Coverage for Young Adults
Under the ACA, if your plan covers children, your employees can add or keep their children on their health insurance policy until they turn 26.
Children up to age 26 can join or remain on your plan even if they are:
- not living with you
- attending school
- not financially dependent on you
- eligible to enroll in their employer’s plan
Which plans are affected?
All groups, including small, large, self-insured, direct pay, and Healthy NY are affected. Medicare, Medicaid, Family Health Plus, Child Health Plus, and stand-alone dental/vision plans are not affected.
Age 29 option
The benefit in New York state allows adult dependents to purchase coverage through a parent’s plan through age 29. There are two options: The Young Adult and the Make Available. The dependent does not have to live with a parent, be financially reliant on a parent, or be a student.
For the Young Adult option, the parent must be covered under the group policy as an employee or member of the group. The dependent may purchase coverage through his or her parent’s policy.
For the Make Available option, groups can choose to include the eligible young adult as a dependent under family coverage.
To qualify for the coverage, the dependent must meet the following criteria:
- Be unmarried
- Be 29 years of age or younger
- Not be insured by or eligible for comprehensive health insurance (medical and hospital) through his or her own employer
- Live, work, or reside in New York or the health insurance company’s coverage area
- Not be covered by Medicare (Young Adult option only)
For each option, the coverage must be a group or group remittance health insurance policy that includes coverage for dependents, is issued in New York state and subject to state law, and is fully insured.
This benefit does not apply to self-funded plans. The law also does not apply to dental only, vision only, pharmacy only, accident only, or specified disease coverage.
Catastrophic coverage is a high-deductible plan that is available to young adults (under age 30) and individuals with a certification of exemption based on hardship or inability to afford or obtain coverage. This type of plan covers essential health benefits after you reach the annual out-of-pocket costs. In addition, the plan covers at least three primary care visits per year before you reach the deductible.