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How long can a child stay on my health insurance?

Keep in mind...
  • Under the Affordable Care Act guidelines, your child can stay on your health insurance plan until they reach the age of 26
  • They are eligible to stay on your plan even if they are married or have a full-time job that offers insurance
  • When your child turns 26, they must get their own health insurance plan or they will be responsible for paying the individual mandate penalty fine
  • There are specific health insurance benefits that must be available under the ACA for children under the age of 19

The Affordable Care Act regulations allow children to stay on their parent’s health insurance plan until they are 26 years old. Children are able to stay on their parent’s plan even if they are married, do not live with their parents, or have children of their own.

If you are a child on your parent’s employer-based health insurance plan, you will most likely lose coverage as soon as you turn 26. However, if you are on your parent’s Marketplace plan, you should not lose coverage until December 31st of the year you turn 26. Some of these regulations can vary depending on the state.

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What should my child do about health insurance when they turn 26?

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When your child turns 26, they are required to get their own health insurance coverage or they will be responsible for paying the individual mandate penalty fine. There are several health insurance options available for young adults aging off their parents’ insurance plan.

If your child is a tax dependent when their coverage ends, they can apply for an insurance plan through the Marketplace or for a Medicaid plan. However, they will not qualify for any tax credits based on their own income.

If they are not considered a tax dependent when they turn 26, they can also apply for both Medicaid or a Marketplace plan, but they will be eligible for savings based on their own income.

If your child works a full-time job, they might also be able to enroll in their employer-based health plan. They should be eligible for a special enrollment period outside of the typical health insurance open enrollment period.

What is the individual mandate penalty fine?

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When your child turns 26, they must get their own insurance plan or they will be responsible for paying the individual mandate penalty fine. The fee is calculated in one of two ways. It will either be 2.5 percent of your income or a set annual fee of $695 per adult in the household and $347.50 for each child in the household with a maximum set at $2,085.

Your child will be responsible for paying the fee when they file their tax returns for the previous year.

Only people in the household who do not have health insurance are required to pay the fine, so you will not have to pay it even if your child lives in your house and lost their insurance coverage.

You are only required to pay 1/12th of the fee for every month that you went without coverage. If your child only went without health insurance for a short period of time after they turned 26, they might be eligible for the short coverage gap exemption and will not have to pay the penalty fine. In order to qualify for a short coverage gap exemption, your child must have only gone no more than three months without coverage.

What pediatric health benefits must be covered?

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When you have a child on your insurance plan, there are certain pediatric benefits that must be covered under the Affordable Care Act regulations. This includes autism screening for young children, vaccines, and obesity screening. There are many other pediatric preventive benefits that might be different than adult benefits.

Additionally, dental coverage and vision screenings must be available for all children until the age of 19. Pediatric dental coverage can either be offered as part of your main health insurance plan or as part of a separate stand-alone dental plan. This is only a pediatric benefit as insurance companies are not required to offer dental coverage to adults and many do not.

How long can a child stay on my health insurance?

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In most cases, your child can stay on your health insurance plan until they reach the age of 26. At that time, they are required to enroll in their own plan through Medicaid, the marketplace, or an employer-based plan or they will have to pay the individual mandate penalty fine. They will be eligible for a special enrollment period during this time.

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