Can You Add a Dependent to Your Health Insurance Plan?
Yes, you can generally add a dependent to your current health insurance plan, which includes your children and spouse. In fact, many private and employer-sponsored health insurance plans offer coverage for dependents. This allows you to purchase benefits for your children, spouse, and other eligible individuals.
Adding dependents to health insurance plans provides financial protection if they have a serious illness or accident requiring expensive medical treatment. Even if you and your dependents are relatively healthy, it’s important to remember that unexpected medical emergencies happen every day. An emergency room visit can cost more than $1,500, and that does not include the cost of any necessary follow-up treatments. While there is an additional cost to cover additional people, the benefits may be well worth it.
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Health Insurance Mandates for Dependents
Health insurance is no longer federally mandatory for yourself and your dependents, though some states still have their own health coverage requirements for residents. The original Affordable Care Act (ACA), also referred to as Obamacare, initially required every American to have health insurance or pay a tax penalty, and the states that mandate coverage still impose penalties for not having health insurance.
The following five states and districts require health insurance for yourself and your dependents:
- California
- Massachusetts
- New Jersey
- Rhode Island
- Washington, D.C.
The ACA also offers protection for dependents, requiring insurers that offer dependent child coverage to make it available until December 31 of the year the adult child turns 26 years old.
Types of Dependents
Ensuring your dependents are covered helps protect them financially and can also help ensure they can get the medical care they need. For the most part, if someone can be counted as a dependent on your taxes, they’re also considered a dependent for health insurance purposes. Most health insurance policies consider the following to be eligible dependents who may be added to an existing policy:
- Children
- Spouses
- Parents and other family members (or non-relatives) meeting specific criteria
If you are adding dependents to your health insurance plan, ensure you have the information you need to make sound decisions about your family’s healthcare coverage.
Children
- Relation eligibility: To be eligible, they must be your biological child, stepchild, adopted child, or a foster child in your care. If your child has other siblings, half-siblings, or children of their own, these children can also be included as dependents on your plan.
- Residence eligibility: The child must have lived with you for at least six months to be eligible.
- Financial eligibility: The child’s taxable income must be less than half the cost of their support expenses, and they cannot file a joint tax return with anyone else.
Your children can typically stay on your health plan until they turn 26, after which they must find their own coverage. Note that a child can only be claimed as a dependent by one household at a time. This means if you and an ex-spouse share custody of children and no longer live together, you must determine who will add which child to your respective policies.
Health Insurance Needs
Younger children typically use insurance benefits to cover the cost of routine pediatric visits, required vaccinations, and common issues like ear infections, sore throats, and injuries. Teens and young adults may incur medical expenses for things like cavities, acne, menstrual disorders, mental health issues, or sports-related injuries.
Spouse
- Enrollment window: You may add your spouse to your health insurance plan within 30 to 60 days after getting married. During this timeframe, you can usually add your spouse as a dependent or enroll in a new plan.
- Marriage eligibility: All married spouses can be added to a health insurance plan as long as the marriage legally took place. This means married same-sex couples may also be added to their spouse’s health insurance as a dependent, even if the state they reside in does not recognize same-sex marriages.
As long as your and your spouse plan to file a joint federal tax return, you may add them to your health insurance. Note that if you choose not to add your spouse to your insurance within the 30 to 60 day window after you get married, you generally have to wait until the next open enrollment period to make a change.
Health Insurance Needs
Healthcare costs can add up quickly; without health insurance, an unexpected medical issue could cause significant financial problems. For example, the average cost of a 3-day hospital stay is approximately $30,000, and fixing a broken leg can cost about $7,500. Adding your spouse to your health insurance as a dependent ensures they receive the same coverage as you and can help streamline your household’s coverage needs.
Parents and Other Family Members (or Non-relatives) Meeting Specific Criteria
Adding parents to health insurance plans is typically not allowed. However, if you can claim your parents as your tax dependents, your plan may offer them coverage as a dependent. This is not a common option, and the rules and requirements may vary depending on the insurance company and plan.
If your parents need health coverage and your plan does not allow you to add them, they may be able to obtain it through their job, by purchasing an individual health insurance plan, or through Medicare, once they are eligible.
Other Family Members and Non-relatives
You may also be able to add other family members as dependents if all of the following are true:
- You are responsible for providing more than half of their financial support.
- Their gross annual income is less than $4,300.
