You can typically add your spouse and children to a health insurance plan, but it’s ultimately up to your employer or health plan.
Health insurance is a valuable commodity and getting added to a family member’s health plan can be vital to both your health and wallet.
However, who you can add to your health insurance is limited. Common questions people have are:
- Can I add my parents to my health insurance?
- How long can you stay on your parents’ health insurance?
Let’s look at those questions and other common questions about who you can add to your health plan.
- You can generally add a spouse and children until they turn 26 onto your health insurance plan.
- Members can’t usually add other family members, such as parents and grandchildren.
- A divorce generally makes the ex-spouse eligible to stay on health insurance coverage, but not on their ex-spouse’s health plan. Instead, they qualify to get COBRA coverage for up to 36 months after a divorce.
- When young adults turn 26 and drop off your health insurance, they’re eligible for COBRA coverage or may get a different health plan.
When you can and can’t add someone to your health plan
Adding a spouse or dependent to your health plan is a way to get them health coverage. However, not all dependents may be eligible to enroll on your health insurance.
Here are common questions about adding someone to your health insurance.
Are young adults allowed to stay on their parent’s health plan?
The Affordable Care Act allows parents to keep their children on a health plan until the age of 26 — as long as their employer allows for children to get health coverage.
However, if that young adult has their own child, the new child will likely not get covered by the grandparent’s plan. The young adult could stay on their parent’s plan, but the grandchild would need a different health plan.
If I get married, can I add my spouse’s child to my health plan? Is there a time frame in which enrollment must take place?
A stepchild is an eligible to stay on a parent’s plan up to the age of 26. If your coverage is through an employer group plan that provides benefits to children, you’re given at least 30 days to enroll the new dependent.
An eligible child can be a biological child, adopted child, stepchild or foster child, according to the Affordable Care Act. The child doesn’t have to live with you, be a student or still be in school to be covered by your health coverage.
The federal rule states you have “at least 30 days,” but an employer could give you a longer period, says Rich Gisonny, senior consultant at Towers Watson in White Plains, New York.
This gives employees a reasonable period to make a decision and complete the enrollment.
However, employer-based coverage doesn’t have to cover children. Gisonny says there’s no employer mandate that it must cover employee families.
If I am an unmarried man and get a woman pregnant, can I put the child on my employer’s health plan?
There can’t be restrictions on eligibility if a plan covers children.
“The employer can’t require that the child reside with the employee or that the child is financially dependent on the employee,” says Gisonny.
That said, the plan may require a birth certificate as proof or verification of the dependent relationship. Some health plans are more rigorous in requiring dependent or biological verification than others.
“If a plan so chooses, it has the discretion or the right to require proof that a dependent relationship actually exists,” says Gisonny.
Can I add my parents to my health insurance plan?
Health plans typically limit the definition of dependents to a spouse and children. Even if a parent is a tax dependent and lives with you, you typically won’t be able to add the person to your health coverage. The same is true is the parent isn’t yet eligible for Medicare.
Gisonny says that there’s no federal mandate that an employer health plan must cover an employee’s parents. Some plans may, but they’re in the minority.
Can my boyfriend or girlfriend’s child be added to my health plan? Does it make a difference if we’re living together?
A health plan may allow you to add a boyfriend or girlfriend’s child to your health plan but it’s unlikely.
Some individual health insurance plans allow unmarried couples to be on the same plan, along with any legal dependents, if they’re living together or there’s a court order for the one partner to provide insurance for their child, says Colleen King, CEO of Colleen King Insurance Agency in Los Angeles.
“Group health insurance also may allow the same, but it may vary by carrier and by employer,” says King.
If an adult child is on a parent’s health plan and has a baby, can the baby (i.e. the grandchild) be added to a health plan?
A handful of states mandate that grandchildren must be eligible dependents, according to the Council for Affordable Health Insurance.
But you’re more likely to find that the coverage isn’t extended to the baby. Instead, the child’s parent will have to get a plan for the child. Some options include a health insurance marketplace plan, Medicaid or Children’s Health Insurance Program (CHIP) plan.
Medicaid and CHIP are federal/state programs that cover low-income people, including children. Check with your state about eligibility.
