How Long Can Adult Children Stay on My Insurance Plan?

When it comes to receiving mental health services, health insurance coverage for drug rehab can get tricky.

You may have questions about how long your children can stay on your insurance plan and the pros and cons of keeping your young adult on your plan. For example, does your insurance carrier consider drug addiction a pre-existing condition?

While there are straightforward answers to these questions, it is important to be aware of the external factors that may contribute to whether or not your child should stay on your plan.

Before your child is admitted into a treatment facility, it is essential to understand the expected costs and your insurance coverage. 

Children and young adults qualify for insurance coverage on your health care plan until they turn 26 years old, given that your insurance plan covers dependents. The Patient Protection and Affordable Care Act (ACA) of 2010 enforced that all health insurance carriers offer coverage to adults and their dependents until the dependents turn 26.

Once a child turns 26 years old, they will need to get their own health care coverage. If your young adult does not take action around the time they reach their 26th birthday, they may end up without health care coverage. 

Your child or young adult can remain on your insurance plan even if:

• They get married

• They become a parent

• They no longer live with you

• They attend school

• They are not financially dependent on you

• They are eligible to enroll in their own employment plan

When your child gets their own health care coverage, they can first consider enrolling in their own job-based plan. If their employer offers health insurance that your child has not enrolled in, they can remain on your insurance plan until age 26. At this point, they age out of eligibility for your coverage and can qualify for enrollment in their employer's insurance plan even if it is outside the yearly enrollment period.

Your child can also enroll in their own Marketplace insurance plan, depending on if you are enrolled in your insurance plan through the Health Insurance Marketplace or your job. 

There are notable positives and negatives associated with your child staying on your healthcare plan until they turn 26. One of the primary advantages is that it is a financially valuable option for both you and your child. 

If your child is not the only dependent on your plan, it most likely doesn't cost any additional fees to keep them covered. If the number of dependents you claim does not change the cost of your insurance plan, it may be beneficial for your child to stay on your plan instead of paying their own health insurance premium. 

Another benefit of your child staying on your insurance plan is that they will likely find greater access to in-network care. In-network primary care physicians and hospitals may be more convenient for your child to find if they stay local to you.

There are also a few circumstances that may encourage your child to leave your insurance plan, the first being if they are about to turn 26. Another reason is if they move away from you, especially out of state or out of the region. Your child may be forced to pay out-of-network fees because they do not have access to in-network physicians or practices. In this case, it may be better for your child to get their own insurance. 

A final circumstance that may lead your child to get their own insurance plan is if they have children of their own before they turn 26 years old. While your child is covered under your plan, their partner or a new baby cannot be covered under your plan. If your child is working on gaining independence and starting a family of their own, they must consider their insurance options to make the best decision for themselves and their family. 

The cost of treatment and recovery varies greatly between treatment facilities. It can be challenging to understand how much of your child's treatment can be covered by insurance, especially because the cost of treatment, in general, is so variable. It is important to consider your child's unique mental health or substance use treatment needs to get a better idea of how much treatment will cost and how much can be covered by insurance. 

Since substance use disorders (SUDs) and mental health disorders are both considered diseases, both are eligible for assistance with insurance coverage. You should contact your insurance provider for a better estimate of out-of-pocket treatment costs vs. treatment costs covered by insurance after discussing your budget and needs with your child's potential treatment facility. In many cases, health insurance can cover up to 100% of treatment costs. 

If you have questions about your insurance coverage or other concerns about mental health treatment coverage, it is important to speak with your insurance provider as well as your potential treatment facility. The Edge Treatment Center is an addiction treatment facility that will act as a companion to both you and your adult child.

We are here to support and educate you on everything you need to know while your loved one goes through our treatment program. We are devoted to helping our clients as well as their families throughout the entire experience of recovery. To learn more about insurance qualifications, or for more about our facility, contact The Edge Treatment Center today.

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If you or a loved one is struggling with addiction, there is hope. Our team can guide you on your journey to recovery. Call us today.

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