.us
    DKH and Forest might benefit from a slightly different perspective.
    If they are interested!
    Thanks

    Reply
  12. DKH

    Jimmy,

    I read your article. It is well written but misinformed on a couple of subjects. Quoting from your article:

    “If an employer offers health care coverage, and if they extend that coverage to the dependents of their employees, they must offer it to all dependents up to age 26.”

    This is precisely my point. There is a cost to the increased coverage. Someone has to pay for it! Hospitals and doctors must be paid. So there will absolutely be an increase in premiums. That was my original point. There is no free lunch. Those who don’t have their healthcare coverage dropped will pay larger premiums.

    “So employers spend great resources to split these hairs. They hire consultants to estimate their potential liability. They hire lawyers to decipher the countless pages of legislative and regulatory “guidance.” They expend their own staff time to weigh the conflicting goals of higher costs, administrative simplicity, and happier employees against those of lower costs and a fatter bottom line.”

    I have purchased the healthcare plan for my company for 26 years. Never once have I done any of the things you listed above. Where do you get this garbage? Our only consideration is to compete for top employees by providing the employment package that is competitive in our industry. For the past 26 years that has been an excellent package.

    As for “a fatter bottom line”, in this economy small businesses are having big problems just having a positive bottom line much less a fat one. Most small businesses are squeaking by at a low profit or losing money. Piling these new healthcare costs on now will put some out of business. Profit is not a four letter word. We are for now a capitalist system. (And by the way – wasn’t this plan supposed to save money?)

    Finally, you clearly favor a single payer, Government run system. I will repeat my previous comment – The purpose of the healthcare reform plan is to run up costs so high with the private insurance providers that the government will have to step in with a single payer system. It’s already working. Call the IRS to ask a question, or even better call the INS. Then after a day or two of phone calls and voice mail heck, decide whether or not you want government drones running your healthcare. Good luck.

    The system is broken but there are some other options that don’t involve big government sticking their bureaucratic nose in our healthcare. Let’s talk about those.

    Reply
  13. Jimmy1920

    You may argue that I am misguided, but you don’t make the case that I am misinformed.

    I fully concede that health care reform is an unfunded mandate on employers. The point I am trying to draw attention to is that the whole system does not serve the interest of employers.

    I am also trying to draw attention to the fact that employers pay a cost to keep this system going – a cost that doesn’t count toward the national accounting system of health ccare costs.

    I don’t know how many employees your plan covers, but the plan I administer covers 10,000 active and retired employees. And like most plans anywhere close to that size, it hires various outside experts.

    You may use a broker to help sort through the current maze and to help you make decisions about coverages, etc. Your time, or your staff’s time in that buying process doesn’t get counted toward health care costs, nor does it add to the value of the health care system.

    And lastly, a ‘fatter” bottom line by no means suggests a fat bottom line. I may be ten pounds thinner than I was three months ago, but I am still a long ways from thin.

    I too can suggest ways that reduce the role of government, (read my blog) but I stand on the principle that an equitable health care system has to have rules that apply to everyone. And only the government has the authority to make those rules.

    One reason why we have the convoluted system that we have now is that the governement is in the business of making different rules for different groups and that cannot work.

    Reply
    1. esbioeng

      “One reason why we have the convoluted system that we have now is that the governement is in the business of making different rules for different groups and that cannot work.”

      I agree; we should not have different rules for different groups. So I assume you are in favor of a flat tax rate? I can’t think of a more glaring example of “different rules for different groups”.

      The main reason that we have a convoluted system is the fact that government is involved in the first place.

      With no exceptions, any program with any level of government involvement will be overly expensive, mismanaged and just generally ‘broken’.

      If you want to fix health care (or education, or retirement, or… ), take government out of the equation.

      So, to reword Jimmy1920′s statement, “The reason why we have the convoluted system that we have now is that the governement is in the business of making rules”.

      Reply
  14. Dora Fix

    If your plan through your company is a self insured plan does the age 26 mean that the dependant can go on dental and vison, is this part of the Health Reform or only medical

    Reply
    1. Money Funk

      Hi Dora, even if self insured, I am understanding it is still only for medical insurance.

      Reply
  15. JMAC

    My daughter – college student – turns 23 in three weeks. She will be dropped from my company’s insurance that day. To comply with the new law I have been told that she will not be eligible to be reinstated (until she is 26) until Jan 1, 2011, and that to keep her insured I must pay $374 a month for COBRA until Jan 1. If the rule has been signed into law, and she turns 23 after Sept 23, how can the insurance NOT cover her without interruption???

    Reply
  16. DKH

    JMAC,

    I have a similar situation. My daughter changed jobs and she is 24. She has to wait 90 days to be on her new employer’s plan so I tried to get her under my plan for the 90 days. I was told that the law says the insurance company has to cover these young people as of the first renewal date following Sept. 23, 2010. In our case it is not until Feb., 2010. I’m guessing the Jan. 1 date is your renewal date. So the big announcement is not really true. These young people are not getting covered as of Sept. 23.

    This gives the insurance company time to evaluate the cost impact on your plan. I’m waiting to see how much higher our premiums will go at the next renewal.

    Jimmy,

    I own a small business with 60 employees. We don’t do all that garbage you are talking about. Small businesses provide the majority of job growth in the US. We are NOT big bad corporations. Just some honest hard working people from plumbers to engineers, from dry cleaners to IT service providers. And we provide GOOD jobs for our employees and we don’t screw them over. We treat them well. So don’t include small businesses in your corporate bad guy crap.

    Reply
  17. Jimmy1920

    JMAC
    The age 26 requirement is effective the first of the plan year (renewal date as DKH indicates) after six months after the bill was signed. The bill was signed March 23rd. Six months later is 9/23. Most plans renew on the calendar year. So the change for those plans won’t be effective until January 1. A Plan that renews July 1 could wait unitl July 1, 2011.

    There is a lot of confusion. That was a point of my initial response. First, there is political pressure to adopt early. So many of the insurance companies decide it is admistratively easier to allow dependents to stay on the plan rather than disenroll them then re-enroll them a few months later. They do that for their insured business, but not their self insured business. The press releases they put out only add to the confusion.

    Then their is state law which may have different requriements than the feds, adding to the confusion.

    And some employers make the decision to adopt earlier choosing adminstrative simplicity and employee satisfaction along with the marginally small increase in costs.

