Dependent medical coverage for children and spouses can be easily purchased. Regardless of where you live, a wide range of affordable policies are offered through an employer or a private medical insurance policy that allows you to directly enroll through a broker or insurer. Usually, rates tend to be especially low for infants and children. Exchange plan prices for a husband, wife, or partner are determined by age, zip code, and smoking status only.Parents are not considered dependents.
A Special Enrollment Period is created for young persons that reach age 26 and need guaranteed coverage. Non-Obamacare plans, however, are typically medically-underwritten and specific limitations may apply. Short-term plans provide extremely affordable rates, but unlimited duration periods are not offered, and the cap on lifetime benefits is typically $1 million or $2 million. Also, many states severely curtail the duration of temporary plans.
Young adults can remain on their parent’s policy (Affordable Care Act regulation), regardless if the son or daughter graduates college. Also, both married and unmarried persons are eligible to keep benefits along with members of the family covered under a corporate group plan. However, parents can not include dependents in their federal subsidy calculation, if the son or daughter files their own federal tax return.
For job-based plans, the 2023 Open Enrollment period typically occurs near the end of the year. A new healthcare plan can be selected or a new carrier can be chosen. The instant tax credit is based on the following year’s projected income. Changes in the number of household members can impact the subsidy. Medicare and Medicaid eligibility can also have an impact. Household income limits also change, which can impact eligibility for specific programs.
The OE period for federally-run Marketplace states is from November 1 through January 15th. A child can join their parent’s plan and enjoy the same policy benefits. The termination date would be December 31st of that year. Dependents under age 26 can also remain on a parent’s policy if they get married, adopt or have a child, decline employer-provided healthcare benefits, leave or begin school, reside outside or inside a parent’s home, or aren’t claimed on a federal tax return as a dependent. A dependent can also apply for their own Exchange plan or purchase a non-Obamacare option, including short-term contracts.
Who Is Considered A Dependent?
Traditionally, it is your spouse or child. Stepchildren are usually included in the definition, although an ex-spouse is typically not allowed to be classified for insurance purposes. A biological child, adopted child, stepchild and foster child can qualify. If they are listed on your tax return, there could be an exception. Children that are not living in your household are often covered under another policy. However, in certain situations they can still be supported by you.
For example, if your son or daughter has not yet reached age 26, generally, they can remain on your personal plan. This includes situations when they are married, are a parent themselves, live at home, are not considered a dependent for tax purposes, or are a student. However, enrolling in a separate policy should also be considered, especially if a large federal subsidy is offered.
A student living most of the year away from home, may require a different network of doctors and hospitals than the provider network utilized by their parent’s plan. A PPO plan may be available in one area, but only HMO and EPO plans in other areas. Many Universities offer supplemental benefits along with access to campus medical centers. Copays are often low, although maximum coverage limits are low.
How Do I Find Out How Much It Costs To Insure A Spouse Or Child?
We make it easy to view rates from all of the top companies. The top portion of this page allows you to enter your zip code to start the free quote process. Quickly, you’ll be able to provide some basic information to determine which companies offer the lowest rates. You can view information for yourself (only) or yourself and other family members. Comprehensive, catastrophic, and high-deductible plans are offered. Inexpensive temporary contracts are attractive options if your need is short-term. However, short-term plans do not include all “essential health benefits.”
We also make it easy to compare University medical plans with privately-offered options. Often, major carriers (Aetna, Cigna, Humana, or UnitedHealthcare) underwrite school plans. Deductibles can be less than $2,500, and office visits and many medications are only subject to copays. However, many colleges and universities do not provide coverage or endorse a specific plan. Although campus medical centers are available, specialized treatment may not be available. University supplementary plans are offered, but major medical benefits are generally not included. Treatment may need to be provided by a specific facility during normal business hours, and Urgent Care hours may be limited.
Accidental and preventative options are offered by many carriers which can be purchased in addition to other coverage. These riders are typically offered on non-Obamacare plans, including short-term and limited benefit options. If major pre-existing conditions are present, a Marketplace policy should be considered. A federal subsidy may be available along with cost-sharing benefits on Silver-tier plans.
