Dependent Health Coverage and Age for Healthcare Benefits

11/1/2016

Girl on ComputerThe Patient Protection and Affordable Care Act (ACA) mandates that all health insurance carriers in every state that offer coverage to both adults and their dependents must allow dependents to remain on their parents or guardians’ “family” plans until the dependents are 26 years old.

The issued regulations state that young adults are eligible for this coverage regardless of any, or a combination of any, of the following factors: financial dependency, residency of the young adult, student status, employment status, or marital status. This applies to all plans in the individual market and to almost all employer plans (small group, large group, including self-funded or so-called ERISA plans) created after March 23, 2010. 

PPACA & HCERA; Public Laws 111-148 and 111-152: Consolidated Print

‘‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.

‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age. Nothing in this section shall require a health plan or a health insurance issuer described in the preceding sentence to make coverage available for a child of a child receiving dependent coverage. [As revised by section 2301(b) of HCERA]

‘‘(b) REGULATIONS.—The Secretary shall promulgate regulations to define the dependents to which coverage shall be made available under subsection (a).

‘‘(c) RULE OF CONSTRUCTION.—Nothing in this section shall be construed to modify the definition of ‘dependent’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of the cost of coverage.”

The States’ Role

The extension of coverage for young adults under their parents’ or guardians’ health insurance plans, like many of the ACA’s provisions, originated in state legislatures. Prior to the implementation of the ACA, at least 31 states required carriers to extend coverage to young adults. The age at which insurers were no longer required to provide coverage to young adults under their family plans varied by state. Additionally, some states required certain conditions to be met by young adults in order to be eligible for coverage under their guardians’ plans. For example, a number of states required that young adults be unmarried in order to qualify.

States may continue with current state law requirements for extended dependent coverage unless they prevent the application of the ACA. As with other state health insurance statutes, the state mandate language enables the state insurance departments to educate the public, and to implement and enforce those laws directly, including use of state courts and state-specific penalties.

State and local governments, as employers and sponsors of coverage plans, are required to notify those under the age of 26 whose coverage has ended or who were denied coverage under their plans before turning 26, of enrollment opportunities. 

State Actions

The federal ACA law applies to young adults in all states. 

As of 2012, (before the ACA was fully in effect)  the following 37 states had already extended the age that young adults can remain on their parents' health insurance plan:  Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin and Wyoming

There is considerable variation among state laws in terms of eligibility requirements. At least 30 states have extended dependent coverage, regardless of student status. Most states require that a young adult be unmarried and financially dependent on their parents in order to qualify for extended dependent coverage. 
States may continue to apply current state law requirements for extended dependent coverage except to the extent that the requirements prevent the application of the Patient Protection and Affordable Care Act (ACA). [Reviewed/updated 2016]

The box allows you to conduct a full text search or type the state name.

State Laws
State Laws

Colorado

Colo. Rev. Stat. § 10-16-104.3 states that a child is considered a dependent for insurance purposes up to age 25 (even if they are not enrolled in an educational institution) as long as they are unmarried and are financially dependent or share the same permanent address as the insurance provider.

Connecticut

C.G.S.A. § 38a-497 requires that group comprehensive and health insurance policies extend coverage to unwed children until the age of 26 provided they remain residents of Connecticut or are full-time students.

Delaware

Del. Code Ann. Tit. 18, § 3354 requires insurance providers to cover policyholder's dependent children until age 24. Dependents must be unmarried and a resident of Delaware or, if living outside the state, a full-time students. Insurance companies may charge more for dependent coverage past age 18, but it may not exceed 102 percent of the policyholder's cost before the child turned 18.

Florida

Florida 627.6562 allows for dependent children up to 25, who live with their parent or are a student, and up to 30 years old, who are also unmarried and have no dependent child of their own, to remain on their parents' insurance.

Georgia

Ga. Code § 33-30-4 allows dependent children up to age 25 who are enrolled as a full-time student at least five months during the year or are eligible to enroll but are prevented due to illness or injury to remain on their parents' insurance.

Ga. Code § 33-24-28 requires that a health services plan or health insurer exempt dependent children incapable of self-sustaining employment due to disability from dependent age limits. 

Idaho

Idaho Stat. § 41-2103 allows for any unmarried dependents to remain on their parents' health insurance until age 21; any full-time, unmarried student until age 25; or a dependent with a disability without regard to age.