    DKH

    I wish you would criticize me for things I say and stand for and not for things that I don’t say or stand for.

    My position is pretty straightforward. The current employement based system for health care does not serve the interests of employers, workers, patients or providers. I say that as someone who has been an employee benefits professional for 25+ years. In my ideal world, my job would be far less necessary.

    The current system inhibits corporate agility, restricts workforce mobility, and limits the ability of doctors to deliver efficient care to patients.

    It has nothing to do with corporate good or bad guys or with good jobs or bad jobs. (Unless you define a bad job as a job without health insurance).

    I don’t advocate a single payer system because just because I want to do good to patients without healthcare. I think it is extremely detrimental to the American economy and especially small business.

    Smarter people than me have made that arguement and asked why should health care costs be an additional barrier to entry for an entrepreneur with a good idea.

    Reply
  18. DKH

    Jimmy,

    Reading your article referenced in your previous post, most people will definitely feel a slant towards the bad corporation attitude. My main point is that we can’t fault businesses for trying to contain costs to make a profit. The only reason for being in business is to make a return for the owners or stockholders. The stockholders in public corporations are everyday people with their retirement funds invested in the market. Your “fatter bottom line” comment is a negative swipe at trying to be profitable. (You didn’t say less skinny – You said fatter). Criticize the system but don’t blame it on the employers. They’re just trying to operate under the burdens of the system the best they can. Businesses provide jobs and that’s how our society lives. Government is the place to make changes. Considering your expertise, what is the answer?

    Reply
  19. Peggy

    I was just informed by my former employer (I am retired and under retiree health plan) that the new law only covers “Active Health Plans”. I have a son 22 that will be graduating college in Dec. and needs health insurance until he gets a job. Is this right? Please let me know where I can document this information?
    Thanks.POB

    Reply
  20. Jimmy1920

    Peggy

    As near as I understand and can determine, stand alone retiree plans are exempt from this requirement. However, if your employer offers a plan that covers both actives and retireees, then coverage would need to be extended to your son. The wrinkle in this will be the defintion of “plan” and how the regulators interpret a separate policy inside of a larger employer sponsored plan, if that should be the case.

    DKH

    I knew we could cross the divide. I’m not sure this is the best forum to answer your question though. We have probably already generated more heat than light. Thanks.

    Reply
  21. Reason

    everyone should be covered ONLY if they can afford it. No one should be rob to pay for somebody else’s care.

    Reply
    1. Jimmy1920

      Reason
      The logical consequence of your opinion, is that doctors hospitals and emergency rooms should not treat anyone who cannot afford to pay or who does not have health insurance.
      When they do treat the medically indigent (and I would argue that is not too often) someone else is being “robbed” to pay that expense.
      And the “sucker” in this shell game are the sponsors of employer health care plans.
      And since both Medicare and Medicaid depend on tax payer support, does that meat your test of someone being “robbed” to pay for someone else’s health care.
      If you carry your argument to its logical extreme ( and if not, where do you draw the line) health care should be a cash and carry proposition.
      There are not too many people that heartless.

      Reply
  22. Kat

    I’m still learning about this whole health care reform so hopefully this isn’t a dumb question. If the ability to keep your adult child on until they are 26 is for plans renewing after September 23rd. What about plans that are grandfathered in? Or plans that won’t renew until January or later? How does that impact kids that might need this now? Can anyone help explain please??

    Reply
  23. Jimmy1920

    Kat
    I hope I am not horning in on MoneyFunk’s turf here.
    Grandfathering does not apply to certain requirements of ACA and one of those includes the age 26 requirement.
    The change is effective the first of the plan year after September 23, 2010. That could be Oct 1, 2010 or Sept 1, 2011,
    Kids that need it now are in the same boat as someone over 26 – SOL (a very technical term :>) ). If they are aging off the plan now, they can take advantage of the COBRA that gives you 60 days to elect coverage and an additional 45 days to pay for it.
    If a child comes off the plan 9/30/2010, he or she has 60 days to elect coverage (11/30/2010). You then have an additional 45 days to pay for that coverage.
    That gives you 105 days to weigh the cost of any medical bills you might have incurred versus the costs you would need to pay for that coverage. Of course, someone with a current medical condition might not be willing to take that risk.

    Reply
    1. Money Funk

      You’re not bothering my turf at all. ;) I am thankful that we have someone available to answer all these questions. So Thank you. I am finding all this very informative.
      I was told next year near renewal for employee health care is going to raise our rates by 14% – 17% . Not that I am looking forward to it, but seems kind of low.

      Reply
    2. Kat

      Jimmy1920…thanks for the info! That really helps!!

      Money Funk…Our rates only went up 1.7% this year at our July 1 renewal! Unbelieveable. But I knew it had to be a fluke…and that we’d make up for it at a later renewal!

      Reply
  24. Sherry

    Sorry if this was exsplained and I just didn’t understand it, but I have a question: if you are 21, not in college, unimployed, and don’t have insurance, you are not foirced to be on your mothers plan that she gets through her work, are you?? And if you are, she dosent have to pay extra for it right? I’d like to be covered BUT my mom said that shed need to pay an extra $400 a month to add me, she can’t afford it, and I don’t wanna be the reason she loses her apartment!!!

    Reply
  25. Jimmy1920

    Sherry
    Wow! One more argument why employer sponsored health care is a bad idea.
    $400 seems like a lot, especially if it is the increase to the employee for family coverage.
    The employer must be putting more than half of the difference between single and family coverage onto the employee.
    Competitve pressures force employers to make choices that are not good for society.
    But pardon my soapbox.

    My experts tell me that it is the dependent’s choice not the employee’s. That means that your choice trumps your mother’s. That my be a good choice for your physical health, but perhaps not a good for one for your family’s.
    I am sure we will get some pushback on that as well.
    The question that I do not know the answer to is whether the choice you make would affect you eligibility for other coverage through the state (Medicaid).
    Someone else would need to answer that one.

    Reply
  26. Chrissy

    My husband was in the Air Force for 24 years. We have been told that our children are excluded from the new health care plan. Military dependents coverage ends at age 23 even if they are in college. Do I have my facts right? or are families with Tri-Care Prime able to cover their family members under the new bill?

    Reply
  27. jimmy1920

    Chrissy,

    It appears that, sadly, you are right.

