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Who is a dependent for health insurance purposes?

Keep in mind...
  • Dependents can be children of the policyholder, spouses, and other qualifying family members
  • Dependents receive coverage from the policyholder
  • Dependents that are adult children can stay on their parents’ plans until the age of 26

The precise definition of a dependent, as it relates to health insurance, is a complex issue with many sides to it. Certain people can be claimed as dependents on your health insurance and certain people cannot be claimed as dependents on your health insurance.

There are also regulations surrounding how you add someone as a dependent on your health insurance. This includes the fact that sometimes dependents can only be added during specific special periods in time where such additions are permitted. That is not always the case for health insurance plans, but a great deal of variety exists when it comes to adding dependents.

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What is a dependent?

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Before going into who exactly is classified as a dependent in the realm of health insurance, we must first examine the definition of a dependent. One of the major points in its definition is that the person receives over half of their financial support from the policyholder as shown by dependents.

If someone does not receive such financial support, then they cannot be classified as a dependent of the person who is the policyholder of the insurance plan. This restriction applies regardless of whether the dependent in question is the policyholder’s child or not.

Categories of Dependents

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There are different categories of dependents that exist and each one is unique. The categories have separate regulations that apply to them. The first major category of dependents, as far as health insurance goes, is a qualifying child, as detailed by categories of dependents.

The qualifying child category is the more common category of those two categories; these are children of health insurance policyholders who are claimed as dependents by their parents. The other major category is a qualifying relative — family members that are not children but are claimed as dependents.

Qualifying Child Dependent

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Before the Affordable Care Act, there were several more restrictions about who could be claimed as a qualifying child dependent than there are now. It is no longer relevant if you support them financially at all or if they live independently of you, which describes. You might not provide them with any financial support whatsoever and have not had them live with you for years, but they are still eligible for consideration as such a dependent.

Additionally, employed children who are eligible for a health insurance plan provided by their employer are still allowed to be dependents.

Qualifying Relative Dependent

A qualifying relative dependent is the other major category of dependent for health insurance purposes. A qualifying relative must have a specific relationship to the health insurance policyholder. Additionally, a qualifying relative must have a gross income that is lower than the exemption amount.

A qualifying relative must receive at least half of their financial support from the health insurance policyholder.

Finally, a qualifying relative must not be considered a qualifying child of any other policyholder or they do not meet the requirements for a qualifying relative dependent.

Child of an Employee

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There is a sub-category of dependents, but this sub-category is only applicable to group health insurance plans provided by an employer. This is known as the child of an employee. In order to meet the requirements, the child of the employee must also be younger than 26 at the end of the year.

Biological children, adopted children, and step-children are all eligible for consideration as a dependent of the employee. Foster children who are otherwise eligible are also permitted as dependents of this variety.

Tax Results of a Dependent

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Covering a dependent under your health insurance plan can affect your taxes. Sometimes, states mandate that employers cover dependents after the age of 26 which demonstrates. This is not the case for every state, but some states do have such mandates and require that employers follow them.

If the child is not considered a dependent under tax laws, then the situation is somewhat different. Covering them cannot be paid before taxes and oftentimes the policyholder must pay extra for covering such a person, even if the child is eligible for the health insurance plan.

Claiming a Parent as a Dependent

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Generally speaking, dependents are children or family members that depend upon the health insurance policyholder for financial support. Most of the time, they must also live with the policyholder. However, sometimes, a parent can be claimed as a dependent for health insurance purposes as proves.

A select few larger companies will allow you to claim your parent as your dependent on your health insurance plan. The parent must be younger than sixty-five, live with you, and must be classified as a dependent on your federal tax return. As stated, this is a special case and, generally, parents cannot be claimed as dependents.

Spouses as Dependents

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Aside from qualifying children and qualifying relatives, the final category of dependent that is more common throughout a great many health care plans is a spouse. Spouses can be considered dependents under their legal partner’s coverage, something that addresses. In fact, it is often a requirement that spouses be considered dependents on their legal partner’s health care coverage.

This is not necessarily true in all cases, but it is a general rule. Spouses might have their own health care plan and remain on that instead, however.

Domestic Partners as Dependents

Dependency status can also be offered to domestic partners of the health insurance policyholder. In the event that this coverage is offered, such coverage must remain similar to coverage that spouses are given. Domestic partners can be of the same sex, of the opposite sex, or both.

An affidavit of domestic partnership must be signed in order for domestic partners to gain these benefits, however. This exists to prevent roommates or others who simply live in the same location from fraudulently claiming dependency status.

Siblings as Dependents

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In certain situations, siblings can be claimed as dependents of the insured policyholder. These situations are exceptions to the rule rather than a common occurrence. The qualifying child and qualifying relative requirements mentioned earlier are particularly relative to covering siblings here.

If the insured policyholder receives their health care plan from their employer, a sibling can receive coverage if they are considered the qualifying child or qualifying relative of the aforementioned policyholder. Otherwise, coverage is not available for siblings as dependents on another person’s health care plan.

Who is included in your household?

The health insurance marketplace is one source of health insurance for many people under the current health care laws. Knowing who is included in your household is important since they can sometimes be considered dependents.

Typically, a household consists of the person filing taxes, their spouse in the event they have one, and any tax dependents as the source discusses.

Your legal partner is always part of your household, and include any tax dependents even if they already possess health care coverage.

States’ Role in Defining Dependents

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Generally, the federal government is in charge of determining who is and who is not a dependent for health insurance. This is related to tax dependents, which was mentioned above. However, some states extend the definition of dependents via their own health care laws and regulations.

In fact, thirty-seven states have increased the age that young adults can stay on their parent’s health insurance. In Florida, for example, a young adult may remain on their parents’ health insurance plan up until the age of thirty.

Taking Care of Your Dependents

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There are federal and state laws and regulations surrounding who can be claimed as a dependent on your health insurance plan. If this insurance is provided by your employer, further restrictions may exist depending on the plan and your employer. However, generally, dependents are qualifying children or relatives of the insured person.

In some cases, the parents of the insured person can be claimed as dependents on the health insurance plan as well. Domestic partners are also sometimes eligible for consideration as dependents. The children of the insured person are the most common dependents in health insurance, though.

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