Getting on parent's insurance under 26

December 20, 2017 12:37 PM

My mother lost her job and now has to get a Marketplace insurance plan. I was under the impression that as long as I'm under 26 I can be on her plan. She says two people on the ACA hotline have told her she can't add me unless I'm a dependent on her tax return. Can I be on her insurance or not?

This link states that I can get on a job-based plan at any point even if I'm not a dependent on the tax return. However, it's not clear about the Marketplace plan. It seems like it could also be read as if I was on a Marketplace plan as a dependent I can stay on until I'm 26 regardless of whether or not I'm still a dependent. But it doesn't say if I can get on a Marketplace plan if I'm not a dependent. E. g., you won't be kicked off a plan for not being a dependent, but you could be barred from getting on it.

Is my mother misunderstanding what the people are telling her, or can I really not be added to a Marketplace plan if I'm not a dependent? Is there any way to get me on her insurance?

posted by brook horse to Law & Government (10 answers total)

Your link does say "When a parent applies for a new plan in the Marketplace, they can include you on their application." What state does she live in?
posted by soelo at 1:03 PM on December 20, 2017

The link also says:

Generally, you can join a parent’s plan and stay on until you turn 26 even if you:

Get married
Have or adopt a child
Start or leave school
Live in or out of your parent’s home
Aren’t claimed as a tax dependent
Turn down an offer of job-based coverage

So it sounds like the hotline people are wrong.
posted by cooker girl at 1:14 PM on December 20, 2017 [1 favorite]

Response by poster: We're in Wisconsin. I'm just not sure if the wording about applying for a new Marketplace plans means both dependents and non-dependent. And for the section that says you can stay on even if you aren't a dependent, it's talking specifically about job-based plans right above and right below it, so I'm not sure if it only applies to that. Or why two separate people told her I can't be on it. If anyone has gone through the Marketplace enrollment and knows if there's a place to add non-dependents that would be helpful.
posted by brook horse at 1:30 PM on December 20, 2017

State of Wisconsin Dept. of Revenue, Treatment of Health Insurance Benefits for Adult Children

On November 4, 2011, the Governor signed legislation that adopted the federal law provisions (sec. 1004(d) of P.L. 111-152) relating to the treatment of health insurance benefits provided to an adult child who has not attained the age of 27 as of the end of the tax year. These provisions are effective for taxable years beginning on or after January 1, 2011.

WISCONSIN TREATMENT
Effective for taxable years beginning on or after January 1, 2011, the Wisconsin treatment of health insurance benefits provided to an adult child who has not attained the age of 27 as of the end of the tax year is the same as the federal treatment.

FEDERAL TREATMENT
The exclusion from gross income of an employee for employer-provided accident or health insurance benefits for the employee, the employee's spouse, or the employee's dependents was extended to apply to any child of the employee who, as of the end of the tax year, has not attained the age of 27.

Thus, if the child is age 26 or less at the end of the tax year, the exclusion applies even if the child provides more than one-half of his or her own support, earns more income than the exemption amount, does not live with the taxpayer, or if any other restriction applies which prevents the employee from claiming a dependency exemption.
posted by Iris Gambol at 1:32 PM on December 20, 2017 [1 favorite]

brook horse, work your way through this (very short and easy) questionnaire on HealthCare.gov. To me, it looks as if you can indeed be added to your mother's marketplace plan, even if she does not claim you as a dependent on her tax return. Which means either the hotline people are misinformed, or your mom is misunderstanding what they are telling her.

Maybe try calling the hotline yourself, or working with a navigator?
posted by merejane at 3:14 PM on December 20, 2017 [1 favorite]

there are various organizations around Milwaukee where you can sit with a real person (for free) and talk about this stuff... if you're interested please memail me
posted by AFABulous at 6:54 PM on December 20, 2017 [1 favorite]

er, by "real person" I mean "trained Navigator"
posted by AFABulous at 6:55 PM on December 20, 2017 [2 favorites]

I believe you should be able to be on the same family marketplace plan, but that this does change the premium tax credit calculation since you're not in the same tax household as your parent. I think you each have to calculate the premium tax credit separately based on your separate income and family size. For tax purposes, this kind of plan would be called a shared policy (a single insurance policy shared by two tax households).

I don't know how the application process works in detail, but the issue may be arising when your parent is determining their advanced premium tax credit eligibility rather than choosing the insurance plan itself. I'm not sure if that's a process that can be decoupled on your end, but the term "shared policy" might get you better answers on the phone or with an in-person navigator.
posted by melissasaurus at 4:28 AM on December 21, 2017

I *think*, based on what you've said, that the issue is between eligibility to enroll in a (full-price) Marketplace plan and eligibility for premium tax credits.

In other words, your parent could put you on their Marketplace insurance but wouldn't be able to get tax credits to subsidize your being on their plan. The credits would be calculated as if they were buying a plan for only themselves (and other tax dependents).

Is there a reason that you're not looking at just getting a Marketplace plan for yourself? (This assumes that you file taxes and take a personal exemption for yourself, that you're earning too much to qualify for Medicaid and that you're not offered insurance through work yourself.) Let's say your income is $1500/mo. You should be able to get pretty significant tax credits that will make insurance fairly affordable to you.

Happy to talk offline with specifics -- send me a MeMail if you're interested. I'm a insurance counselor in Illinois but you wouldn't be the first Badger I'd helped -- not even the first MeFite Badger, actually...
posted by tivalasvegas at 2:46 PM on December 26, 2017

Also, note that you have 60 days from the time the insurance ends to sign up for MP coverage -- and that if you enroll *before* the current plan becomes inactive, the new coverage will start right away without any gap. Otherwise you may be without coverage for a month or two.
posted by tivalasvegas at 2:47 PM on December 26, 2017