ObamaCare Under 26: Rules for Children and Young Adults

Children can stay on their parent’s plan until 26; when they turn 26, they qualify for special enrollment. Dependent coverage is also offered by employers. Below is everything you need to know about the Affordable Care Act and young adults under 26.

What the ACA Does for Young Adults and Children Under 26

• Young adults under 19 must be offered pediatric dental and vision on all marketplace and employer plans (parents don’t need to accept).
• Low-income young adults who file taxes with their parents qualify for CHIP in most states, even if their parents don’t qualify for the Marketplace (some parents qualify for coverage due to being parents in non-expansion states). Typically the CHIP cut-off age is 19.
• Low-income young adults who don’t file taxes with their parents may qualify for Medicaid based on income.
• Young adults can stay on their parent’s plans until 26.
• Dependents under 26 have to be offered coverage on plans offered by large employers. (TRICARE has unique rules)
• Up to 82% of uninsured young people will qualify for either Medicaid coverage or subsidies to purchase coverage through the Health Insurance Marketplace.
• Young adults have seen the seen the largest rise in the rate of insured since 2013. The uninsured rates among adults under 26 dropped 46% by 2016 (HHS).
• Half of young single adults who are eligible to buy health insurance on the marketplace could get covered for $50 or less due to cost assistance. Cost assistance is only offered through your State’s Health Insurance Marketplace.

Can My Child Stay on My Health Plan?

Children can stay on any major Medical family plan until they turn 26. They can no longer be offered coverage through a family plan starting on their 26th birthday. This is only true for private plans and employer coverage. Medicaid and CHIP eligibility is based on other factors, typically CHIP covers those under 19 while Medicaid coverage depends on whether a state expanded or not. TRICARE has special rules.

What Happens When A Child Turns 26?

When a child turns 26, they can move off their parent’s plan and enroll in their own plan. Most young adults qualify for low-cost coverage through the Marketplace or Medicaid or have coverage options through their employer or university.

Turning 26 and Special Enrollment

When a young adult turns 26 and is dropped from their parent’s plan, it triggers a special enrollment period. This period starts when they lose coverage and lasts for 60 days. However, a young adult can enroll before they lose coverage to prevent a gap in coverage. Please note that short gaps of a few days may occur due to logistics.

Are Both Married and Unmarried Young Adults Covered?

Marriage doesn’t affect eligibility for the 26 rule, but it can affect cost assistance amounts on the Marketplace and Medicaid eligibility.

Are Dental and Vision Required to All Young Adults Under 26?

Dental and vision are only required for children under 19.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a.

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