You can also exclude any person if they are covered by Medicare, CHIP or Medicaid. The federal subsidy can drastically reduce your healthcare costs if your household income meets Federal Poverty Level government guidelines. However, if your state expanded Medicaid-eligibility, lower-income households may have to place children in CHIP, or forfeit a subsidy. CHIP benefits are very comprehensive, and include preventative, wellness, and symptomatic coverage. It is possible that children in a household are covered by CHIP while their parents have enrolled in a Marketplace plan.
CHIP-qualified children can be covered through the Marketplace, although a subsidy would not apply. A common scenario occurs when the parents qualify for tax credits to help pay the cost of coverage, and the children are Medicaid-eligible and qualify for CHIP. Generally, the dependent deductibles and maximum out-of-pocket limits are lower than their parents are required to pay.
How Expensive Is It To Add A Dependent To An Existing Plan?
The cost depends on a number of factors. Of course, a single person is going to cost less than adding a spouse and multiple children. Also, rates in certain states, such as Ohio, will tend to be cheaper than other states such as New Jersey or New York. If you are covered through a group-sponsored plan, than the percentage of the premium paid by the employer will have a tremendous impact on your cost. Short-term plans cover dependents, but preventative benefits typically are not covered prior to a deductible being met.
Many years ago, most employers paid the full cost of provided benefits. Today, of course, that has dramatically changed. Now, many small businesses provide limited benefits for their employees. Full-time and part-time workers, however, can apply for low-cost plans through their State or Federal Marketplace. Comprehensive and catastrophic plans are offered with a wide variety of deductibles, copays, and prescription drug coverage. A subsidy may be offered, if their Group coverage is determined to be “unaffordable.”
The Healthcare and Education Reconciliation, and the Patient Protection And Affordable Care Acts require that employers also must offer coverage in the same way. However, a private policy is not likely to be expensive if they are removed from the group coverage. Catastrophic options are offered to persons under age 30, although the deductible is typically $9,100.
If you already have an existing independent health insurance policy, juvenile premiums are usually not expensive. Usually, the monthly cost is between $25 and $100 per month per person. However, adding a spouse can be more expensive since the husband or wife will be much older than the children. Also, the likelihood of a major health condition is higher, so the risk of submitting a major claim to the carrier is a larger possibility. Online kids medical coverage is always available.
If a spouse or child is currently without benefits, there are other alternatives. All states offer “Open Enrollment” for their “on” and “off” marketplace plans. “High Risk Pools” have been eliminated, so higher premiums, waiting periods, and exclusions for existing conditions have been eliminated. The “Family Glitch” has also been eliminated. Prior to 2023, the “affordability” determination was based on the employee’s cost of their employer-provided group medical coverage, That was changed to base eligibility of the employee and their family. Thus, more households can qualify for premium tax credits if their company-provided healthcare coverage is quite expensive.
Although “Catastrophic” plan options are specifically designed for persons under age 30, they are ineligible for federal subsidies. Therefore, Bronze-tier options often provide much more comprehensive benefits at a cost that is often equal or substantially lower than “catastrophic” policies. Many Bronze options also offer unlimited pcp office visits (with a copay) instead of limiting the number.
Sample Rates For Adding A Child To An Existing Plan
Rates shown are monthly and represent the DECREASE in premium when a dependent is added to popular Bronze-tier US plans. The rate reduces since the updated federal subsidy exceeds the cost of coverage for the dependent. Figures below assume a married 30-year-old couple with $60,000 household income adding a dependent. Rates can vary, depending on the county of residence. CHIP eligibility may result.
Arkansas Ambetter Clear Bronze – $180 decrease
Oscar Bronze Classic – $128 decrease
Indiana Cigna Simple Choice 9100 – $168 decrease
Kansas Ambetter Virtual Access Bronze – $138 decrease
Kentucky Anthem Bronze Pathway Transition HMO 9100 – $156 decrease
Michigan Ambetter CMS Standard Bronze – $172 decrease
Missouri Anthem Bronze Pathway X 9100/0% Standard – $114 decrease
Nebraska Ambetter CMS Standard Bronze – $115 decrease
North Carolina BCBS Blue Home Bronze 7000 – $139 decrease
New York MetroPlus Bronze Plus NonStandard – $34 decrease
Ohio Anthem Bronze Pathway X HMO 9100 – $163 decrease
South Carolina BCBS BlueEssentials Bronze 2 – $127 decrease
Tennessee Bright Health Bronze 8700 – $170 decrease
Virginia UnitedHealthcare Simple Bronze 3 – $171 decrease
How Long Can A Child Stay On A Parent’s Plan?