- No one else has named them as a dependent.
You may be able to include a non-relative who has lived with you for a minimum of one year if all of the above criteria are also met.
Health Insurance Needs
If your elderly parents qualify as dependents, your health insurance coverage can help offset expenses for health conditions like osteoporosis, diabetes, Alzheimer’s disease, respiratory diseases, heart disease, and cancer. It can also cover injuries from falls and other types of accidents.
While regular preventative care and timely treatment of conditions can help reduce some medical expenses, having sufficient health insurance coverage can significantly lower your out-of-pocket costs for medical expenses. Ultimately, health insurance coverage makes quality healthcare more affordable and accessible.
How to Add a Dependent to Your Health Insurance
If your dependent meets all the requirements to be added to your health insurance, you would generally follow these steps to get them coverage on your policy:
- Gather the required information.
- Pay attention to enrollment windows.
- Contact your insurance company to add them to your plan.
- Receive confirmation of their coverage.
Ensuring you’re prepared before contacting your insurer can save you time and help you avoid unnecessary frustration. Each insurance company may have a slightly different process or specific requirements. However, it will generally involve the following steps.
1. Gather the required information
The documentation required by the insurance carrier may vary depending on your relationship to the person you’re adding to the plan. The insurance company typically requires you to complete an enrollment or change form. If you’re adding a spouse, you may also need to provide a copy of your original marriage certificate, your spouse’s Social Security card, and their birth certificate or driver’s license.
When adding a dependent, you may need to provide a copy of their Social Security card and their birth certificate. Some carriers may also require you to sign and submit an affidavit confirming your relationship to the person you’re adding to your plan.
2. Pay attention to enrollment windows
Health insurance plans typically have an annual Open Enrollment Period that runs from November 1 through January 15 for most states. Employer-sponsored plans may also have their own annual enrollment window for changes. During this time, individuals and families can change their plans, such as choosing a different plan, adding or removing benefits, and adding or removing covered individuals.
Special Enrollment Periods
There are some “life-changing events” which are recognized as legitimate reasons to make changes to a health insurance plan outside of the open enrollment period. Some of the qualifying circumstances include:
- Marriage or divorce
- Birth or adoption of a child
- Beginning or ending of your spouse’s employment
- Change in hours that affects you or your spouse’s eligibility
- Beginning or ending of unpaid leave of absence for you or your spouse
There is generally a limited amount of time to change your health insurance policy after the event. Otherwise, you may need to wait until the next open enrollment period. Contacting your insurer quickly after a life-changing event may help ensure you’re able to get your dependents the coverage they need in a timely manner.
3. Contact your insurance company to add them to your plan
You can typically contact your insurance carrier by calling their service phone number. Some carriers may allow you to request the necessary forms and information online through a live chat or by submitting a request form. To avoid potential delays, read all instructions carefully, and don’t hesitate to ask questions if you need further clarification.
4. Receive confirmation of their coverage
Once your request has been processed, the insurance carrier provides written confirmation of the change. Depending on your delivery preferences, you may receive communication electronically or in the mail. If you don’t receive a confirmation, reach out to the carrier to make sure the change is complete.
The Cost of Adding Dependents
Since health insurance plans charge by the person, when you add a spouse or dependent to your plan, the monthly premium costs increase. If you were previously the only person covered, adding another person typically requires you to switch from an individual plan to a family plan. A family plan covers you and other individuals, including your spouse, your dependents, or both.
Copays and coinsurance may apply to each covered service or medication received by a covered individual. Many family plans also have both an individual deductible and a family deductible. It’s common for the family deductible to be twice the amount of the individual deductible.
When a covered person pays a deductible, the amount is applied to both their individual and family deductible amount. If an individual meets their deductible, but the family deductible has not yet been met, the policy begins to pay healthcare expenses for that individual only. Once the family deductible is met, the policy pays benefits for each family member, even if they have not met their individual deductibles. Annual out-of-pocket maximums typically work in the same way.
What This Means for You
Many private and employer-sponsored health insurance plans allow you to add coverage for dependents, including your spouse, children, and other eligible individuals. Sometimes, you may need to wait for an open enrollment period. However, certain life-changing events allow you to make changes outside this timeframe.
Communicating with your insurance carrier, providing the necessary documentation, and ensuring you receive confirmation of the change are all essential steps to help your coverage update go smoothly.