    According to the Tri-Care website

    http://www.tricare.mil/NHCB_QnA.aspx

    “The new health care bill allows adult children to stay on their parent’s health care plan until age 26 if their employers don’t offer insurance. Will TRICARE adopt this policy?

    The recent Patient Protection and Affordable Care Act (Public Law 111-148) requires civilian health plans that provide medical coverage to children to make that coverage available until the child turns 26 years of age. The Act did not give the Department of Defense the authority to offer this benefit through TRICARE.

    There are provisions in the Senate and House versions of the pending National Defense Authorization Act for Fiscal Year 2011 that would extend dependent medical coverage up to age 26 via a premium-based program. If enacted into law, the Department will make every effort to implement its provisions as soon as possible.”

    Reply
  28. Kat

    Just learned that my daughter can go back on my husbands insurance in January, but it is medical only, no prescription coverage. This is a total shock as she is a Type 1 diabetic and prescriptions and supplies for insulin pump are astronomical. Doesn’t seem fair that she doesn’t have the same coverage as she had before she graduated, and the same that we have under the family policy. Is this for sure?

    Reply
  29. Jimmy1920

    Kat

    That sounds fishy to me. I am not aware of interpretation that exempts prescription drug programs.

    There might be some other reason such as:

    The pharmacy benefit has a different plan year; in which case your daughter may be eligible later in the year.
    The pharmacy benefit already excluded dependents.

    Good luck!

    Reply
  30. kathy

    My employer as a self-insured plan. I am being told that they do not have to opt into the part of the law that calls for coverage of adult children up to age 26? Is this true?

    Reply
    1. jimmy1920

      Kathy

      You’re employer is wrong.
      I administer a self-insured plan and we are most surely not exempt.
      There may be some other reason, but that is not it.

      Reply
  31. Kelsey P.

    Health care reformed or not, I’m a 22-year-old female whose father refuses to put her on his insurance. Now I make about $6,000 a year at my part-time job with no benefits and have a pretty terrible case of borderline personality disorder, so how am I supposed to support my doctors’ bill? I can’t. I’m left to go insane until I can’t tolerate it anymore and kill myself as a last ditch effort. I tried a few months ago, failed, got put in a hospital to get “help,” and have had more of a death with than ever. Why can’t seeing a psychiatrist and getting cheap prescriptions be easy? Why can’t it be done without filling out mounds of stressful paperwork? All I know is that if I don’t get an SSRI and some benzos soon, my parents are really going to be pissed about having to shell out the cash for a tombstone and burial. No joke.

    I need help so bad it isn’t even funny. In fact, I’m bawling about it.

    Reply
    1. Jimmy1920

      Kelsey
      As I explained to Sherry above, the choice is yours, not your fathers.
      You may not want to upset your father, but it sounds like he will upset regardless.

      Reply
  32. kim

    my husband has been employed by the nypd for 17 years….our health coverage is through GHI….my oldest son who is now 21 and will be 22 in december 2010 has been off of our insurance since 2007….he did not go to college that is why it stopped when he turned 18….he works but his job does not supply healthcare…he still lives at home and is not married and is a us citizen..i have been making numerous phone calls to GHI and the PBA and no one will give me an answer as to when and if my son is eligable to go back on our plan…it is very fustrating that no one will give me a straight answer…i need help…i am really at my wits end….thank-god he hasnt needed any medical services for any emergencies….please help me with any info that you may have…..thanx kim

    Reply
  33. Jimmy1920

    Kim
    The determining date is the Plan year or renewal date. For most plans that is January 1, but it could be as late as 9/22/2011.
    But breathe easy. Plans are required to conduct a mini open enrollment prior to that date to identify and allow people like your son to enroll
    Just make sure they have your current address.
    Someone should be able to tell you when the Plan renews, though.

    Reply
  34. Joe King

    Paying for the kids untill 26 years old is crazy, what happens when they need major operation and your legal resposibilities are too pay the deductables…maybe 30,000 on a transplant, times that by two kids, and your BROKE and Bankrupt in retirement…ya what a F*** up idea this is!
    Joe King Seattle

    Reply
  35. Carolyn

    Hi :) My husband has coverage through GHI with the NYPD. We were recently married, and my soon to be 23 year old daughter is in Florida taking a semester off of school and going full time again in the spring. I am trying to find out if under the new guidelines she can be covered as a step daughter under my husband’s policy. I was told she could be covered up until age 23 and after that (January) she will have to pay a premium of $450 and up depending upon coverage. Is this correct? Does this change if she returns to being a full time student? I am looking into this but it is extremely confusing. I also looked into her being covered on her dad’s plan, but it is a very local plan and will not include Florida without paying out of pocket and then getting reumbursed. Any help would be appreciated :)

    Reply
  36. Jimmy1920

    Carolyn

    Here is what the preamble to the regs says:

    >However, with the expansion of dependent coverage required by the Affordable Care Act to children until age 26, conditioning coverage on whether a child is a tax dependent or a student, or resides with or receives financial support from the parent, is no longer appropriate in light of the correlation between age and these factors. Therefore, these interim final regulations do not allow plans or coverage to use these requirements to deny dependent coverage to children. Because the statute does not distinguish between coverage for minor children and coverage for adult children under age 26, these factors also may not be used to determine eligibility for dependent coverage for minor children.<

    In short, your daughter should be able to get coverage under your husband's plan.
    There are two important conditions. It is effective with the first of the next plan renewal year. For most plans that means January 1, but some plans
    may have until next September 1.
    There are some plans that are finding a way to impose additional requirements on step children. I am not sure how I understand that logic given the language I quoted above. But it is enough of a concern that some have requested additional regulatory guidance.
    http://theccfblog.org/2010/08/cross-post-three-cheers-for-dependent-coverage-expansion.html
    I suspect the $450 is COBRA premium. There may be two reasons why they offer that.
    First the plan is not extending the coverage to step children, or
    Second, the plan year may not start for many months, in which case you should refer to my answer to Kat above.

    Reply
  37. Money Funk

    FYI: My medical/dental costs went up $13.18/paycheck ($343.68/annually) – for Anthem HMO 1 adult + 2 dependents. Dental – my employer dropped Delta Dental :( – and went with AETNA DMO. I hope I do not need to change dentist for my children – they have a good Pedio.