If my spouse and I have filed for a legal separation, do I have a choice whether or not to keep them on my health plan?
Legal separation and divorce are both COBRA qualifying events for continuing group health coverage. Generally, a divorcing spouse doesn’t remain on the plan and is removed by the spouse who carries the plan through work once the divorce is final.
Can I drop my spouse off my health insurance if we are separated?
You likely will have to wait to remove your spouse from health insurance until the divorce is final. Until then, the spouse is eligible to stay on your health plan.
That side, your spouse can decide to get removed from your health coverage and get their own health plan. Losing coverage through a separation or divorce starts a special enrollment period for the spouse.
During special enrollment, you can get individual health insurance directly from a health insurer or the health insurance marketplace. Or the person may get a health plan from another job, if eligible.
How do you remove dependents from health insurance?
You can remove family members from your health insurance during any time of the year. You don’t have to wait until open enrollment to make that change.
Removing a family member may change your type of coverage, such as moving from family coverage to single coverage. In that case, you may actually save money by removing a family member from your health coverage.
Divorces are painful, and there are often health insurance implications. Let’s walk through the process of removing a former spouse from your health plans.
Give notice of divorce within 30 days
If you change your marital status, you’re required to give your health plan notice in a “timely manner,” Matthew Tassey, past chairman of the Life and Health Insurance Foundation for Education (LIFE), says. Timely is usually within 30 days.
Once your divorce is final, the ex-spouse’s coverage is likely terminated immediately.
“However, some plans will let you stay on until the end of the month following the date of the divorce,” Tassey notes.
Eligible for COBRA
Divorce qualifies you for COBRA, which is a temporary continuation of your health care coverage under the same plan and provider network, Tassey says.
COBRA provides temporary health coverage for individuals who lose their health insurance for specific reasons — but that comes at higher costs. Divorce is one of the qualifying reasons. You can stay on the health plan through COBRA for up to 36 months if you lose health coverage as the result of a divorce.
You must be given notice of your eligibility for COBRA within 14 days of your divorce. You have up to 60 days to decide whether you want COBRA coverage.
Going on COBRA keeps your ex-spouse’s group health plan coverage for you. However, the premiums will likely skyrocket since you won’t get any help with premiums from the employer. Instead, you pay the full amount for premiums, plus up to a 2% administrative fee.
If you can get a health plan elsewhere, it will likely be cheaper than getting a COBRA plan.
State laws involving divorce differ
The rules involving health insurance and divorce are somewhat different in a few other states, says Susan Sonkin, compliance specialist for EBS Capstone insurance brokers in Newton, Massachusetts.
“In Massachusetts, we have an insurance rule that says fully insured plans must continue to offer the former spouse coverage as if the divorce had not taken place,” she explains.
The former spouse may remain eligible for coverage on the employed spouse’s plan for no additional premium until either spouse remarries or the employed spouse loses their eligibility, Sonkin says. The employed spouse loses eligibility for the plan if they change employers or die.
Also, the former spouse may not be eligible for coverage if the couple’s divorce decree states the spouse doesn’t have to provide their ex with health insurance coverage.
Repaying health insurance benefits
There are good reasons to notify your employer of a divorce once it’s final. If you don’t, you could face repercussions.
First, you could be liable for any benefits the health plan pays for your ex.
“If you don’t tell them and there is a claim, the insurance company can try and recover the cost of the claim from you,” Tassey says.
Legally, you would have to reimburse your health plan.
“Your ex-spouse will become liable for all medical expenses from the date of the divorce unless he or she opts for continued coverage through COBRA,” Jurney says.
Second, there could be tax implications. An ex’s coverage can’t be paid for with pre-tax dollars.
“The value of the health coverage provided to the ex-spouse is taxable to the employee, to the extent it is not paid for with post-tax dollars,” says Sonkin.
Some health benefits may remain after a divorce
You and your children may still have access to some of your ex-spouse’s health benefits after a divorce.
Tassey says if you and your ex had been contributing to a health savings account, you still may be able to use your share of the money in that account to pay health care premiums or for qualified health care expenses.
Also, even though your ex-spouse is no longer eligible for your health plan, your children are still eligible.