The American Care Act (ACA) was enacted in March 2010 to ensure that all Americans obtain health coverage and seeks to improve the overall quality of the care provided. Quality of care provided includes Medicaid expansion, coverage for pre-existing conditions, continuous coverage for individuals until age 26, and the development of the health insurance marketplace. Not only did it do these things, but it also carved out the ability for parents to keep their adult child with a disability on their health insurance past the age of 26.
This can be more than a little confusing! One thing to remember is you will need to contact your private insurance carrier (i.e. BC/BS) directly to understand the “rules.” In addition, if your employer group is self-insured (typically larger employer groups), they may have their own guidelines.
Want to see if this is an option for you?
START EARLY! After you’ve received notice that because your child has turned 26, they will be terminated from your policy. So don’t wait until the last minute.
Instead, notify your employer and insurer as early as possible (ideally several years before your child’s 26th birthday) that your child has a disability and will need to remain on your policy after they turn 26. Paperwork to keep your child on your insurance may not be able to be submitted until right before their 26th birthday but knowing the “rules” in advance is always the best way to prepare.
To prepare, you (or subscriber of the plan) need to contact the insurance carrier directly to understand what needs to be done and to see if your plan allows for continued coverage of disabled adults past the age of 26. If so, the insurer is likely to require documentation, including “proof” of the disability from a medical professional. Note that some insurers may only approve the coverage for a limited period and require a new application or review of the disability to continue coverage.
What should I be doing now?
- If your adult child with a disability is under 26 and covered on your policy, contact your insurer or employer to learn what specific steps you need to take to keep them on your policy at 26.
- If your adult child with a disability is under 26 and not covered on your policy, consider adding them back to your policy now.
- If your adult child with a disability is over 26, it is still worthwhile to ask your employer and/or insurer whether they might still allow you to include this child under your policy.