    I am glad I was able to keep my Anthem, as my employer considered dropping it last year. Thankful they did not as I have been with Anthem forever! And love the coverage and service I have received.

    Overall, I can handle the raise in prices. I just hope others are not too hard hit with the pending/current changes in health care.

    Reply
  38. zmom

    Hey Christine, how about this?..

    We have an 18 yr old. Beginning Jan 2011 our company insurance plan changes per the new regulations and he will be allowed to stay on our insurance until he’s 26 (current dependent age limit is 23). However, if I retire in 2012 the company will take those 3 years back and i will only be able to cover him until he’s 23. Can they do that?

    Reply
    1. Christine Post author

      Hi zmom, thank you for stopping by. Wow, retiring is getting tough. I am glad you bring that up. Now I went onto HealthCare.gov and the US Department of Health & Human Services to skim the Fact Sheet, the Regulations (that like reading a novel in itself – I don’t know how anyone is to understand that), and the FAQs. What I did find in the FAQs – is that “expanded health care tax benefit applies to various workplace and retiree health plans”. Will your retiree health plan be through your employer? If not, it may just be a transition from employer to retiree benefits.

      Check out Jimmy1920′s site (http://thehealthcaremaze.us/) and get in contact with him there – if you don’t hear a follow up comment to your question on this site. He’s been super helpful in answering all these questions.

      I wish you the best with your transition.

      Reply
      1. Jimmy1920

        zmom
        If my math is right, your son won’t be coming off your plan right away when you retire, but will only be covered until age 23. In other words, they are not covered under the new rules.
        That sounds a bit fishy, but MoneyFunk is right. Especially for retiree plans, the regs can be very convoluted. There are several exceptions for “stand alone” retiree plans. And the definition of “stand alone” is not an easy one.
        But if your employer is providing the coverage under a single plan, then the rules should still apply.
        Keep me posted.

        Reply
  39. Babs

    We have a 24 year old daughter who is married and working part time. She can get medical benefits through her husbands company, however, it will cost them a lot of money to add her to his plan. It will not cost any extra for my husband to add her to our plan. Can we put her on our plan even if she could get coverage through her husbands plan? Also, if my husband puts her on our plan, what would happen if he lost his job? Could she then be added to her husband’s coverage? Thanks!

    Reply
  40. Jimmy1920

    Babs
    The new rules expand the definition of dependent to include children who are working, are married or have other coverage.
    So for another year plus, she can be added to your plan at the beginning of the next plan year. If that is January 1, 2011 or earlier, you should have received some open enrollment notice by now from your husband’s employer.
    don’t miss it. Otherwise, you will need to wait until the next open enrollment.

    Reply
  41. Sue

    Hey people,

    My husband and I have health, vision & dental through his empployer (Motion Picture Pension & Health). We contacted them to add our 22 year old who is not a full time student, they told us he was only eligible to receive medical coverage only, not vision nor medical. I guess something is better than nothing!!!

    Reply
  42. Sue

    Sorry – a typo in my last entry. Our 22 year old son is eligble to receive only medical coverage, no vision, no DENTAL. Better something than nothing!!!

    Reply
  43. Jo

    I am only 17 years of age and, I am suppose to be getting braces on here soon but also along with the braces I am suppose to be getting jaw surgery. I was living with my grandparents for awhile and I had to move back home because my step dad says that he will not be paying for the braces and the surgery if I am not living under his roof. Well the thing is that I am under my moms’ insurance not his, and he is saying that I have to live under his roof for in order the insurance to cover it. Is this true?

    Reply
  44. Jimmy1920

    Jo

    Here is a quote lifted directly from one prominent law firm that specializes in employment and benefit law.

    “In general, the requirement to make available dependent coverage for children who have not attained age 26 is effective for plan years beginning on or after September 23, 2010 (January 1, 2011 for calendar year plans). However, there is a limited delayed effective date for certain grandfathered plans (i.e., plans in existence on March 23, 2010), which may exclude an adult child who has not attained age 26 from coverage if the adult child is eligible to enroll in an eligible employer-sponsored health plan other than a group health plan of either parent. Thus, for example, in the case of an adult child who is eligible for coverage under the plans of the employers of both parents, neither plan may exclude the adult child from coverage based on the fact that the adult child is eligible to enroll in the plan of the other parent’s employer.

    “The Regulations clarify that plans and issuers may no longer condition coverage on whether a child under the age of 26 is a dependent under the Internal Revenue Code (the “Code”) or student. Instead, the term “dependent” may only be defined in terms of the relationship between the child and the participant. Specifically, the following factors may not be used for defining “dependent” for purposes of eligibility or continued eligibility for children under age 26: (1) financial dependency; (2) residency; (3) student status; (4) employment; (5) eligibility for other coverage; or (6) any combination of these factors. Presumably, a plan could impose these types of requirements for covered children who are age 26 or older, subject to applicable state law for insured plans.”

    The rub for you may be how much of your work is covered by a dental plan and whether both parents have dental coverage and lastly, if it a “HIPAA excepted stand alone dental plan”

    So there are a number of hoops – first is employer plan year start, second is whether you need coverage under a dental plan (I assume you are talking about dental braces) and whether either parent dental plan is an “exempt stand alone plan” and please don’t ask me what that is, but if it files its own 5500 that is a strong indication. And if not, probably not.

    Next is your family satus. You could be eligible under both parent’s plans if your parents are married. If not, you would surely be eligible under your mother’s plan, but eligiblity under your step-father’s plan may depend on the plan and whether you have been adopted by your stepfather and whether your step-father or grandfather are your legal guardians and then, on top of that, what your step father’s plan says about children who are dependents by virtue of a guradianship.

    In short, there could be some truth in what your step father is telling you, but you are definitely eligible under your mother’s plan regardelss of where you live.

    Good luck

    Wouldn’t a single payer plan by so much simpler?

    Reply
  45. Steve

    Per this statement ‘as long as the dependent is not eligible to enroll in other employer provided coverage’ , would our 25 yr old son who has Crohns disease be eligible to participate in our health plan even though his crappy job offers health insurance at a substantial premium to him.

