In some cases, you can get coverage from Medicare for children. This is mostly the case for those receiving Social Security Disability for at least 24 months.
Unlike private health insurance plans, Medicare coverage doesn’t offer family plans. However, some very specific situations may allow Medicare coverage for your children.
This is what you need to know.
Medicare for Children
Dependent children are eligible for Medicare in certain situations. This is especially the case when a child is severely ill.
Your child is entitled to Medicare if one of the following applies:
- Children with an end-stage renal disease requiring dialysis and currently receiving SSA benefits may qualify for Medicare
- If your child has ESRD that requires regular dialysis or needs a kidney transplant, Medicare eligibility is possible
- A child that has a disability resulting in entitlement from Social Security Disability Insurance (SSDI) payments
Medicare for Disabled Child
Your child must have received SSDI benefits for 24 months to qualify for Medicare benefits.
Children over the age of 20 must be disabled and receiving disability benefits for two years before applying for Medicare.
They qualify for Medicare due to disability if disabled prior to turning 22 years old.
Certain relationship requirements must be met by the child in order to qualify for Medicare:
- The child must be related to you by birth or legal adoption
- Exceptions are made if the child is your stepchild for a year or longer, they may also qualify
- You must have received Medicare credits through your employer in prior years
- Benefits will remain available for adult children that qualify if they
- Remain disabled
- Remain unmarried
Medicare Waiting Period for Children
Often there’s a two-year waiting period for Medicare coverage for children with disabilities. If your child was born with a disability, you’ll have to wait until the child’s second birthday to receive Medicare.
However, children with ESRD or Lou Gehrig’s disease have no waiting period for Medicare.
Your child may be eligible for Medicaid or CHIP insurance if your child doesn’t have a disease or chronic/severe condition.
Medicaid is an option for children who reach 133% of the federal poverty level; that’s not always the case though, most states cover children at higher income levels as well.
CHIP will cover children until the age of 19 if income is too high to qualify for the Medicaid program.
In some cases, your child may be disabled but is still capable of working. For cases like this, your child will have a trial work period of 9 months.
If your child continues to work after the trial work period ends, Medicare will continue for over 7 years. After that, your child will be considered a Medicare enrollee instead of a Medicare beneficiary.
This means your child will be required to start paying for continued Medicare coverage.
Medicare with Dependent Child
Health insurance is often received by workers through their employer, which includes coverage for their spouse and children as well.
The Department of Health and Human Services allows children to stay on parent’s health insurance until 26 years old.
If you’re 66 years old and retired with a 24-year-old child, your child might be covered under your employer’s plan.
Medicare doesn’t usually cover children. If you’re enrolled in Medicare, your child might be eligible for COBRA or Health Insurance Marketplace coverage.
Medicare Beneficiaries Can Enroll in Medicare Advantage Plans
If your child qualifies for Medicare due to ESRD, you need to enroll them; enrollment isn’t automatic.
Depending on where you live will determine if this program is available to your child with ESRD. Medicare Advantage SNPs have certain conditions that need to be met to qualify for eligibility.
Different SNPs have different eligibility criteria; one or more of these will need to be met:
- Must have a specific chronic or disease/condition that leaves them disabled (such as ESRD)
- Institutionalized in long-term care or another health facility
- Eligible for Medicaid
If your child qualifies for Medicare due to a disability, they can join a Medicare Advantage plan.
Remember, Medicare Advantage Special Needs Plans (SNP) are not available in all areas. If SNPs are available, you’ll still pay your Part B premium.
Part D Coverage for a Child
Any child who is eligible for Medicare may join a Medicare Prescription Drug Plan.
These plans work paired with Original Medicare or as part of a Medicare Advantage plan.
SNPs include coverage for medical treatments and medications necessary to manage a certain condition, like ESRD. If your child qualifies, no additional prescription drug plan is necessary.
Medicare Enrollment for Children
There are many circumstances that will determine if your child is eligible to qualify for Medicare coverage.
Medicare for children can cover costs and help care for a child. If you believe your child might qualify, start the application process now.
If you need more questions answered, contact your local Medicare agent.