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 kids. This is what you need to know.
Can a Child Qualify for Medicare?
Dependent children are eligible for Medicare in certain situations. This is especially the case when a child is severely ill.
- He/she has 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
Does Medicare Cover Disabled Dependents?
Your child must receive 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 kids 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 kids 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 nine months.
If your child continues to work after the trial work period ends, Medicare will continue for over seven 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.
Are My Dependents Covered Under Medicare?
No, a dependent child or adult must qualify for Medicare separately to be covered. This is the same for spouses.
Are Children Eligible for Medicare Advantage?
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 kid qualifies for Medicare due to a disability, they can join a Medicare Advantage plan. Remember, Medicare Advantage Special Needs Plans are not available in all areas. If SNPs are available, you’ll still pay your Part B premium.
Can My Child Enroll in Medicare Part D Coverage?
How to Apply for Medicare for My Child
There are many circumstances that will determine if your kid 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. For more information, contact CHIP or your local Social Security Office. If you're looking for information on Medicare Supplements, Medicare Advantage, or Part D, fill out our compare rates form to see what's available in your area now.