Can a Grandchild be a Dependent on Health Insurance?
Adding a grandchild to health insurance is possible but can be complicated. There are a few ways grandparents can get coverage for grandchildren, but it depends on the health plan, the relationship between the grandchild and grandparent, and the child’s situation.
This guide covers the key things grandparents need to know about adding a grandchild to their health insurance.
When Can a Grandchild be Added to a Grandparent’s Health Insurance?
There are a few scenarios when a grandparent may be able to add a grandchild to their health insurance policy:
The Grandchild Lives with the Grandparents?
If the grandchild lives full-time in the grandparent’s home, they may be eligible for coverage under the grandparent’s family health plan. The health insurance company will likely require proof that the grandchild lives at that address permanently.
Documents like school enrollment records or a letter from the child’s parent can help demonstrate this is the child’s residence.
The Grandparent Has Legal Custody or Guardianship
If the grandparent has legal custody or guardianship of the grandchild, they can usually add them to their health plan. The insurance provider will need court documents about the custody arrangement.
These could include a court order granting the grandparent custody or guardianship.
The Grandchild’s Parents are Covered Under the Grandparent’s Plan
Some family health plans allow grandchildren to be covered if their parent (the grandparent’s adult child) is covered under the same policy. The grandchild must meet the plan’s general dependent requirements in this case, like being under the age 26.
The Grandparent Adopts the Grandchild
If a grandparent legally adopts their grandchild, the child becomes eligible for coverage as a dependent just like a biological child. The adoption paperwork will be required to enroll the child in the grandparent’s health insurance.
Grandchild Health Insurance Eligibility Requirements
Even if the grandchild falls into one of the above categories, they still have to meet the health plan’s eligibility rules for dependents. Some key requirements may include:
- Age limit – Most health plans allow dependents up to age 26. Some states mandate coverage up to age 30 for dependents if they don’t have other insurance.
- Unmarried – Dependents usually must be unmarried in order to stay on a family health plan. This includes registered domestic partnerships in some cases.
- Not eligible for own employer coverage – If the dependent grandchild has access to affordable health insurance through their job, the grandparent’s plan may not cover them.
- Income limits – For grandparents covered under public health plans like Medicaid, there are income limits for adding dependents.
- Residency – The grandchild must live in the health insurance company’s service area in order to be covered.
Grandparents should check their specific health plan details to see if their grandchild meets all of the eligibility requirements.
Enrolling a Grandchild in Health Insurance Coverage
Once grandparents confirm the grandchild is eligible for coverage under their health plan, they will need to formally enroll them during open enrollment or upon a qualifying event. Here are some steps for successfully getting a grandchild enrolled:
- Fill out the dependent section – When a grandparent signs up for health coverage or renews it, they need to include the grandchild’s information in the dependents section. Medical history and other details will be required.
- Provide relationship documentation – The health plan will require proof of the dependent relationship, such as a birth certificate, adoption paperwork, or a court order granting custody.
- Choose a health plan – If the grandparent’s policy offers multiple health plan options, they will pick the best one to cover the grandchild’s needs.
- Pay premiums – Adding a dependent will increase monthly premiums. Grandparents should budget for the extra health insurance costs. Discounts may apply for adding a child.
- Get new insurance cards – Once approved, the insurance company will issue member cards for the grandchild to access benefits. Grandparents can check when cards will arrive.
- Set up medical services – Grandparents should establish a pediatrician and manage health services to get routine care established right away.
Updating coverage each year and staying on top of open enrollment periods will help ensure continuous health benefits for the grandchild.
Paying for Grandchild Health Insurance
One major consideration for grandparents is taking on the additional insurance costs for a grandchild dependent. There are a few ways to manage these extra expenses:
- Use grandparent health insurance subsidies – If grandparents qualify for premium tax credits based on income, these can help pay for a portion of the grandchild’s coverage.
- See if the child’s parents can contribute – Depending on the situation, the grandchild’s parent may be able to pay for some of the health premiums or copays. Setting up a shared costs arrangement can offset the grandparent’s expenses.
- Look into public health programs – If household income is limited, the child may qualify for low or no-cost coverage under Medicaid, CHIP, or other public health plans. These programs factor in the whole household’s income.
- Use a special needs or adoption subsidy – For grandparents who adopt a grandchild, especially those with disabilities or special needs, there may be financial assistance programs to help cover medical costs and insurance.
- Research advocacy groups and non-profits – Organizations like Generations United offer resources and support for grandparents raising grandchildren, including help with medical costs.
Finding ways to access financial help can make obtaining health coverage for a grandchild more feasible for grandparents.
Types of Health Plans that Cover Grandchild Dependents
Several different forms of health insurance allow adding grandchildren as long as eligibility requirements are met. Some common options include:
Employer-Provided Health Insurance
Many grandparents have access to family health coverage through their job. This group health plan will define rules for dependents and often allows adding grandchildren. Retiree coverage may also permit dependents.
Individual Private Health Plans
Private health plans purchased by individuals, like those offered under the Affordable Care Act, can include dependents. Grandchildren can be added to individual health policies.
Medicare Advantage Plans
For grandparents enrolled in Medicare Advantage through a private insurer, these plans may offer dependent coverage. Rules are set by the insurer providing the Medicare Advantage plan.
Medicaid and CHIP
Government health programs like Medicaid and Children’s Health Insurance Program (CHIP) can provide coverage for eligible low-income grandchildren living with a grandparent. Specific income thresholds apply.
TRICARE military health benefits allow grandchildren as dependents in some cases. Active duty family members may qualify to enroll grandchildren. Retiree dependents can also be eligible for certain TRICARE plans.
