The 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 regulations issued establish that young adults are eligible for this coverage regardless of any or a combination of any of the following factors: financial dependency, residence of the young adult, student status, employment status or marital status. This applies to all plans in the individual market and almost all employer plans (small group, large group, including self-funded or erisa plans) created after March 23, 2010.
ppaca & hcera; public laws 111-148 and 111-152: consolidated printing
‘‘sec. 2714. extension of dependent coverage.
”(a) in general.—A group health plan and a health insurance issuer that offers individual or group health insurance coverage that provides coverage to children’s dependents will continue to provide such coverage for an adult child until the child turns 26 years of age. Nothing in this section will require a health plan or health insurance issuer described in the previous sentence to make coverage available to a child of a child receiving dependent coverage. [revised by hcera section 2301(b)]
‘‘(b) regulations.—The secretary shall promulgate regulations to define the dependents to whom coverage shall be made available pursuant to subsection (a).
”(c) interpretation rule. 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.”
- ncsl datasheet
- white house fact sheet
- commonwealth fund: rite of passage: young adults and the affordable care act of 2010
- summary of the founding of the kaiser family
Are you a parent or young adult looking for more information about the Young Adult Health Insurance coverage provisions in the Affordable Care Act?
Read the 2016 White House Answers to Frequently Asked Questions and a White House fact sheet on the topic.
Also read the Department of Labor’s Answers to Frequently Asked Questions for additional information on coverage details for young adults.
If you have specific questions about health insurance coverage for young adults, discuss them with your employer’s benefits administrator or contact your state insurance department.
the role of states
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 ACA’s implementation, at least 31 states required providers to extend coverage to young adults. the age at which insurers were no longer required to cover young adults under their family plans varied by state. Additionally, some states required young adults to meet certain conditions to be eligible for coverage under their guardians’ plans. for example, several states require young adults to be unmarried to qualify.
States may continue current state law requirements for extended dependent coverage, unless they prevent application of ACA. As with other state health insurance statutes, the state mandate language allows state insurance departments to educate the public and directly implement and enforce those laws, including the use of state courts and state-specific penalties.
State and local governments, such as employers and sponsors of coverage plans, are required to notify those under age 26 whose coverage has ended or who have been denied coverage under their plans before turning 26 of the enrollment opportunities.
Federal law here applies to young adults in all states.
As of 2012 (before the law here went into full effect), the following 37 states had already extended the age at which young adults can stay 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, Dakota North, 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 coverage for dependents, regardless of the student’s status. Most states require a young adult to be unmarried and financially dependent on his or her parents to qualify for extended dependent coverage. States may continue to enforce the requirements of current state law for extended dependent coverage, except to the extent that the requirements preclude enforcement of the Patient Protection and Affordable Care Act (ACA) . [revised/updated 2016]
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colo. Rev. Statistical § 10-16-104.3 states that a child is considered a dependent for insurance purposes until age 25 (even if not enrolled in an educational institution) as long as they are not married and are financially dependent on or share the same permanent address as the child. insurance provider.
c.g.s.a. § 38a-497 requires group health and comprehensive insurance policies to extend coverage to unmarried children through age 26, as long as they remain Connecticut residents or are full-time students.
del. ann code tit. 18, § 3354 requires insurance providers to cover dependent children of the policyholder up to age 24. Dependents must be unmarried Delaware residents or, if living out of state, full-time students. Insurance companies can charge more for dependent coverage after age 18, but it can’t exceed 102 percent of the cost to the policyholder before the child’s 18th birthday.
florida 627.6562 allows dependent children up to age 25, who live with their parents or are students, and up to 30 years old, who are also unmarried and have no dependent children of their own, to remain on the insurance from their parents.
ga. Code § 33-30-4 allows dependent children up to age 25 who are enrolled as a full-time student for at least five months during the year or are eligible to enroll but are unable to remain on their parents’ insurance due to to illness or injury. .
ga. Code § 33-24-28 requires a health care plan or health insurer to exempt dependent children incapable of self-supporting employment due to a disability from the dependent age limits.
idaho statistics. § 41-2103 allows unmarried dependents to remain on their parents’ health insurance until age 21; any single full-time student up to age 25; or a dependent with a disability regardless of age.
