Coverage for Adolescents and Young Adults: Up to Age 26 and CHIP
Coverage Up to Age 26
Under the Affordable Care Act, if an employee's plan covers children, an employee can now add or keep their children on their health plan until their child turn 26 years old. Before this law, insurance companies could typically remove enrolled children at age 19. However now that children are allowed to stay on their parents' plan until age 26, young adults have a more affordable way to have health insurance coverage. A child can join or remain on their parent's plan even if they are married, not living with the parent, attending school, not financially dependent on the parent, or eligible to enroll in their own employer's plan. Any qualified young adult must be offered all of the benefit packages available to similarly situated individuals who did not lose coverage because of termination of dependent status. The qualified young adult cannot be required to pay more for coverage than those similarly situated individuals. However, until 2014, grandfathered group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parent's plan. This provision of the Affordable Care Act also does not apply to Medicare. This new policy only applies to health insurance plans that offer dependent coverage in the first place — while most insurers and employer-sponsored plans offer dependent coverage, there is no requirement to do so.
Children’s Health Insurance Program (“CHIP”)
For some families who do not qualify for Medicaid,7 but also cannot afford to buy health insurance, there may be coverage through the Children’s Health Insurance Program (“CHIP”). CHIP is a state and federal partnership program that works closely with Medicaid, and in several states CHIP and Medicaid are combined into one program. For more information about the CHIP coverage program in your state, use the Healthcare.gov insurance and coverage finder. Children up to age 19 in families with incomes up to $45,000 per year (for a family of four) are likely to be eligible for coverage. In many states, children in families with higher incomes can also qualify. Pregnant women may also be eligible for CHIP. Coverage for expectant mothers generally includes lab testing and labor and delivery costs, and at least 60 days of care after delivery.
Under CHIP, routine “well child” doctor visits are provided free of charge, but there may be copayments for certain other services. Many states also charge a monthly premium for coverage. The costs you will be responsible for under CHIP are different in each state, but cannot be more than 5% of your family’s income each month. The benefits covered through CHIP are different in each state, but all states are required to cover routine check-ups, immunizations, dental and vision care, inpatient and outpatient hospital care, laboratory and X-ray services.
7See below for the Medicaid section of this fact sheet