Checking on specific plan rules is important, since dependent eligibility requirements can vary. But many common health plan types allow adding grandchildren given the right circumstances.
Coordinating Insurance Coverage for Grandchildren
Since rules around grandchild dependents can be complicated, it’s good for grandparents to understand how their coverage interacts with other options the child may have access to.
- The grandchild’s coverage is primary – If the grandchild is covered under a parent’s plan, that insurance is primary and the grandparent’s is secondary. The primary plan pays claims first.
- Grandparent’s plan is secondary – As a secondary insurer, the grandparent’s plan may cover copays, deductibles, and other costs after the primary coverage pays.
- Coordinate benefits carefully – Grandparents will need to work with both health plans to file claims appropriately and avoid denial of coverage.
- Look out for shadow benefits – Some coordinated plans don’t cover areas where the primary plan offers benefits, called shadow benefits, so there are gaps in coverage.
- End overlapping coverage if premiums get too high – Dual coverage can lead to double premiums. Removing the grandchild from a parent’s plan can lower costs if the grandparent has good coverage.
- Make sure providers are in-network – Using out-of-network services can void the coordination of benefits and lead to larger out-of-pocket costs.
While coordination opens up options for dependents, it also requires close management by grandparents to ensure seamless coverage for grandchildren.
Special Enrollment Situations for Grandchild Dependents
Outside of open enrollment periods, there are a few qualifying events that create special enrollment opportunities for grandparents to add grandchildren as dependents:
Loss of Prior Health Coverage
If the grandchild loses other health benefits like Medicaid or parent’s employer plan, this triggers a 60-day special enrollment window for the grandparent’s health plan.
Change in Custody or Guardianship
If the grandparent gets legal custody or guardianship, this life event allows adding the grandchild within 30 days in most cases.
Move to Grandparent’s Service Area
If the grandchild moves into the geographic area covered by the grandparent’s health insurer, this permits a special enrollment period of 60 days to add them.
Adoption of Grandchild
Finalizing the adoption of a grandchild means they can be signed up as a dependent within 30 days following the adoption date.
Marriage of Grandchild’s Parent
If the adult child on the grandparent’s health policy gets married, that gives 60 days to enroll the new son or daughter-in-law and grandchildren.
Watching for qualifying events that make grandchildren eligible for special enrollment is key for grandparents to get them added on during the year.
Health Plan Options When Grandchildren Age Out
One important consideration for grandparents is what happens when a grandchild’s dependent reaches the plan’s age limit, usually 26 years old. At that point, the grandchild has to come off the health policy. Here are some options to maintain coverage:
Extend Coverage to Age 30 in Some States
A few states require health plans to cover dependents up to age 30 outside of open enrollment. Grandparents in those states may be able to keep grandchildren insured longer.
Enroll in COBRA
COBRA allows extending a health plan for 18-36 months in most cases. Grandchildren can elect COBRA when they age out to preserve benefits temporarily.
Explore Individual Health Plan Options
Losing dependent status due to age qualifies for a 60 day special enrollment window to enroll in an individual health plan, either on or off the Marketplace exchange.
Check Out Student Health Plans
If the grandchild attends college, they may have access to health coverage offered by the university. Student health plans can provide comprehensive benefits.
Assess Eligibility for Medicaid/CHIP
Grandchildren losing insurance may qualify for Medicaid or CHIP based on limited income. These programs provide free or low cost health benefits.
With some planning ahead of time, grandparents and grandchildren have ways to deal with losing dependent coverage and prevent gaps in health benefits.
Grandchildren with Special Needs or Disabilities
Grandparents raising grandchildren with special needs like mental health conditions, developmental delays, or physical disabilities have some additional considerations when it comes to health coverage:
- Understand coverage of needed services – Carefully evaluate if the grandparent’s health plan covers the grandchild’s speech therapy, medications, durable medical equipment, and other required services.
- Look into public insurance options – Special needs children may qualify for Medicaid coverage of benefits not typically included in private health plans. Medicaid also has no pre-existing condition exclusions.
- Research advocacy groups – Organizations like Generations United and The Arc provide resources for grandparents caring for grandchildren with disabilities, including help accessing coverage.
- Maximize coordination of benefits – Make sure primary and secondary insurers are fully covering needs like medical supplies or counseling and coordinate claims processing.
- Plan for transition to adult healthcare – As special needs grandchildren become adults, work with providers to shift from pediatric to adult services and modify coverage.
- Consider legal arrangements – Guardianship or power of attorney for healthcare decisions may be necessary to manage care and insurance for disabled grandchildren as adults.
Getting optimal medical benefits through both public and private insurance takes additional planning and coordination for special needs grandchildren, but worthwhile to ensure their health.
Key Takeaways on Grandchild Health Insurance
Adding grandchildren to health insurance policies takes some research but can provide vital coverage when needed. Here are some of the main points for grandparents to consider:
- Grandchildren may qualify for coverage if living with grandparents full time, if grandparents have legal custody, or other specific situations.
- Health plans have eligibility requirements like age, residency, and income limits that apply to dependents.
- Enrolling grandchildren involves paperwork proving eligibility plus paying any increased premiums.
- Coordinating benefits with multiple insurers is crucial but can be complex.
- Special enrollment periods allow adding grandchildren upon certain qualifying events.
- Helping grandchildren transition to their own policies as adults ensures continued coverage.
- Special needs grandchildren likely need Medicaid benefits in addition to private insurance.
With proper planning and coordination, securing health insurance for grandchildren through a grandparent’s health plan can ensure access to coverage so they get the care they need.