Can an insurance company stipulate it’s own exceptions to kids being covered on their parents plan until 26? I have a family member that had her 24 year old son on their insurance, but he graduated last year from college, and their insurance carrier indicated that because he is no longer in school, and because the insurance is through her husband who is a retiree, their son can no longer be on the policy.


Exemptions from the 26 rule include TRICARE and grandfathered plans. The retiree plan may count as a grandfathered plan (a plan that was in effect when health reform was signed into law on March 23, 2010, and have not significantly raised premiums or changed benefits.)

According to the Department of Health and Human Services, the key is whether the retiree health plan is made up only of retirees and their dependents or a mix of both active and retired employees and dependents. If it’s a retiree-only group plan the typical setup, according to experts — then it doesn’t have to abide by the market provisions of the health law.

Read more from Kaiser.

If you are unsure you can always call the federal Department of Labor at 866-444-3272.

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Kxxx Cxxx on

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What the heckkkk. That is so lame. I have a bad illness that requires very expensive medicine; I was seriously needing to stay covered by my parents until 26, but I’m only 23 and losing coverage! Welcome to the real world, I guess. on

So sorry, if your state Expanded Medicaid you can get free or low cost coverage through Medicaid if your income is 138% of the Federal Poverty Level or less (just make sure Medicaid will cover the Medication before going that route).

If your state didn’t expand Medicaid you need to make between 100% – 400% to get Marketplace subsidies. If you make 100% – 150% then you can get some really amazing subsidies that cover most of your costs.

For people with costly medical issues you really want to get a Silver plan and claim around 150% of the federal poverty level in income.

The caveat is this is based on household MAGI income. That means income after deductions for your whole household. So in this regard you’ll need to file taxes independently from your family and will need to make sure your personal income falls in the right place. At 23 this should all be doable just by getting a job that doesn’t offer health coverage. Unfortunately that is the kicker, you can’t have access to employer based health coverage to be eligible for Marketplace subsidies.

Lastly, even for TRICARE and grandfathered plans. They can kick you off at 23, but sometimes they will offer other options. So call the insurer and see what options they are offering.

erick on

Can an unadopted dependent be dropped from your insurance if they are not living in the home and on their own and not in school. She is 20 and working.