215 ilcs 5/356z.12 gives parents the option of keeping unmarried dependents on their health insurance until age 26. parents with dependents who are veterans can keep them on their plans until age 30.
ic 27-8-5-2,28 and ic 27-13-7-3 require commercial health insurers and health maintenance organizations to cover children up to or without regard to age 24 age if unable to support themselves employment due to disability.
Iowa Code § 509.3 and Iowa Code § 514e.7 require health insurance providers to continue to cover unmarried children under their parents’ coverage as long as the child 1) is under the age of 25 and are a current Iowa resident, 2) are a full-time student, or 3) have a disability.
ky. Rev. Statistical § 304.17a-256 allows parents to keep their unmarried children in their health plans until age 25. parents may have to pay more for their adult children.
the. Rev. ana statistic § 22:1003 allows an unmarried dependent child to remain on the parent’s insurance until age 24 if he is a full-time student.
24-a mrsa § 2742-b requires individual and group health insurance policies to continue coverage of a dependent child through age 25 if the child is dependent on the policyholder and has no dependents . own self.
md code, insurance § 15-418 requires that health insurance be extended to, at the policyholder’s request, unmarried dependents under the age of 25.
mass. gene laws ann. chap. 175 § 108 allows dependents to remain on their parents’ coverage for two years past the age of dependency or until age 26, whichever comes first, or regardless of age if unable to hold employment for themselves due to a disability.
Young adults ages 19-26 are eligible for lower-cost insurance coverage, tailored to their needs, offered through the commonwealth health insurance connector. summary of the reform and technical sheet, powerpoint presentation.
minnesota chapter 62e.02 defines “dependent” as a spouse or unmarried child under the age of 25, or a dependent child of any age who is disabled.
month rvdo. Statistical § 354-536 defines a dependent as an unmarried child up to the age of 26. If a health maintenance organization plan provides that a dependent child’s coverage ends upon reaching the age limit for dependent children, such coverage will continue as long as the child is and continues to be incapable of self-employment due to a mental or physical disability and rely primarily on the member for support and maintenance.
mca 33-22-140 provides insurance coverage under the parents’ policy for unmarried children up to age 25.
nrs 689c.055 allows an unmarried dependent child who is a full-time student to remain on his parents’ insurance until age 24 if the parent is covered by a small group policy.
nrs 689b.035 requires dependents to maintain coverage beyond the termination age of the policy if they are unable to maintain employment on their own due to a disability.
n.h. Rev. Stat § 420-b:8-aa defines dependents as those who are unmarried until age 26 and are full-time students or New Hampshire residents for purposes of health insurance coverage.
sb 115 of 2009 allows people up to 26 years of age to enroll in coverage through the state chip program, healthy children.
n.j.s.a. 17b:27-30.5 states that, at the option of the insured person, a dependent may be covered until age 31, provided he is not married and has no dependents of his own.
nm statistics. Ana. § 13-7-8 states that dependent health insurance cannot be canceled based on age until age 25.
n.y. insurance code, sec. 3216. (2009 ab 9038) allows an unmarried adult child to remain on the parent’s insurance until age 29 (until 30) if she is a new york resident. [link updated 4/2015]
n.d. penny. code § 26.1-36-22 allows an unmarried dependent child to remain on the parents’ insurance until age 22 if they live with the parents. if they’re a full-time student, they can stay on their parents’ insurance from ages 22 to 26.
ohio rev. code § 1751.14, amended by 2009 oh h 1 allows an unmarried dependent child who is a resident of ohio or a full-time student to remain on the parent’s insurance until age 23, or regardless of age if are incapable of self-sufficient employment due to a disability.
o.r.s. § 735.720 defines a dependent as an unmarried child up to age 23, elderly parents, and disabled adult children for purposes of insurance coverage.
