This week, the CMS Assister Newsletter addressed an important issue concerning the eligibility of an adult dependent with a disability. The question and answer as they appeared in the assister newsletter can be found below.

Q: If an adult dependent is over the age of 26 but is wholly dependent on a parent due to a disability, can the parent still carry them on a Marketplace plan?

A: The Affordable Care Act requires plans and issuers that offer dependent coverage to allow young adults to enroll in or remain enrolled in their parent’s health coverage up to age 26.  However, some states have enacted higher age requirements, and some issuers allow children age 26 and over to be on a parent’s plan.  Health and dental plans submit their rules to the Marketplace about the maximum age for an adult child, so when applicants for Marketplace coverage report the ages of their children, they will see if any plans in the area allow the family to enroll on one plan together, or whether the older adult children need to enroll in separate policies.  However, in many states and with many issuers, maximum dependent ages don’t apply to disabled adult dependents.  Applicants with a disabled child dependent should identify their family member as both a “child” and a “ward” on the Marketplace application so that Healthcare.gov can apply the appropriate rules used by health and dental plans. Consumers may also check with their state Department of Insurance to find out if their state has an age requirement beyond 26, and then should check with an issuer to determine if the issuer has more permissible rules for adult children. Remember, even if a plan won’t allow an adult dependent to share a plan with other family members because they are too old, the adult child can still enroll in the same plan on a separate policy.