    Reply
  46. Nan

    I’m confused with the the “grandfather clause” about if your dependent is eligible to enroll inan other employer provided coverage. My daughter is 24, has been working at a full-time job for 2 years and has had employer provided coverage which is pretty expensive since then. She lives with us but is not a dependent anymore on our tax returns. Can she or can she not be put back on our plan until she is 26? It is confusing — some articles say a dependent can be put back on parent’s coverage even if their employer offers health insurance and then there is this grandfather clause which I do not understand. Can anyone give me the right answer?

    Reply
  47. Jimmy1920

    Steve and Nan
    You are understandably confused by “grandfathered” plans. I am in the business and it is confusing.
    In short, “grandfathered” plans are plans as they existed when health care reform was passed in March 2010.
    As anyone who has labored through these comments can see, there are exceptions everywhere. So grandfathered plans don’t have to do some of the things in health care reform. But some of them, they do have to do. The age 26 requirement is one of those things they have to do even if they are grandfathered. But – and here comes the curve ball – if they are grandfathered, they are permitted to put a requirement in their plan similar to what both of you are concerned about – if the dependent is eligible for other “eligible employer sponsored health plan” – the parent’s plan can deny that child the opportunity to enroll in the parent’s plan (until 2014).
    So two questions have to be answered by the parent’s plan and it could be different in each of your situations:
    Is your plan grandfathered? and your plan has to know that.
    did they put that restriction in their plan?
    good luck

    Reply
  48. Melissa

    My MINOR children (who are dependents of their father BUT have NO insurance available to them) have previously been denied coverage by my current husband’s insurance company (their step father) because they are NOT his tax dependents and DO NOT reside in our home because”no parent child relationship” exsist…..

    I reapplied for insurance after reading the code : “The Regulations clarify that plans and issuers may no longer condition coverage on whether a child under the age of 26 is a dependent under the Internal Revenue Code (the “Code”) or student. Instead, the term “dependent” may only be defined in terms of the relationship between the child and the participant. Specifically, the following factors may not be used for defining “dependent” for purposes of eligibility or continued eligibility for children under age 26: (1) financial dependency; (2) residency; (3) student status; (4) employment; (5) eligibility for other coverage; or (6) any combination of these factors. Presumably, a plan could impose these types of requirements for covered children who are age 26 or older, subject to applicable state law for insured plans.”

    and was DENIED COVERAGE again BECAUSE “no parent child relationship” exsist and although they have “made changes for children 19-26 they do NOT need to make any OTHER changes in their policy at this time”.

    Am I misinterrupting something? Are my children NOW eligible?

    Reply
    1. Melissa

      Since posting this I have learned that my insurance copy has decided that “no parent child relationship” exsist because of the definition in the their INSURANCE BOOK – Parent-Child Relationship The term “Parent-Child Relationship” means the child has physical residence in the home of the Eligible Employee except for temporary absences or attendance at an institution of higher learning.

      I have sent them copies of the Regualtion highlighting – “The Regulations clarify that plans and issuers may no longer condition coverage on whether a child under the age of 26 is a dependent under the Internal Revenue Code (the “Code”) or student. Instead, the term “dependent” may only be defined in terms of the relationship between the child and the participant. Specifically, the following factors may not be used for defining “dependent” for purposes of eligibility or continued eligibility for children under age 26: (1) financial dependency; (2) residency; (3) student status; (4) employment; (5) eligibility for other coverage; or (6) any combination of these factors. Presumably, a plan could impose these types of requirements for covered children who are age 26 or older, subject to applicable state law for insured plans.”

      They still feel that they DO NOT NEED to make changes in their policy for minor children – ONLY for children 19-26.

      PLEASE give me some guidance as to what my next step should be.

      Reply
      1. Jimmy1920

        Melissa

        I understand from what you are writing, that the children are your biological children

        It is not clear to me, though, what your “insurance” is. Is it tIs this through your employer? Or are you buying it on your own?

        In any case, I suggest that you write to both your state and federal representatives, including your state insurance department. It seems that you are right, but there are people out there trying to find every loophole in the law and they may have found it. But I have looked through several sources and even those who are objecting to parts of the provision refer to it as offering coverage to biological children “up to age 26″.

        That is clearly not between 19 and 26.

        I wish you success. I can only offer you encouragement.

        Reply
        1. Melissa

          The children are my biological children BUT my health insurance is offered through by current husband’s union (their step father). Before the Health Care Bill my children were DENIED coverage because coverage for step-children is only available when a parent-child relationship exsist. (My insurance book defines a Parent-Child Relationship as means the child has physical residence in the home of the Eligible Employee except for temporary absences or attendance at an institution of higher learning.) The Children live with their biological father.. Not sure if I cleared things up?

          I am writing my letters now. Thank you!

          Reply
  49. Pingback: What are the Pros and Cons of Health Care Reform?

  50. Mom

    Today my husband put in to retire throught the Motion Picture Industry. Our 24yr old son is scheduled to go back on my husband’s plan Jan 1. I called motion picture 3 times and asked the question will my son be able to go back on his fathers plan if my husband retires. Three times by three different people I was told no problem. Guess what. There is a problem according to motion picture. They say he can only be on his fathers plan for the 2 months my husband will still be active and when he goes on the retirees plan my son is without insurance unless he goes on cobra for $400 a month. Is this true? Does anyone know if this is true?

    Reply
    1. Jimmy1920

      Mom

      I cannot say for sure that it is true or not. It is my understanding that only a stand alone retiree plan or a plan that does not otherwise offer coverage to children could be exempt.

      I went on line to look up the 5500 filing for the Motion Picture Industry Fund with an address in Studio City, CA, and it offers coverage for both active and retired employees. One standard for determining whether a plan is a stand alone plan is whether the retiree plan files a separate 5500.

      But it is not the only standard, and I looked up that Plan’s web site and they claim they are exempt from the requirements of health care reform.

      It is also my understanding (I am not a lawyer) that the exemption only allowed plans to exempt over age dependents with other coverage.

      My advice – first put your request in writing to the health plan and mention that you are getting conflicting information from their customer service reps. The more detail (names, dates, etc.) that you can provide, the better. You may need to act quickly. The plan I looked at is a calendar year plan and it may become more difficult to add your child after January 1, 2011.

      Putting your request in writing gives you some protection in case they say that you missed the special enrollment deadline. Fax it to ensure more timely delivery. If we are indeed talking about the same plan, they have a form on-line to add your over age dependent. Include that with your letter.

