Tag: dependent

We just had a baby. Before that my spouse and I were each covered under our own health plans at our own jobs, but now we want the family covered under one policy. Can we all switch to my employer plan now?

Yes. Having a baby is one of the special circumstances that allow you to add dependents to your health plan even outside of the regular open season. You have 30 days from the date of your child’s birth to notify your employer and request that your spouse and your baby be enrolled in your coverage.

I work full time for a large employer (more than 50 full time employees) and I’m married and we have kids. Is my employer required to offer health benefits that cover my spouse and kids?

Your employer is not required to offer health benefits. However, large employers that don’t offer health benefits to their full-time employees and to their dependent children may be liable for a tax penalty. Large employers do not face a tax penalty if they don’t offer health benefits to the spouses of their workers.

If your employer doesn’t offer coverage to your spouse or children, they can apply for coverage in the Marketplace and, if your family income is between 100% and 400% of the federal poverty level, a premium tax credit that may reduce the cost of coverage in the Marketplace.

If your employer offers health benefits (that are affordable and meet minimum value) to you and your spouse and children, you still may choose to purchase coverage through a Marketplace, but your family will not be eligible for premium tax credits to help pay for the coverage.

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

The rules are somewhat different depending on the plan your parents have.

If your parents are covered under a small employer plan (less than 50 workers) provided by an insurance company through the Marketplace or outside of the Marketplace, or if your parents are covered under a nongroup policy they bought themselves, then your parent’s plan is required to cover your prenatal care and delivery.

However, if your parents are covered under a group health plan offered by a large employer (50 or more workers), then your parent’s plan is only required to cover your prenatal care, but is not required to cover the delivery. Medicaid covers prenatal and delivery services in all states. You could see if you can qualify for Medicaid on your own.

Your parent’s plan, regardless of the source, generally won’t be required to cover your child as a dependent. You will be responsible for obtaining coverage for your baby. Depending on your income, your child may be eligible for coverage under the Medicaid/CHIP program in your state. Or, you can buy a family policy through the Marketplace and, depending on your income, you may be eligible for a premium tax credit to reduce your cost of that coverage.

My parents are self-employed and buy coverage through the Marketplace. They earn too much to qualify for subsidies. I’m 24 and only earn $30,000 a year (about 255% of FPL.) My parents don’t claim me as a tax dependent, I file my own return. Can I be covered as a dependent under their Marketplace policy? If so, can I qualify for a premium tax credit and apply that to their premium?

Yes, you can be covered as a dependent up to age 26 on your parent’s Marketplace policy. If your parents don’t claim you as a tax dependent (and you file independently), then your eligibility for premium tax credits will be based on your income alone. With your income at roughly 250% FPL, you will qualify for a premium tax credit. Once you know the amount, you can decide to sign up for a Marketplace policy on your own, or be covered as a dependent on your parent’s policy until you are 26. If you enroll in your parents’ plan, you can elect to have your premium tax credit paid directly to your parents’ insurer each month, or you can claim it on your tax return later when you file.

My 26th birthday is next week and I will lose coverage under my parent’s plan at the end of this month. Open Enrollment has closed. What do I do now?

You should act now to review your coverage options and sign up for new coverage. You may have more than one option.

If your parent’s plan was offered by an employer with more than 20 workers, you will probably be offered COBRA.  This is an option to continue coverage under the plan for up to 36 months.  COBRA coverage is typically an expensive option because your parent’s employer is no longer required to contribute to the premium, but it may be important option for some young adults, for example, if you are currently in treatment for a condition and prefer not to change coverage now.

You should have or will soon receive a notice from your parent’s plan that your dependent status is about to end and informing you of your right to elect COBRA.  You have 60 days from the latter of that notice or the date dependent coverage ends to elect or decline COBRA coverage.  If you elect COBRA, you have up to 45 days to pay the first premium (COBRA coverage will be effective on the first day after your dependent coverage ended, so the first premium will cover the time retroactive to that date.)  If you don’t make the first payment on time, your COBRA election will not take effect.

Once you elect COBRA and pay the first premium, you will not be eligible to apply for a Marketplace plan with tax credits until the next Open Enrollment period.  Even though COBRA lasts 36 months, you do have the option during each Open Enrollment period to drop COBRA and apply instead for subsidized Marketplace coverage.

The Marketplace is another option to consider.  Premium tax credits subsidize the cost of Marketplace coverage if your income is between 100% and 400% of the federal poverty level, so for many young adults, this option may be more affordable.  Generally people can only apply for Marketplace coverage during Open Enrollment.  However, loss of dependent status under your parent’s plan is a qualifying event that makes you eligible for a special enrollment period (SEP).  Your SEP lasts 60 days from the date of your qualifying event (the day your parent’s coverage ends) but when the coverage loss can be anticipated, you can also apply for new coverage up to 60 days before your qualifying event.  Acting early makes it more likely you won’t have a gap in coverage.

You can apply for Marketplace coverage on your own or ask for help from a Navigator or other Marketplace assister program.  Indicate on the Marketplace website that you are applying for coverage during a SEP and make your plan selection.  In federal Marketplace states, you will be required to provide proof of your qualifying event before your new coverage will take effect.   For example, if you were also eligible for COBRA under your parent’s plan, submitting a copy of your COBRA notice can document your eligibility for the SEP.  Healthcare.gov will give you 30 days from the date you select your new plan to provide proof of your other coverage loss.  It is very important to act quickly to complete this verification process.  If you do not submit the required documentation within 30 days, your plan selection will be cancelled and you will no longer be eligible for the SEP.

Finally, if your income is very low, you might qualify for Medicaid.  Medicaid is open for enrollment year round and, in more than half of the states, will cover adults with income up to 138% of the poverty level (about $16,753 for a single person in 2019.)  You can also apply for Medicaid through the Marketplace and can get help with your application from a Navigator or other in-person assistance program.

I’m covered as a young adult dependent on my parent’s policy now, but my 26th birthday is next summer, at which point I won’t be eligible for dependent coverage any longer. Should I apply for Marketplace health plans and subsidies now, during Open Enrollment?

You can remain covered as a dependent on your parent’s policy until you turn 26. Once you lose eligibility as a dependent, you will qualify for a special enrollment opportunity. At that point, you will also be able to apply for health coverage and assistance through the Marketplace, even though it won’t be during a regular Open Enrollment period.  In addition, if your parent’s policy is a group plan offered by an employer with at least 20 workers, you would also be able to continue coverage under the policy through COBRA for up to 3 years.  However, the employer contribution to the premium would end and Marketplace subsidies cannot be applied to the COBRA coverage.

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

The rules are somewhat different depending on the plan your parents have.

If your parents are covered under a small employer plan (less than 50 workers) provided by an insurance company through the Marketplace or outside of the Marketplace, or if your parents are covered under a nongroup policy they bought themselves, then your parent’s plan is required to cover your prenatal care and delivery.

However, if your parents are covered under a group health plan offered by a large employer (50 or more workers), then your parent’s plan is only required to cover your prenatal care, but is not required to cover the delivery. Medicaid covers prenatal and delivery services in all states. You could see if you can qualify for Medicaid on your own.

Your parent’s plan, regardless of the source, generally won’t be required to cover your child as a dependent. You will be responsible for obtaining coverage for your baby. Depending on your income, your child may be eligible for coverage under the Medicaid/CHIP program in your state. Or, you can buy a family policy through the Marketplace and, depending on your income, you may be eligible for a premium tax credit to reduce your cost of that coverage.

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