Typically, you can remain on a group or individual plan until you reach age 26. Although some states have adopted separate guidelines, taking advantage of this provision can save money, and provide richer benefits with lower out-of-pocket expenses. For example, if other family members have satisfied the deductible portion of the policy (often two times the single deductible amount), children won’t have any deductible or copays applied to most medical claims. On January 1, deductibles reset.
Additional scenarios that allow you to stay on a parent’s policy include declining employer-provided health insurance benefits, residing in a parent’s house, adopting or parenting a child, marriage, divorce, and beginning or ending schooling. Of course, you can also voluntarily choose to have a child under age 26 separately enrolled on their own policy (see below). Their carrier can be different, including benefits and network providers. The federal subsidy eligibility may be impacted. Non-Obamacare coverage can be purchased at any time. Short-term plans are often viable stop-gap options.
TIP: Often, if there are currently three or more children covered on a health insurance plan, adding an additional dependent will result in little or no price change. Therefore, if a single person has a choice of purchasing a new policy or (assuming age 26 or less) or joining an existing parent’s plan, the latter option will probably save more than $1,000 per year. However, if a specific carrier or plan is preferred, then enrolling in two separate policies is recommended.
Can A Dependent Buy His/Her Own Medical Insurance?
Yes, they can. In certain situations, it may be cost-effective by limiting the potential maximum out-of-pocket expenses. For example, if a serious (and perhaps chronic) medical condition is present, and the deductible will easily be met, placing a young person on their own policy will keep the premiums, deductibles and coinsurance low. The savings could easily be thousands of dollars. Although non-ACA plans will be offered, pre-existing conditions will not be covered. Thus, any dependent with chronic medical conditions should never consider a non-ACA or non-Group plan.
The federal tax subsidy and its impact on the premium must be considered. When included on a parent’s policy, a larger instant tax credit may be available. However, a larger deductible may also be necessary to keep the rate affordable. Silver and Gold-tier plans often feature lower deductibles, but maximum out-of-pocket expenses may still be $8,700. Gold-tier plans may have lower maximum out-of-pocket expenses, but the premiums could be significantly higher. We review each scenario with you, so you can easily determine the best option. Note: “Catastrophic” plans are not eligible for the federal instant tax credit, and often are not a cost-effective option.
A spouse can also easily apply for their own personal plan. The cost of a separate cost of a plan is often substantially lower than the group rate through an employer. The reason is that often group medical insurance premiums through employers are very favorable for the employee. But once a spouse and/or dependents are added, the employer may no longer be contributing towards the coverage, and the cost increases. Larger companies generally offer more favorable pricing than smaller companies.
Tip: If you miss the Open Enrollment period, the birth of a child will create a “Qualifying Life Event,” which allows a Special Enrollment Period to be created. This is critical, since a new policy can be approved with pre-existing conditions covered and all plans available. All tiers are available with no waiting periods. Extended OE periods may also be offered.
Are Federal Benefits for Dependents Of Veterans Available?
Depending on the circumstances, very affordable medical coverage may be available. Many federal programs have been created that offer accessible low-cost plans to veterans and their families. One of the most popular options is the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Cost-sharing is provided, which will possibly pay some, but not all of your covered expenses. A program guide is provided that details covered and excluded expenses.
To qualify, the dependents can not be eligible for TRICARE. Also, benefits satisfy the Obamacare requirements, so a non-compliant penalty would not be applied. If the veteran parent or spouse is totally and permanently disabled as a result of a service-related event, or as a result of a condition at the time of death, benefits are payable. A death that occurred during active duty would also qualify. Medicare recipients are required to submit a copy of their ID card. Applicants that have reached age 65 and are not Medicare-eligible need to provide documentation from the SSA that benefits are not being paid to any person.
Generally, expenses and treatment that are “medically necessary” are covered, including prescriptions. But if you secure other coverage, you must notify CHAMPVA, since it may impact benefits. Several of the covered services include mental health services, skilled nursing care, ambulatory surgery, hospice, family planning, transplants, prescription drugs, and maternity.