Before a young adult with a disability reaches age 26, you may want to take action to ensure that health insurance coverage continues. Please note that the following options are not available to everyone. If you do qualify, extending insurance is not automatic and there are steps you need to take.
Continuing Coverage Under Your Current Plan
A young adult with a disability may be able to continue the same health insurance coverage they have under their parent’s plan if:
- the young adult can’t sustain employment due to an intellectual, developmental, or physical disability; and
the young adult is dependent on the parent for support.1
Proof that the young adult meets these requirements must be submitted to the parent’s insurer no later than 31 days after the individual turns 26. The insurer may require the same proof to be submitted on an annual basis.
Note that an employer that operates its own insurance program, such as the State of Texas, is exempt and does not have to extend coverage. When an employer is self-insured, you need to ask if the employer extends insurance. If not, there are other options to consider before the young adult reaches age 26.
COBRA. If you can’t continue coverage with your existing insurance program, you may want to consider obtaining coverage with COBRA (an insurance plan offered under the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA).
COBRA is a federal law that requires certain employer-sponsored health insurance programs to offer a temporary extension of coverage at a cost. You should discuss the details about the length and cost of coverage with your employer. After the young adult turns 26, the employer must allow the parent at least 60 days to apply for COBRA.
ACA. If COBRA is too expensive, you may want to contact the marketplace of plans offered under the Affordable Care Act (ACA). Staff there may be able to help you find other plans that meet your needs and are at a lower cost. To access the marketplace, visit the HealthCare.gov website.
Help with Insurance Premiums
HIPP. The Health Insurance Premium Payment (HIPP) program may help families save money on insurance premiums. HIPP can help some families with out-of-pocket costs for insurance. HIPP covers the premium or part of the premium for (A) employer-sponsored health insurance and (B) COBRA. Families with at least one person who receives Medicaid may be eligible to enroll in the program.
1. Texas Insurance Code, Title 8, Subtitle A, §1201.059, statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm