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Medicare for Dependents

Summary: If you have children or dependents, you may wonder what happens when you sign up for Medicare. Though Medicare is health coverage for individuals, there are instances where your child or other dependents may qualify for Medicare coverage based on your work record. In this article, we’ll discuss how children can qualify for Medicare. Estimated Read Time: 7 min

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Table of Contents:

  1. Are My Dependents Covered Under Medicare?
  2. Can a Child Qualify for Medicare?
  3. Medicare for Disabled Adult Children (DAC)
  4. Are Children Eligible for Medicare Advantage?
  5. Can My Child Enroll in Medicare Part D Coverage?
  6. If My Child Isn’t Eligible for Medicare, What Other Options Do I Have?
  7. How to Apply for Medicare for My Child

One of the most significant differences between Medicare and other health insurance is that there’s no family plan for Medicare. Medicare only provides coverage for individuals, which means your Medicare coverage cannot cover your dependents. However, there are some specific situations in which your child may qualify for Medicare coverage themselves.

Below, we’ll take a look at how Medicare eligibility works for children under 18 and how adult children with disabilities can qualify for Medicare through their parents’ earning records.

Are My Dependents Covered Under Medicare?

You cannot add dependents, such as your children or spouse, to your Medicare coverage. For your dependents to receive Medicare, they must be individually eligible. Even if your spouse is also eligible for Medicare, you both must sign up for coverage individually. This applies to Original Medicare, as well as any supplemental coverage options such as a Medigap or Part D plan.

If you have dependents who are covered under your group health plan and you are switching to Medicare, your dependents will need to find other healthcare coverage. If you are qualifying for Medicare due to a disability and your household has limited income, your dependents may be able to qualify for health coverage through Medicaid or CHIP.

Can a Child Qualify for Medicare?

Though Medicare is generally a program for people over 65, dependent children are eligible for Medicare in certain situations. If your child is diagnosed with End-Stage Renal Disease or has ALS, they may qualify for Medicare coverage. Additionally, adult children over the age of 18 can qualify for Medicare coverage if they have a disability.

If your child has End-Stage Renal Disease

Your child can qualify for Medicare at any age if they are diagnosed with End-Stage Renal Disease (ESRD) if the below requirements are met.

One of these requirements must apply to you (the parent) One of these requirements must apply to your child
You or your spouse have earned at least 6 credits within the last 3 years by working and paying Social Security taxes. Your child needs regular dialysis because their kidneys no longer work.
You or your spouse are getting, or are eligible for, Social Security or Railroad Retirement Board benefits. Your child has had a kidney transplant.

Children who receive Medicare coverage due to ESRD and do not qualify for Medicare for another reason will lose their coverage either 12 months after the last month of dialysis treatment, or 36 months after the month of a kidney transplant.

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If your child is under the age of 18 and does not have ESRD, they will not be able to qualify for Medicare.

If your child has Amyotrophic Lateral Sclerosis (ALS)

You may have read that individuals under age 65 are eligible for Medicare if they have ALS. This is true, however, unlike ESRD, children cannot qualify for Medicare due to ALS until they turn 18. This is because they must first be eligible for SSDI, which is only for people ages 18 and older.

If your child has a disability and you have limited income, your child may be eligible for Supplemental Security Income (SSI) payments. Once they turn 18, they may be able to qualify for Social Security Disability Insurance (SSDI) benefits, which can allow them to qualify for Medicare down the road.

My Child Gets Auxiliary Benefits from My SSDI – Can They Get Medicare?

If you are receiving Social Security Disability Insurance (SSDI) benefits, your children may qualify to receive auxiliary benefits. These benefits are additional monthly benefits that are paid to your dependents or immediate family members based on your SSDI benefits. If your child is receiving auxiliary benefits, that does not count as “receiving SSDI” and will not qualify them for Medicare, regardless of how long they receive those benefits.

Medicare for Disabled Adult Children (DAC)

Disabled Adult Children (DAC) are individuals who are 18 years of age or older and have a qualifying disability that began before age 22. These individuals can qualify for SSDI benefits based on a parent’s Social Security earning records. (This means that your child doesn’t need to have worked to get these benefits).

To qualify for this “child’s” benefit, an individual must have a parent who:

  • Is receiving Social Security retirement or disability benefits
  • Has died and had worked enough to be eligible for Social Security benefits

A Disabled Adult Child can be a biological child, adopted child, stepchild, grandchild, or step-grandchild.