2009 sb 189 states that an unmarried child can remain on the parent’s insurance for up to 30 years if they have no dependents and are a pa resident or enrolled as a full-time student.
51 pa.c.s.a. § 7309 states that full-time students whose studies are interrupted by service in the reserves or national guard must receive extended health care benefits as dependents of their parents beyond the age of termination equal to the length of their deployment .
r.i. gene laws § 27-20-45 and gen. § 27-41-61 laws require insurance plans covering dependent children to cover unmarried dependent children up to age 19 or, if a student, up to age 25. if the dependent child has a mental or physical disability, the plan must continue coverage after the specified age.
s.c. ann code § 38-71-1330 allows an unmarried dependent child who is a full-time student to remain on the parent’s insurance until age 22 if the parent is covered by a small group policy.
s.c. ann code § 38-71-350 requires that a dependent child who is not capable of self-support be allowed to remain on her parent’s insurance, regardless of age.
codified laws sd ann. § 3-12a-1 states that any insurance provider that offers benefits to a dependent may not cancel those benefits due to age before the dependent’s 19th birthday. if the dependent is enrolled in an educational institution, he should not be laid off until he turns 24 and should not be laid off if he cannot seek self-sufficiency due to a disability.
sd § 58-17-2.3 codified laws state that if the dependent remains a full-time student upon his or her 24th birthday but not to exceed 29, the insurer will provide continuation coverage for that dependent at option of the insured.
tennessee code ann. § 56-7-2302 allows dependent coverage for children under their parents’ health insurance plan up to age 24, as long as the child is unmarried and financially dependent on the parents.
v.t.c.a. insurance code § 846.260 and v.t.c.a. insurance code § 1201.059 makes dependent status available to an unmarried child up to age 25 for insurance purposes.
utah code ann. tit. 31a § 22-610.5 requires coverage for unmarried dependents to continue through age 26, regardless of whether or not the dependent is enrolled in higher education.
goes. ann code § 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.
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.
w. Virginia. code § 33-16-1a defines a dependent for health insurance coverage as a child or stepchild up to age 25.
wisdom. Statistical § 632.885 requires coverage for unmarried dependents to be offered through parent’s insurance up to age 27 if they are not offered insurance through an employer. full-time students called to active duty in the armed forces may be covered beyond age 26 depending on several factors.
wo. Statistic § 26-19-302 states that if the child is unmarried and a full-time student, he can remain on the parent’s insurance until age 23 if the parent is covered by a small group policy.
coverage beyond the federal aca | update 2016
six states, including florida, illinois, new jersey, pennsylvania, south dakota andwisconsin have enacted laws requiring or authorizing insurers to cover young adults older than 26 years. new york and ohio previously enacted such laws, however, those provisions are no longer in effect.
age limit for required coverage
30 (must be single with no dependents of your own)
f.s.a. western § 627.6562
30 (applies to veterans only)
215 ilcs 5/356z.12
40 p.d. § 752.1
sdcl § 58-17-2.3
full-time students, regardless of age
wisdom. statistics § 632.885
The cost of notifying families of new enrollment opportunities is shared between insurance providers and employers. the cost of covering young adults taking advantage of the extension is shared between the employers and the families of the newly covered young adults. For families without employer health coverage, the cost may fall on the parents. those families who qualify for the states, as sponsors of coverage plans for state employees, also share the costs with the families. A qualified young adult cannot be required to pay more for coverage than similarly situated individuals who did not lose coverage due to loss of dependent status.
irs notice 2010-38 provides guidance for extending the general gross income exclusion for medical care reimbursements under an employer-provided accident or health plan to any child of the employee who has not yet reached age 27 at the end of the taxable period. year, making the benefit tax-free.
*Information on this page is intended for state policymakers. it is not intended as legal or medical advice or guidance for individual policyholders.
source: ncsl legal research, 2016; state of health facts by kff. legal review, 2011-2015: richard cauchi, ncsl health program. 2016 research update: ashley noble, j.d., ncsl health program