Q. When my daughter turned 23, my insurance company told me she would no longer be covered under my family plan. I heard I can insure her now, under the new health care law. Is that right?
A. Yes. Under the new health care reform law, plans that offer coverage for children must now cover young adults until their 26th birthday — regardless of where they live and whether they are students, financially independent or married. This requirement applies to individually purchased plans and group plans offered through employers.
Exceptions to the new rule: The young adult provision does not apply to families covered by TRICARE, the government program for active troops, military retirees and their families. TRICARE limits coverage for children to age 21, or to 23 if they are students.
There’s another important exception to the rule: some young adults who are lucky enough to land a job that offers health insurance are not allowed to get coverage under their parents’ health plan, even if the family plan is better or cheaper. The restriction applies until Jan. 1, 2014, to “grandfathered” plans that were in effect when health reform was signed into law on March 23, 2010, and have not significantly raised premiums or changes benefits.
All other plans that began or renewed after Sept. 23, 2010 (six months after the legislation was signed) must offer coverage to young adults under their families health plans, explained Jessica Santillo, a spokeswoman for Health and Human Services.
Readers raised other questions about the requirement:
Q. Will young adults have to buy a rider, individual policy or COBRA policy? Can they stay on or rejoin their families’ plans?
A. A separate policy isn’t necessary. Young adults can stay on or return to their family health plan. However, only plans that cover children have to raise the age limit to the child’s 26th birthday. And there is no requirement that all health plans cover children.
Q. Can insurers charge more for the family plan — raise premiums, deductibles, copayments, etc. — because it will be extended to adult children?
A. No, all covered children must be charged the same, regardless of whether they are 5 years old or 25 years old, said Sara Collins, vice president for affordable insurance at the Commonwealth Fund. However, plans may offer differently priced premiums based on how many dependents are included.
Q. Will I be able to add my 22-year-old son to my Medicare coverage as if I had private health insurance?
A. No, the requirement doesn’t apply to Medicare.
Q. Does the law extend family health plan coverage to grandchildren under 26 years of age?
A. No, it does not.
Susan Jaffe of Washington, D.C., covers health and aging issues. She is the author of the Bulletin’s column Health Care Reform Explained: Your Questions Answered.
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