      Second, send a copy of your request to your Congressman. He or she just may be able to help. But the letter will also let the Congressman know that is not working, or not working easily, for some people.

      You might also add that the next time Congress tackles health care reform, they should be more open to a single payer model.

      Good luck

      Reply
  51. jnd

    This is in response to DKH comments.

    First of all I love my freedom also. But I am in favor of this Health care reform, it does have good and bad points. I will tell you why I am in favor of this health care reform. I went to the doctor with my sister and the doctor looked at her and told her that I cannot help you because you don’t have insurance. My sister could not be put on the list for a liver transplant because she did not have insurance. So, yes I see problems with the health care reform and problems will have to be worked out, but I believe that a person LIFE is more important than any thing else.

    Reply
  52. Mom

    Hi Jimmy 1920,

    Thanks for the response. My son did get on my husband’s plan starting tomorrow. It is to our understanding that when my husband retires on 3/1/11 that is when they will kick him off. I already put a call into my local congressman and I was told someone would return my call next week. I also spoke to someone here locally at the Dept. of Labor/ US government and they are in the dark about this. They did say that when our son gets kicked off the plan on 3/1 I should file a claim with motion picture and ask them to show us where in writing it states that a dependent can not be covered under a retiree health plan and show us in the new health care reform bill where that is stated. Believe me, I am no where near done with this.

    Reply
  53. Help

    I am 23 and I am married. It would cost over five hundred dollars a month for me to be on my husbands insurance plan as a school teacher. I have very limited insurance through my work. I am overwise healthy but I am in need of a surgrey that will cost me between $12,000 and $15,000 after my insurance pays there portion. I have been looking for another job with no sucess. My mom just added me to her insurance plan through work where the surgery would cost only $250.00 effective Jan 1. Can I quit my job or take a leave of absence to be able to benifit from her insurance?

    Reply
  54. Jimmy1920

    Mom
    Good luck! Keep us posted!

    Help
    See my response to Steve and Nan above.
    The general rule with the Affordable Care Act is that the dependent relationship is primary. It does not matter if you are married, if you are working, or if your job offers health insurance.
    So on that basis, there is absolutely no need for you to quit your job.
    UNLESS, and here comes one of those reform curve balls, your mother’s plan is “godfathered”. Plans can claim “godfathered” status and that permits them – until 2014, to exclude dependents with access to their own employer sponsored health care.
    Your mother should know, and her plan must tell her, 1.) whether the plan is “godfathered”, and 2.) whether they elect to impose that restrictions on child dependents.
    If the Plan does exclude dependents with access to other employer sponsored health insurance, you have a difficult decision to make.
    The biggest clue will be, did they ask your mother that question when she enrolled you in her health plan.
    If they did not, you are most likely safe and there is no need for you to think about quitting your job.
    Best wishes!

    Reply
  55. joe_345

    it’s just cost-shifting, letting someone else pick up the tab for all these free-loading 18-26 year olds…the democrats have this fantasy that you can just legislate the cost of goods or services away, like the silly price controls on gas in the mid-70′s by Jimmy Carter….

    America is crumbling and these fools are going in the wrong direction…..we should be raising more strong self-sufficient young adults instead of these parasites of the “me, me” generation…

    Reply
    1. Jimmy1920

      Joe
      Of course it’s cost shifting. That is the basic principle of health insurance. People who are healthy pay for people who are sick. And people who earn income pay for those who don’t, the poor, the elderly and children.
      Or, taking a longer term view over time, we pay while we are healthy and working in order to to be covered while we are sick or without income.
      People with money pay for those without – that is what Medicare and Medicaid is all about. Many employers charge employees based on income earned.
      So the argument that it is cost shifting is a completely irrelevant.
      Not that cost shifting isn’t an issue. But it occurs because docotrs and hospitals are paid based on who they treat. they are paid less than cost for treating people on Medicaid, about costs for treating people on Medicare and they make up the shortfall by overcharging private payers such as employers, and indivudal policy holders.
      I might agree with you if you were to argue that the age 26 requirement is an unfunded mandate on the employers who choose to offer their employees coverage. And I might agree with you that it is inequitable and threatens to further erode the base of employer sponsored coverage.
      If you want equitable, then everyone needs to be covered and to pay based on ability to pay and providers must receive the same payment for the same service regardless of who they treat.
      And please don’t interpret that last sentence to mean that all providers should be paid the same.

      Reply
  56. tracy

    babs, if your dependent is eligible for other employer sponsered group covereage ( with her spouse) she is NOT eligible to be added to your policy even if does cost her money to go on her spouses policy.

    Reply
  57. Jimmy1920

    tracy
    Unless you have specific information on the plan that covers babs, be careful about absolute pronouncements. What you say MAY be true, IF her plan has elected ‘grandfathered’ status.
    Otherwise it is not.
    And let me turn that statement around. IF her plan has chosen ‘grandfathered’ status, what you say MAY be true. See my comment to HELP above.
    The plan that I administer is grandfathered and we chose not to enforce an “other coverage” provision, in part because we don’t do it now for spouses and, in part, because our right to do will expire in 2014 anyway.

    Reply
  58. Mom

    Hi Jimmy

    Heres the latest with Motion Picture. I did contact my local congressman in DC and was transferred to the Committee on Energy and Commerce. I spoke with someone there and she sent me an email telling me that if my husband is going to retire on what is known as “the early retirement plans” then our son cannot be on his coverage. However, Motion Picture doesn’t have an early retirement health plan. It is either active or retiree with no change in benefits. I did contact someone at Motion picture and of course I am getting the runaround. I faxed over to them the email correspondence with the girl in DC and of course they lost it. Couldn’t find it. I said Im driving down to hand deliver it to you and it was a miracle. She found the fax. I am giving them until the end of next week to make a decision. I will keep you posted.

    Reply
  59. Jimmy1920

    Mom
    Thanks for the update.
    It shouldn’t be this hard. Did you contact your Senators as well? Can’t hurt. The more pressure these politicans and administrators feel, the harder it is to hide behind their own interpretation of the rules.
    Good luck.

    Reply
  60. Josh

    Hi! My wife is not offered any health insurance through her employers but my employers do. Would she qualify to be put on her parents?

    Reply
  61. jerry

    Our son will be 26 yaers in October. A letter from Blue Cross of Michigan indicated he would no longer be covered effective Jan. 1 2011, WHY? Obama’s Healthcare indicates coverage would be until child turned 26.

