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Who Counts as a Health Insurance Dependent?

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Who Counts as a Health Insurance Dependent?

Who Counts as a Health Insurance Dependent?

Just the Essentials...

  • A health insurance dependent is a person, aside from yourself, who is eligible for health insurance coverage under your plan.
  • Children and spouses are the most common type of dependent, though other types of dependent exist.
  • At Health Insurance Providers, we can help you compare plans in your area in order to help you find better coverage for you and your loved ones.

What is a dependent for health insurance?

A dependent for health insurance is any person (aside from the policyholder) eligible for health insurance coverage under a policyholder’s plan. Typically, dependents are spouses and biological, adopted, or stepchildren of the primary beneficiary. 

In some circumstances, a dependent may also be a grandchild, an adult child with a disability, a foster child, or someone of whom the policyholder is the legal guardian. A good rule of thumb for determining whether someone is eligible to be a dependent on your health insurance is if they can also be considered a dependent on your taxes.

The policyholder, or primary beneficiary, is the individual who initially enrolled in the plan. For example, an employee who receives health insurance through their job or the person who usually pays the premiums for the plan.

What should I know about covering my child as a dependent for health insurance?

If you have children, they are usually the first people who come to mind when considering who should be eligible for health insurance coverage as a dependent under your plan. But what are the requirements for adding children as dependents?

Generally, any child who fits the following criteria may be considered a dependent under your health insurance plan:

  • The child must be under 26 years of age (or have been diagnosed with certain disabilities)
  • The child must be your biological child, adopted child, stepchild, or foster child who is under your care. If your child has siblings or children of their own, these children may also be covered as dependents
  • The child must have lived in your household for at least six months
  • The child may not be their own primary source of support. If the child works, their income must be less than half of the cost of their support expenses
  • The child cannot be claimed as a dependent by more than one household

It may also be useful to know that there are certain circumstances that do not disqualify your child as a dependent, despite what you might expect. The following statuses are not required to claim a child as a health insurance dependent:

  • Where the child currently lives: Your child does not need to be living with you in order to be a dependent, provided they have lived with you for at least six months at some point in their life
  • Marital status: The child can still be considered a dependent even if they are married
  • School enrollment: The child does not have to be enrolled in school to be eligible as a dependent
  • Whether the child has employment-based coverage: Even if the child is eligible for employment-based health insurance, you may still claim them as a dependent provided they do not enroll in their own coverage
  • Tax status: The child does not have to be considered a tax dependent to be eligible for health insurance dependency.

What should I know about covering my spouse as a health insurance dependent?

You may freely add your spouse as a dependent on your health insurance. Upon getting married, you have a 60-day special enrollment period to either add your spouse to your plan, or to enroll in a new plan. 

Other than your spouse and children, you may be able to include other relatives, such as elderly parents, as health insurance dependents provided they meet the following conditions:

  • No one else has named them as a dependent
  • Their gross annual income is less than $3,000
  • You are responsible for more than half of their living expenses

Even certain non-relatives can be claimed as health insurance dependents provided they meet the above criteria and have also lived in your house for at least a year.

What else should I know about health insurance dependents?

It’s important to note that once you have named someone as a health insurance dependent, that person will generally have access to the exact same benefits that are afforded to you by your health insurance plan.

In addition, if you have been getting health insurance coverage through an employer and experience a major life event (like a change in job, a marriage or divorce, retirement, or if you become eligible for Medicare), your previously enrolled dependents are eligible for continuation of health insurance coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA). 

COBRA lets your dependents continue to be part of the same group health plan that they previously had through you. However, your previous employer will likely require you to pay the full cost of your plan premium out-of-pocket.

Ensuring that your loved ones’ health is well attended to and their medical expenses are covered is one of the most important things you can do for them. At Health Insurance Providers, we are committed to helping you understand everything there is to know about health insurance coverage.

Often, comparison shopping is the best way to ensure that your health insurance plan meets all the requirements you and your dependents have. If you’re ready to find the ideal health insurance plan for you and them, enter your zip code in our free search box to start comparing plans and prices today!

Key Resources:

  1. What is a Medical Policy Holder?
  2. Affordable Care Act – Healthcare.gov
  3. Who to include in your household – Healthcare.gov