How Will Exchanges Change Options For Kids' Health Coverage?

Sep 24, 2013
Originally published on September 24, 2013 3:53 pm

As the scheduled launch of the state health insurance marketplaces on Oct. 1 approaches, many parents have questions about covering their children. Here are a few we got recently.

I am a divorced dad who has responsibility for maintaining my 15-year-old daughter's health insurance. It was easy when I was working and had a corporate health plan. Now that I am retired and covered by Medicare, I am looking for alternatives when the new exchanges open. Can I buy health insurance for just my underage daughter on these new exchanges?

Yes, you can. The new health insurance marketplaces, also called exchanges, are required to sell child-only policies for children up to age 21.

If you claim your daughter as a dependent on your tax return and your income is less than 400 percent of the federal poverty level ($62,040 for a family of two in 2013), you may qualify for a tax credit to reduce the cost of coverage. If your ex-wife claims your daughter as a dependent, however, in order to receive the tax credit she would have to apply for it based on her household income, says Brian Haile, a health policy specialist at Jackson Hewitt Tax Service in Nashville.

Depending on your income, your daughter might qualify for health insurance through your state's Medicaid or CHIP programs for lower income people. As of January 2013, all but four states covered children in families with incomes up to at least 200 percent of the federal poverty level ($31,020 for a family of two in 2013) through one of those programs, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

My 21-year-old son is a college student, and I know the Affordable Care Act has made him eligible to remain on my employer-based insurance plan until age 26. However, if it's cheaper for him to get subsidized coverage through the health insurance marketplace, can he do so?

It depends. Almost anyone can shop for coverage on the health insurance marketplace. But your son will only be eligible for subsidies to reduce the cost of coverage under certain circumstances. If you don't claim him as a dependent on your tax return and his own income is between 100 and 400 percent of the federal poverty level ($11,490 and $45,960 in 2013), he could be eligible for premium tax credits on the exchange. But if you do claim him as a dependent, his eligibility for subsidies will be based on your family's income, not just his own.

It's also probably worth looking into Medicaid eligibility for your son. Roughly half of states have decided to expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013) as provided for under the Affordable Care Act. Medicaid would be even less expensive than a private plan on an exchange. But if you claim your son as a dependent on your tax return, your family's income would have to be no more than 138 percent of poverty in order for him to qualify, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

My husband served for 22 years in the Marine Corps. My adult children are still in college, but they have been dropped from our insurance Tricare Prime. Why is it that the adult children of retired members of the military can't stay on their parents' insurance?

The Affordable Care Act allows adult children to remain on their parents' health plan until they reach age 26 in most cases. But Tricare, the health plan for military service members, is governed by a different set of statutes, and the ACA's provisions that expand young adult coverage don't apply.

Tricare allows dependent children to remain on their parents' plan until they turn 21, or until they turn 23 if they're full-time students who are supported financially by their parents, says Austin Camacho, chief of the benefit information and outreach branch of Tricare Management Activity.

Once adult children are no longer eligible for regular Tricare, they can sign up for Tricare Young Adult, which provides coverage for children up to age 26 who are unmarried and don't have employer coverage available to them, says Camacho. Unlike regular Tricare, however, the young adult program is a premium-based plan that costs up to $180 per month.

Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.