    Reply
  62. Jimmy1920

    Jerry
    Good question.
    You did not indicate what kind of coverage you have. Is it an individual plan, an employer sponsored plan, a retiree plan? There are some things in your question that make very little sense? Why Jan. 1, if your son’s birtday is in October. That date would only make sense if your son finished school in December.
    If the plan is an individual plan, then ask the carrier. Otherwise ask the plan sponsor, which would be your employer or whomever is sponsoring the plan.
    It may well be a mistake. We have certainly had enough of those. It seems some of the carriers have computer systems that are not adapting quickly to the new rules.
    Good luck.

    Reply
  63. Kay Elle

    I am a third year college student. I have been pretty clueless as to what I want to do until just recently, so I’ve finished up all of my general education requirements and a minor. In my infinite wisdom I have chosen a major that I have to apply to be accepted into, and I have to take prerequisite courses prior to applying in order to begin the major coursework. This will extend my graduation date dramatically, but hey, what can I do? It’s what I want to do! I’m not going to change my career plan for the rest of my life over a few extra years. The sequence of prerequisite classes means I will be a part time student next year (9 credit hours per semester, full time is 12), and that I will have ONE class left to take the year after that before I can apply.

    My mother’s insurance plan, which I am currently covered under, is one of the plans offered by Blue Cross Blue Shield of Michigan. I called them today to see if I would still be eligible for coverage as a part time student, and they claimed that the law goes into effect in July. This means I will have coverage (and would even if I didn’t take classes at all), but if the July start date is correct maybe it explains why Jerry’s son is not covered (perhaps he can re-apply and be covered from July-October).

    I am so thankful for this. I would have to take a total of EIGHT classes that aren’t applicable to my major over the course of the next 2 years if I had to be a full time student to receive benefits. I absolutely need the benefits as well, as I have a pre-cancerous condition that has required me to have 4 biopsies and 2 surgeries in the past year alone, not to mention all of the miscellaneous doctors appointments to check up on post-surgical healing and pre-surgical consultations and appointments to discuss results and treatment options.

    It is a tough thing for an 18 year old to do to choose a college major and stick with it. Not many 18 year olds have their minds made up as to what they want to do. I am almost 21 and I am practically starting from square one again. This has truly been a blessing in my life, I now don’t have to make a choice between sacrificing my time and money on unnecessary classes or sacrificing my health.

    Reply
    1. Jimmy1920

      Kay Elle
      I am glad that you are benefiting from health care reform. Most likely your plan is on a July renewal cycle (like my own), which is why the change is not effective until July 1.
      But your situation does not explain Jerry’s situation. I am not sure what does.

      Reply
  64. Tammi

    Here’s my dilema, my daughter aged out because she wasn’t going to be in college full time Jan 2010. We took it upon ourselves at the advisement for our Kaiser Permanente insurance to start her own plan instead of waiting to have her removed when they found out she wasn’t fulltime anymore. We switched her Dec 2009, effective Jan 2010. Then this law passed, we talked to a Kaiser rep and was told “tough once a person goes off, they are off”. So my daughter had to cut back even more on her courses because of finances of covering herself. She has had her own plan with Kaiser, mind you, since Jan 2010. Now we find out from other family members in the same situation that they were actually notified by their plans that they could add their aged out children back on to their plans. My youngest has a cystic fibrosis social worker who confirmed this was true that our oldest could be added back, as long as shewasn’t uninsured and had a current health plan somewhere.

    Now the rub, we notified Kaiser Permanente that we wanted to add her back on and they are saying ‘no we can’t because she doesn’t have the same health plan through Kaiser as we do”. Our plan hasn’t changed in 6 years and I am not reading anywhere that the aged out child must have the same exact insurance plan as their parents to be added back to the parents. Could someone help me out in understanding this? What would you do? Where should I turn to for help? I am lost right now but not willing to just quit.

    I think Kaiser is just trying to convince me that she can’t because they don’t want to lose $130 a month if they let her back on our plan. She has been to the doctor only twice in the time she has had her plan. Once with a hairline fracture (maybe? it was inconclusive), and once with swollen glands from a virus that cleared within 3 weeks.

    Reply
    1. Jimmy1920

      Tammi
      Sorry I missd this earlier.
      Do you have an individual plan? If you have a plan through your employer, you should not be talking to Kaiser. you should be talking to your employer.
      If you are buying your plan directly through Kaiser, I still think they do not have it right. i would put your request in writing to kaiser and explain that you are appealing a decision you got over the phone from the customer service rep.
      Good Luck

      Reply
  65. Tony M

    My wife is a health care worker for a local hospital. Does ObamaCare force her health insurance to offer coverage for her 2 stepchildren (my 2 kids from a prior marriage) who do not live with us? Ages 20 and 17.

    Reply
    1. Jimmy1920

      Tony M
      While there are many parents who are thrilled to be able to add their children who do not live with them, PPACA does not force you to do so. (Employers, of course, have a different perspective)
      The governing definition of dependent is section 152(f)(1) of the Internal Revenue Code (Code). That section of the Code defines children to include only sons, daughters, stepchildren, adopted children (including children place for adoption), and foster children.
      It does not matter if the dependent is married, working, or has access to other insurance.
      There are reasons why your plan may not fall under PPACA, but if it does, the decision to add or not add your children or step-children is yours, not theirs.
      I presume from the tone of your comment that your are not obligated by a Qualified Medical Child Support Order to provide health insurance for your children. If you were, that obligation existed prior to and after PPACA.

      Reply
  66. Jimmy1920

    Tony M
    While there are many parents who are thrilled to be able to add their children who do not live with them, PPACA does not force you to do so. (Employers, of course, have a different perspective)
    The governing definition of dependent is section 152(f)(1) of the Internal Revenue Code (Code). That section of the Code defines children to include only sons, daughters, stepchildren, adopted children (including children place for adoption), and foster children.
    It does not matter if the dependent is married, working, or has access to other insurance.
    There are reasons why your plan may not fall under PPACA, but if it does, the decision to add or not add your children or step-children is yours, not theirs.
    I presume from the tone of your comment that your are not obligated by a Qualified Medical Child Support Order to provide health insurance for your children. If you were, that obligation existed prior to and after PPACA.

