Is there any situation in which a health insurance can deny coverage to a college student based on the fact that a)the parent’s insurance does not come from an employer and b)the dependent adult child has turned 21 and is now considered “an adult”?
This situation has been posed by a college student on my nursing forum and everyone is maintaining that the insurance company is in violation of the ACA but the student insists that on multiple phone calls with the insurance company, they have been told that they are not required to carry her until age 26 because this isn’t employer provided health insurance.
There are circumstances in which this can be the case. If the individual policy pre-dates the ACA cutoff date (back in 2010) then it is not possible to add family members or make any other changes to the policy. We still have this type of policy. The advantage is that it costs less than half as much as an equivalent ACA policy (because back in the day you had to have no pre-existing conditions when signing up).
If the individual policy pre-dates the ACA, as Twoin18 says, then they wouldn’t have to add the child. If the individual policy is a “short-term” plan, then it doesn’t have to be ACA compliant and they wouldn’t have to add the child.
I think it might make sense for the student to talk to an insurance broker or agent rather than posting questions in online forums. My guess is that there is some detail that is not understood and therefore not disclosed, tied to the existing plan.
Our pre-ACA policy (Blue Shield) allows the kids to stay on our plan until 26. Then they would have to buy a new (ACA compliant) policy. But other companies may want to push people off these plans sooner (after all, then they can charge more). Quite a few insurers just terminated their plans in 2014 and forced everyone to buy a new ACA plan.
The rules they have to follow are mixed, certain features of ACA (including free annual checkups and no lifetime limit) had to be added when that came into force. Some things are better than the ACA (eg they are not allowed to restrict the list of providers that are in-network), and the price is great (currently $1100 per month for a family plan with $3500 deductible, $6000 out of pocket max). So we will keep it for as long as possible.
Saying the insurance is “government issued” is no clarification. What kind of “government issued” insurance doesn’t covered adult children until age 26?
For Medicaid, dependent adult children are still in the parents’ household. But maybe this is a non-expansion state? Non-expansion states have weird and restrictive rules.
Very often Medicaid recipients are actually placed on a private insurance program – that is, Medicaid pays the premiums for the private insurance, and the recipient has a private insurance card for the carrier the government has contracted with. Here’s an article that sheds light on that: https://www.modernhealthcare.com/insurance/health-insurers-migrating-medicare-Medicaid
She didn’t seem that interested in pursuing it the insurance angle. She is accepting what the insurance company is telling her. She needs vaccinations for nursing school and people are giving her advice re: county health department, etc.
“Government issued” could be Medicare, Medicaid, military service health care, veterans benefits, civilian government employee benefits, or prisoner health care.