In most cases, health insurance plans cover the policyholder and their immediate family members. However, some individuals may be able to add non-family members to their plan if they meet some very specific criteria. If you're curious about adding non-family members to your health plan, you need to understand the potential implications, limitations, and requirements for dependent coverage.
In this article, we'll explore the considerations involved in extending coverage to non-family members and provide guidance on making informed decisions about your health insurance coverage.
Takeaways from this blog post:
- Dependents for health insurance plans typically include spouses, children, stepchildren, adopted children, and foster children.
- In some situations, you can add non-family members to a health insurance plan if they're a domestic partner, in a civil union, or financially dependent on the policyholder.
- If you can’t add non-family members to your health insurance plan, they may be eligible for individual health insurance plans on the Health Insurance Marketplace or government-sponsored programs like Medicaid, CHIP, or Medicare.
In healthcare terminology, a dependent is someone you can add to a health insurance plan. This gives them access to similar benefits as the policyholder. A dependent is usually an individual for whom you can claim a personal exemption tax deduction from the IRS. However, this definition is broader under the Affordable Care Act (ACA).
According to HealthCare.gov1, eligible dependents typically include:
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Relationship to policyholder |
Notes |
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Spouse |
You can include your spouse, including same-sex spouses, if you’re legally married. |
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Dependent children |
You can include any children you claim as a tax dependent. This includes biological children, stepchildren, adopted children, and foster children. |
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Non-dependent children |
Depending on the type of plan, dependent healthcare coverage typically extends to adult children. You can keep your biological, step, adopted, or foster children on your health insurance, even if they aren’t dependent on you, until they turn 26. |
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Dependent siblings |
You can include siblings on your plan if you can claim them as tax dependents with the IRS. |
After a divorce2, an ex-spouse is usually not eligible for dependent coverage on the other's health insurance plan. The ex-spouse may qualify for COBRA if they received employer-sponsored health insurance coverage before the divorce.
While adult children can typically remain on a health policy until age 26, there are certain exceptions for college students and disabled children.
Each health insurance plan has specific criteria for who qualifies as a dependent, so it's important to check with your insurance provider to see who's eligible for coverage.
Most Americans are covered by traditional, employer-sponsored group health insurance. But an increasing number of individuals are offered health reimbursement arrangements (HRAs) as their health benefit.
With an HRA, employers can reimburse their employees for more than 200 eligible expenses, including their individual health insurance premiums.
If you have an HRA through your employer, your spouse, children, and other tax dependents can also qualify for tax-free reimbursements. While your family members won't receive their own monthly allowance amount, you can submit their personal expenses for reimbursement through your allowance.
However, there are some additional rules for HRAs. For both qualified small employer HRAs (QSEHRAs) and individual coverage HRAs (ICHRAs), the spouse or dependent must have minimum essential coverage (MEC) to receive tax-free reimbursements through the employees’ HRA.
Additionally, if an employee wants to submit a dependent’s expense for reimbursement with an ICHRA, the dependent must also have an individual health insurance policy. If the employee has a qualifying family plan with MEC from the marketplace that covers their spouse and/or dependents, this is enough to satisfy the requirement.
Generally, you can't add your parents to your healthcare plan since they only cover dependent children and spouses. However, you may be able to add your parents as dependents if you have legal guardianship3 of them or if they have special needs. You should only add your parents if you plan to claim them as tax dependents.
However, the rules differ in California, where the Parent Healthcare Act4 allows adult children to add their parents or stepparents to their individual health insurance coverage. This law applies when the plan allows for dependent coverage and the applicant lives within the plan’s service area.
The short answer is it depends. Typically, medical plans will only allow you to add dependent family members, such as your spouse or children, to your plan. However, there are a few exceptions to this rule.
One option is domestic partnership coverage. Some health insurance plans allow you to add a domestic partner to your plan as long as you can provide proof of your committed relationship. This may include living together for a certain period of time or having a joint financial account. You may also be able to add an unmarried domestic partner if you have a child together.
Some states also acknowledge civil unions as a legal partnership. This allows partners to be dependents on health insurance policies. The same applies to states that recognize common-law spouses.
Additionally, some plans allow you to include people who are financially dependent on you, such as a sibling or another relative who lives with you and relies on you for support.
Unless you meet one of these exceptions, you can't add a dependent who isn’t related to you. Adding a friend to a family health insurance plan is typically only allowed if they meet the IRS tax criteria that considers them a dependent.
You can add a dependent to your policy during the annual open enrollment period. If you experience a qualifying life event, you're eligible for a special enrollment period (SEP).
During the SEP, you can make dependent enrollment changes if your qualifying life event results in a change in family. If you get married, you have 60 days to enroll in a new plan or add your spouse as a dependent. The same goes for having a newborn child, adopting a child, or placing a child in foster care.
If you're unable to add a non-family member to your health insurance plan, other options are available. They can explore individual health insurance plans on the Health Insurance Marketplace.
They may also qualify for government-sponsored programs, such as:
Adding dependents to your medical plan can give them access to important medical services and help ensure that your loved ones are protected in case of any health issues.
Before making any decisions about adding non-family members to your health insurance policy, you should contact your insurance provider to see what options are available to you. They can provide you with more information about your specific plan and help you navigate the process of adding non-family members to your health coverage.