Does Your Company Have To Offer Health Insurance to Your Dependents?
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Under the Affordable Care Act (ACA), it is generally illegal for employers who offer health insurance coverage to full-time employees to deny coverage to the dependent children of these employees. However, the company does not have to provide health insurance for the spouse. Here’s everything you need to know to protect your entire family with health insurance.
Health Insurance Coverage Employers Are Required To Offer Dependent Children
Here are the key points related to the legal requirements of children’s health insurance coverage according to the ACA:
- Coverage for Dependent Children: The ACA requires employer-sponsored health insurance plans to extend coverage to dependent children of employees up to the age of 26. This rule applies regardless of the child's marital status, financial dependence, residency or student status.
- No Preexisting Condition Exclusions: The ACA also prohibits health insurance plans, including those provided by employers, from imposing preexisting condition exclusions on children under the age of 19. This means that insurers cannot deny coverage or impose waiting periods for children with preexisting health conditions.
- Grandfathered Plans: Some older health insurance plans that existed before the ACA may have been "grandfathered" and are exempt from certain ACA requirements. However, even grandfathered plans must provide coverage to dependent children up to age 26.
- Employer's Discretion on Family Coverage: While employers are required to offer coverage to dependent children up to age 26, they often also offer coverage for spouses as part of their benefits package. The employer may choose to contribute to the cost of family coverage or require employees to pay the full premium for family coverage.
Other Options for Health Insurance To Cover Spouse
If your employer will not offer health insurance coverage to your spouse, there are several options, depending on your situation.
Spouse's Employer-Sponsored Health Insurance: If your spouse is employed, they can enroll in their employer's plan during their open enrollment period or following a qualifying life event, like losing health insurance coverage. You may even find that your spouse’s plan is more affordable for the entire family.
Individual Health Insurance Plans: Your spouse can buy an individual health insurance plan by comparing rates to see which plan is more affordable and offers the type of coverage they need. The great thing about comparing rates is that your spouse may be eligible for subsidies or tax credits, depending on your combined income. It may even be more affordable to pass up your employer-sponsored health insurance and buy a family plan on the market.
Medicaid: Medicaid provides health insurance coverage to eligible low-income individuals and families. Depending on your household income and state of residence, your spouse may qualify for Medicaid coverage. Medicaid eligibility criteria vary by state, so it's essential to check with your state's Medicaid program.
Catastrophic Coverage (Under 30 or Hardship Exemption): If you or your spouse are under 30 years old or qualify for a hardship exemption, you may be eligible for a catastrophic health insurance plan through the Health Insurance Marketplace. These plans typically have lower premiums but higher deductibles and are designed for individuals and families who want to protect against major medical expenses.