Illinois

215 ILCS 5/356z.12 provides parents with the option of keeping unmarried dependents on their health care insurance up to age 26. Parents with dependents who are veterans can keep them on their plans up to age 30.

Indiana

IC 27-8-5-2,28 and  IC 27-13-7-3 require commercial health insurers and health maintenance organizations to cover children until age of 24 or without regard to age if they are incapable of self-sustaining employment due to disability.

Iowa

Iowa Code § 509.3 and Iowa Code § 514E.7 requires that health insurance providers continue to cover unmarried children under their parents' coverage provided that the child 1) is under the age of 25 and a current resident of Iowa, 2) is a full-time student, or 3) has a disability.

Kentucky

Ky. Rev. Stat. § 304.17A-256 allows parents to keep their unmarried children on their health plans until the age of 25. Parents may have to pay extra for their adult children.

Louisiana

La. Rev. Stat. Ann. § 22:1003 allows an unmarried, dependent child to remain on parent's insurance up to age 24 if they are a full-time student.

Maine

24-A MRSA § 2742-B requires individual and group health insurance policies to continue coverage for a dependent child up to 25 years of age if the child is dependent upon the policyholder and the child has no dependents of the his/her own. 

Maryland

MD Code, Insurance § 15-418 requires that health insurance be extended to, at the request of the policy holder, unmarried dependents under the age of 25. 

Massachusetts

Mass. Gen. Laws Ann. Ch. 175 § 108 allows dependents to stay on their parent's coverage for two years past the age of dependency or until age 26, whichever occurs first, or without regard to age if they are incapable of self-sustaining employment due to disability.

Young adults ages 19-26 are eligible for lower-cost insurance coverage, tailored to meet their needs, offered through the Commonwealth Health Insurance Connector. Reform summary and fact sheet, PowerPoint presentation.

Minnesota

Minnesota Chapter 62E.02 Defines "dependent" as a spouse or unmarried child under age 25, or a dependent child of any age who is disabled.

Missouri

Mo. Rev. Stat. § 354-536 defines dependent as an unmarried child up to age 26. If a health maintenance organization plan provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children, such coverage shall continue while the child is and continues to be both incapable of self-sustaining employment by reason of mental or physical handicap and chiefly dependent upon the enrollee for support and maintenance.

Montana

MCA 33-22-140 provides insurance coverage under a parent's policy for unmarried children up to age 25.

Nevada

NRS 689C.055 allows an unmarried, dependent child who is a full-time student to remain on his or her parent's insurance up to age 24 if parent is covered by small group policy.

NRS 689B.035 requires that dependents retain coverage beyond age of policy termination if they are incapable of self-sustaining employment due to disability.

New Hampshire

N.H. Rev. Stat § 420-B:8-aa defines dependent as those who are unmarried up to age 26 and either a full-time student or resident of New Hampshire for purposes of health insurance coverage.

2009 SB 115 allows those up to age 26 to buy-in to coverage through the state's CHIP program, Healthy Kids.

New Jersey 

N.J.S.A. 17B:27-30.5 states that, at the option of the insured person, a dependent may be covered up to the age of 31, as long as they are unmarried and have no dependents of their own.

New Mexico

NM Stat. Ann. § 13-7-8 states that health insurance for dependents may not be terminated based on age up to age 25. 

New York

N.Y. Insurance Code, sec. 3216. (2009 AB 9038) allows an unmarried adult child to remain on parent's insurance through age 29 (up to age 30) if they are a resident of New York. [link updated 4/2015]

North Dakota

N.D. Cent. Code § 26.1-36-22 allows an unmarried, dependent child to remain on parent's insurance up to age 22 if they live with parents. If they are a full-time student, they can remain on parent's insurance from age 22 up to age 26.

Ohio

Ohio Rev. Code § 1751.14, as amended by 2009 OH H 1 allows an unmarried, dependent child that is an Ohio resident or a full-time student to remain on parent's insurance up to age 23, or without regard to age if they are incapable of self-sustaining employment due to disability.

Oregon

O.R.S. § 735.720 defines dependent as an unmarried child up to 23, elderly parents and disabled adult children for the purpose of insurance coverage.

Pennsylvania 

2009 SB 189 states that an unmarried child may remain on parent's insurance up to age 30 if they have no dependents and are residents of PA or are enrolled as full-time students.

51 Pa.C.S.A. § 7309 states that full-time students whose studies are interrupted by service in the reserves or the National Guard must be extended health care benefits as a dependent of their parent beyond the terminating age equal to the length of their deployment..

Rhode Island

R.I. Gen. Laws § 27-20-45 and Gen. Laws § 27-41-61 requires insurance plans which cover dependent children to cover unmarried dependent children until age 19 or, if a student, until age 25. If the dependent child is mentally or physically impaired, the plan must continue their coverage after the specified age. 

South Carolina

S.C. Code Ann. § 38-71-1330 allows an unmarried, dependent child who is a full-time student to remain on parent's insurance up to age 22 if parent is covered by small group policy.

S.C. Code Ann. § 38-71-350 requires that a dependent child who is not capable of self-sustaining employment be allowed to remain on his or her parent's insurance, without regard to age.

South Dakota

SD Codified Laws Ann. § 3-12A-1 states that any insurance provider offering benefits to a dependent may not terminate those benefits by reason of age before the dependent's 19th birthday. If the dependent is enrolled in an educational institution, they are not to be terminated until they reach age 24 and not terminated if unable to seek self-support due to disability.

SD Codified Laws § 58-17-2.3 states that if the dependent remains a full-time student upon attaining age 24 but not exceeding age 29, the insurer shall provide for the continuation of coverage for that dependent at the insured's option.

Tennessee

Tennessee Code Ann. § 56-7-2302 allows for dependent coverage for children under their parents' health insurance plan up to age 24 provided the child is unmarried and financially dependent on the parents.

Texas

V.T.C.A. Insurance Code § 846.260 and V.T.C.A. Insurance Code § 1201.059 make dependent status available for an unmarried child up to age 25 for insurance purposes.

Utah

Utah Code Ann. tit. 31A § 22-610.5 requires that coverage for unmarried dependents continue up to age 26, regardless of whether or not the dependent is enrolled in higher education. 

Virginia

Va. Code Ann. § 38.2-3525 makes dependent status available to any child up to age 19 or who is a dependent up to age 25 who resides with the parent or is a full-time student.

Washington

West's RCWA 48.44.215 states that, at the option of the insured person, an unmarried dependent may be covered up to age 25.

West Virginia

W. Va. Code § 33-16-1a defines dependent for health insurance coverage as a child or stepchild up to age 25.

Wisconsin

Wis. Stat. § 632.885 requires that coverage for unmarried dependents through a parent's insurance be offered up to age 27 if they are not offered insurance through an employer. Full-time students called to active duty in the armed forces can be covered beyond age 26 depending on various factors.

Wyoming

Wyo. Stat. § 26-19-302 states that if child is unmarried and a full-time student, they can remain on parent's insurance up to age 23 if parent is covered by small group policy.

 

Coverage Beyond the Federal ACA | 2016 update

Six states, including Florida, Illinois, New Jersey, Pennsylvania, South Dakota and Wisconsin have enacted laws that require or authorize carriers to cover young adults beyond age 26. New York and Ohio previously enacted such laws, however those provisions are no longer in effect.

 

State Laws Beyond ACA

State

Required Coverage Age Cut-off

Citation

Florida

30 (must be unmarried and have no dependents of their own)

West's F.S.A. § 627.6562

Illinois

30 (applies to Veterans only)

215 ILCS 5/356z.12

New Jersey

31

N.J.S.A. 17B:27-30.5

New York 29* (unmarried and not eligible for employer-based insurance) McKinney's Insurance Law § 3216

Pennsylvania

30

40 P.S. § 752.1

South Dakota

29*

SDCL § 58-17-2.3

Wisconsin

Full-time students, regardless of age

Wis. Stat. § 632.885

 

Who Pays?

The cost of notifying families about new enrollment opportunities is shared between insurance providers and employers. The cost of covering the young adults who take advantage of the extension is shared between employers and the families of newly covered young adults. For families with no employer health coverage, the cost may fall on the parents.  Those families that qualify for States, as sponsors of coverage plans for state employees, also share the costs with families. A qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

IRS Notice 2010-38 provides guidance to extend the general exclusion from gross income for the reimbursements for medical care under an employer provided accident or health plan to any employee's child who has not yet attained age 27 as of the end of the taxable year, making the benefit tax-free.

*The information on this page is intended for state policy makers. It is not intended as legal or medical advice or guidance to individual insurance enrollees.. 

Source: NCSL legal research, 2016; State Health Facts by KFF. Legal review, 2011-2015: Richard Cauchi, NCSL Health Program.
Update 2016 research: Ashley Noble, J.D., NCSL Health Program