    Reply
  67. Robin in Iowa

    I have Wellmark independent coverage through Farm Bureau. I have been with them since I was 18…I’m 37 now. Due to the premium increases I found myself slowly taking away coverage and going to higher deductibles. I’m currently on the Silver 1200. I thought once my daughter turned 18 yrs old, I would FINALLY be able to get her on her own policy(I wanted Gold 600) that has maternity.(Just in case) Today I found out due to the health care reform, I am now forced to keep her on my plan. Even though when she turns 18, she plans on moving out…is legally an adult…will be responsible for all her other bills….I will still be forced to keep making her payments. I always thought the reform was to keep insurance companies from bumping kids off the plans…NOT to force parents to keep them on theirs!! Unless she gets married, she can’t have her own. WTF is with that?

    Reply
  68. Trident Military University

    Honestly, I wouldn’t want to be covered by my parent’s insurance at 26. When I was 18 I moved out on my own, paid for my own apartment and had a job that offered health insurance. During the times that I was self employed later on in life I paid for insurance out of my own pocket and wrote it off as a big business expense. I am a firm believer of being independent as soon as possible. Depending on your parents for health insurance at age 26 is a bit ridiculous. I was independent and didn’t receive one penny after 18. As a matter of fact, I barely received any financial matter as support even as a minor (I don’t think I had insurance as a kid either but we had relatives who were doctors and gave us free check ups). I think it’s ridiculous for grown ups to receive support from their parents. I would personally rather be broke and homeless than receive anything from parents past the age of 18; I have my pride.

    Reply
  69. Kathy

    I am thrilled that my daughter is able to be covered under my husbands health insurance plan until she is 26. She graduated from college, but unable to find a job that would provide health insurance. She is Type 1 diabetic and no insurance company would provide insurance for her privately, or the cost would be astronomical. You may have your pride, but you also, obviously, don’t have a chronic disease. A little compassion please.

    Reply
  70. Debbie

    We are one of the families this has had a negative result. My 19 year old son works part-time for a company that just started offering health insurance. It is very basic and doesn’t cover much of anything. Pray that he won’t need hospitalization or surgery until 2014.
    1. He has to pay his own premiums off his part-time wages.
    2. He can not be added as our dependent.
    3. He is working to help pay for his college, because we(cough) make too much money for Education grants and his technical school does not accept student loans of any kind. We are paying cash as he goes.
    4. He can be added on our insurance in 2014. I hope he is gainfully employed by then and will have his own group policy.
    It seems that we have been hit in the pocket for being “middle class”

    Reply
    1. Jimmy1920

      Debbie
      The only reason that I know that would explain why you cannot add your son to your health plan (other than your own decision) would be because your Plan is “grandfathered”.
      “Grandfathered” plans are allowed to keep off dependents who have access to health care through their own work.
      I would keep checking back with your Plan because “grandfathered” status is easy to lose.
      Be a pest
      Good luck

      Reply
  71. Ethel

    I would like to no my son just turn 26 and just was told that he will be coming off my health insurance.. What can i do to keep him on he cannot find and work…

    Reply
  72. Jonn

    We are having a little bit of a debate over the following issue….Open enrollment is coming up at work and they are trying to tell us that due to healthcare reform, we cannot carry our spouses on our medical insurance if they have the option to get insurance from their employer. I have had my wife on my insurance for years but now the company is refusing to allow her to be on my insurance…can anybody either validate this or debunk it…

    Reply
    1. Jimmy1920

      Jonn
      See my answer to Debbie. Plans have always been able to discourage spouses from enrolling in an employer’s plan. Usually, it is not an outright ban, but rather a requirement to pay an even higher premium.
      It would make sense if all employer plans were created equal, but we all know that ain’t so.

      Reply
  73. Marva W

    I live in California, and work for a communication company. It is our annual enrollment period, and I cannot keep my son, who will turn 19 on November 10th, 2011 on my insurance, because he was not able to get a full time schedule at the community college. He sat in on 3 classes and was not able to get into any of the three. He does have 2 classes he was able to get into. I thought the healthcare reform law allowed us to keep our kids on our insurance until they reached the age of 26 regardless of weather they are full time students or not?

    Reply
    1. Jimmy1920

      Marva
      You are correct, but if you comb through the questions and answers here, you will see that there are a number of exceptions. I would press your plan Administrator to explain exactly why.
      Contacting your congressman sometimes can help. I nothing else, it can remind him/her of loopholes in the law.

      Reply
  74. catherine williams

    It’s my understanding that the parent is responsible for any copay, and balance due, after insurance, on Dr. visits and Hospital stays.

    If you have a bad relationship with your child due to drug or alchol problems, and they enter a rehab program, the parent is responsible for payment that insurance doesn’t over. If they are in an auto accident and are hurt badly, or injure someone else, you are repsonsible as the “parent” for any balance due after insurance. This will bankrupt most people, and could even cause them to lose the home they have worked their entire life for. Check with yur Insurance Co, and see what your liability is, to cover your children.

    Reply

    Reply
  75. seo

    Howdy just wanted to give you a quick heads up. The text in your article seem to be running off the screen in Firefox. I’m not sure if this is a format issue or something to do with web browser compatibility but I thought I’d post to let you know. The layout look great though! Hope you get the issue resolved soon. Kudos

    Reply
  76. Johnwill

    Health insurance: leagal racket supported by the pocket lining politicians in DC. If not, then why isn’t there one company offering a family plan for under $1000–not one freeeeking company in the capitalist enclave called the good ol USA where every invention brings another–cheaper and better–except health insuranace where they all charge the same , and it is all too high for the middle class anymore. Get ready fof mor uninsured as rates rise. A gneration from now, health insurance will be a thing of the past when the middle class could actually get by inthis country.

    Reply
  77. Edna Ruiz Manrique

    Dear Moneyfunk
    My husband has 2 kids 13, and 18. I have 4 girls 14 to 22. The two older girls have part time jobs except one is living on her own. I have always had health insurance for them. I dropped my oldest because she moved out. I recently added my two stepsons who live with us since my husbands job does not provide insurance. I submitted all my paperwork required but am now being told I need to submit an income tax transcript. Can you tell me why?

    Reply
  78. Pingback: Medical Insurance 26 years old – Medical Insurance | Health Insurance » Blog Archive

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