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.
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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.
The Children’s Health Insurance Program was created to provide benefits to eligible children; through both Medicaid and other CHIP programs.
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.
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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.
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Hello, I am on SSDI and have had Medicare since November of 2020. We have a son with the same medical condition that has disabled me and he is also autistic, homebound, etc. However, my husband makes too much for us to qualify for medicaid, and the waiver list for our state is 7 years. Is there a way to have MY medicare as a secondary insurance for my son to pay the regular $250 ER copays and deductibles? We have insurance through my husband’s job but all of our extra money goes to medical bills, supplies, equipment, etc.
Thank you for your time!
Clare, unfortunately, your Medicare will only cover your medical services as it is an individual plan. So, your son is not covered under the plan.
If you are on ssdi and Medicare can you get plan g for your kids. They are about to loose insurance
Kara, unfortunately Medigap Plan G is only for Medicare beneficiaries. I recommend looking into Healthcare.gov marketplace plans for your children. If they lose coverage, they qualify for a Special Enrollment Period for marketplace plans.
My wife gets SSDI, my adult son with Down’s syndrome gets SSI. He was originally given Medicare under my wife’s Medicare number while he was a minor. How long does that last, and does my wife’s premium cover him or does he have his own premium after 18 years old. He still lives with us, and is dependent on care we provide.
Hi Terry! Generally, when you turn individuals turn 18 they go on their own Medicare plan. However, I would contact Social Security directly to verify regarding your specific situation. There are many different factors that come into play here.
Hi Lindsay, I have an injury and plan on applying for Social Security Disability. It is my understanding that I will then be eligible for either Medicare or Medicaid. My question is whether my 6 year child will get health insurance coverage too? Thanks.
Hi Jay! You will be eligible for Medicare after you’ve been collecting Social Security Disability for 24 months. If you’re considered lower income, you could be dual-eligible for both Medicare & Medicaid. Regarding your child, Medicare is only for individuals 65 and over or those disabled. It’s not for children. However, Medicaid is for low-income families with children. I would contact your local Medicaid office to get started. I hope this helps!
Hello!
My son has Type 1 diabetes and a couple of other medical diagnosis. Is there anyone I can talk to that can help advise me on how to apply for medicare for him. The costs of all of his diabetes supplies / medication on top of his other medication is so incredibly high and we really need assistance – I just don’t know where to start. Thank you.
Hi Shawna! So sorry that you’re going through this with your son. Has he been on disability for at least 24 months? If not, he is not eligible for Medicare. You may be thinking of Medicaid, which is different than Medicare. I good starting point would be to contact your local Medicaid office. They will be able to assist you in getting your son coverage for his medical needs. You can select what state you live in and you will see a point of contact. If he is eligible for Medicare, you can learn about low-income subsidies that he may be eligible for. I wish you the best of luck!