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These individuals must still meet Social Security’s definition of disability for adults to qualify for benefits. If they qualify for SSDI DAC benefits, their benefits will continue for as long as they have a disability. Once they receive SSDI benefits for 24 months, they will qualify for Medicare coverage. (Unless they have ALS, in which case, they will qualify for Medicare immediately).

It is important to note that if your adult child is receiving DAC benefits, those benefits will most likely end if they get married. There are exceptions. Contact the Social Security Administration at 1-800-772-1213 if you have specific questions about DAC benefits or would like to apply.

What Happens if My Disabled Adult Child is Employed?

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. During this trial period, your child will receive full Social Security benefits regardless of how much they earn, as long as they report their work and continue to have a disability.

If your child continues to work after the trial work period ends, their Medicare coverage will continue for 93 months (over 7 years). After that, your child will be considered a Medicare enrollee instead of a Medicare beneficiary and may need to buy Medicare Part A by paying a monthly premium.

Are Children Eligible for Medicare Advantage?

If your child is enrolled in Medicare Part A and Medicare Part B, they are eligible for a Medicare Advantage plan. If your child qualifies for Medicare due to ESRD or a disability, they may be eligible for a Medicare Advantage Special Needs Plan (SNP). These plans are only available to Medicare beneficiaries who meet specific criteria and are not available in all areas.

If your child is receiving Medicare coverage due to ESRD, they may need to enroll in drug coverage for immunosuppressive and oral-only drugs that may not be covered by Medicare Part B. In this case, your child can enroll in a Medicare Advantage plan that includes drug coverage (all SNPs include drug coverage) or enroll in a standalone Medicare Part D Prescription Drug plan.

Can My Child Enroll in Medicare Part D Coverage?

Any child who is enrolled in Medicare may join a Medicare Part D prescription drug plan. Regardless of how your child qualifies for Medicare coverage, it is important to consider getting drug coverage. For kids who get Medicare due to ESRD, a Part D plan can help pay for immunosuppressive and oral-only drugs. If your adult child qualifies for Medicare due to a disability, having drug coverage can significantly decrease out-of-pocket costs of prescriptions.

If your child has limited income, they may qualify for the Extra Help program, which would help them with their Medicare Part D costs.

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If My Child Isn’t Eligible for Medicare, What Other Options Do I Have?

If your child doesn’t meet the strict requirements set for children to be eligible for Medicare, there are other options for receiving healthcare for your child.

We mentioned it briefly above, but if your household has limited income and your child has a disability, they may qualify for Supplemental Security Income benefits. These benefits are monthly payments for children who are under age 18 who have a medical condition that meets Social Security’s definition of a disability. You can learn more about SSI benefits and apply by visiting your local Social Security Administration office or calling Social Security at 1-800-772-1213.

If your child doesn’t have a disability or chronic/severe condition, your child may be eligible for Medicaid or CHIP insurance.

Medicaid is an option for low-income children and families who meet certain income and resource requirements. These requirements vary by state. Even if you don’t think you will qualify, you should fill out an application anyway, as many state systems will check to see if you qualify for any other programs, such as CHIP or other assistance programs.

The Children’s Health Insurance Program (CHIP) may be an option if your household income is too high to qualify for Medicaid. This program provides health coverage to eligible children whose families cannot afford private insurance, but have incomes that are too high to qualify for Medicaid.

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.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Children & End-Stage Renal Disease (ESRD), Medicare.gov. Accessed March 2024.
    https://www.medicare.gov/basics/children-and-end-stage-renal-disease
  2. Original Medicare (Part A and B) Eligibility and Enrollment, Centers for Medicare & Medicaid Services. Accessed March 2024.
    https://www.cms.gov/medicare/enrollment-renewal/health-plans/original-part-a-b
  3. Benefits For Children With Disabilities, Social Security Administration. Accessed March 2024.
    https://www.ssa.gov/pubs/EN-05-10026.pdf
Jagger Esch

Jagger Esch

Medicare Educator
Jagger Esch is the Medicare Educator for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

10 thoughts on "Medicare for Dependents"

  1. 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!

    1. 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.

    1. 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.

  2. 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.

    1. 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.

  3. 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.

    1. 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!

  4. 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.

    1. 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!

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