Which People Can You Cover Under Your Health Plan?

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  • Your family size plays a role in your decisions about health insurance. If you are single, you only need an individual health plan. But if you have dependents, you will need a family plan to cover them. The ACA (Affordable Care Act) requires insurers to cover tax dependents. So, who exactly qualifies as a dependent? The answer may seem pretty straightforward—your children. It turns out there’s more to it than that. Dependents are any qualifying child or relative. Here’s a look at which kinds of people to include on your health insurance for dependents.

  • 1
    Children
    two boys embracing mother on cold winter day

    Children are usually the first people that come to mind as dependents. Qualifying children must be your biological son or daughter, stepchild, foster child, or brother, sister, half-brother, half-sister, stepbrother, stepsister, or a descendant of any of them. The child must live with you for more than half the year (there are special rules for divorced parents). The child must not have provided more than half of their own support for the year. The child must not be filing a joint return with anyone. 

    If you shop for insurance on the Health Insurance Marketplace, you must include these qualifying tax-dependent children on your application.

  • 2
    Young Adult Children
    Young African American teenager or young adult cooking in kitchen with mother

    Under the ACA, children can remain on your coverage until age 26. This is true even if they’re married, have a child, don’t live with you, aren’t financially dependent on you, and have access to job-based health insurance. Not everyone chooses to or needs to cover children through age 26. 

    However, if you use the Marketplace, you need to be aware of the tax status of your children because you have to include tax-dependent children on your application. The IRS doesn’t qualify everyone under 26 as a tax dependent. A tax dependent on your Marketplace application must meet the above qualifying child criteria and be either:

    • Under age 19 at the end of the year

    • Under age 24 and a student at the end of the year

    • Any age if permanently and totally disabled

    If your children are non-dependent and under age 26, only include them on your Marketplace application if you want coverage for them.

  • 3
    Spouse
    Senior-Couple-Walking-Along-Beach-Together

    A spouse isn’t a tax dependent. And the ACA doesn’t require employers with 50 or more employees to offer spousal coverage. But most do. If your employer offers coverage for your spouse, you can include them in your plan. However, if your spouse has access to employer-based health insurance, you may be subject to a spousal surcharge. It may also be cheaper for each of you to take your respective job-based plans.

    For Marketplace plans, a spouse is a member of your household if you are legally married. Divorced or legally separated spouses are not. You must include your spouse on your application, even if you are not requesting coverage for them.

  • 4
    Domestic Partner
    Middle aged male gay couple smiling out doors and embracing

    The ACA defines domestic partners as two people of the same or opposite sex who live together and share domestic life. They are not married or joined by a civil union. Federal law does not clearly outline benefits for domestic partners. Instead, this falls to the states. Insurance coverage for domestic partners will depend on the state in which you live. If your state mandates benefits, you will have the same considerations as a married couple when it comes to enrolling in job-based health insurance.

    For Marketplace plans, a domestic partner is a member of your household if you have a child together or if they otherwise qualify as a tax dependent.

  • 5
    Dependent Relatives
    Senior or elderly woman in chair looking out window with adult daughter

    To qualify as a dependent relative, the person can’t be a dependent of another taxpayer. They must also be related to you by blood or marriage. (The person can be unrelated, but must live with you all year.) Relatives do not have to live with you in order to be dependent. The person’s gross annual income must be less than $4,150, and you must provide more than half of their financial support for the year. Gross income does not include tax-exempt income, such as Social Security. And there are income exceptions for disabled people. This is the category people use for health insurance for dependent parents.

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  1. Dependent. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/dependent/ 
  2. Dependent Health Coverage and Age for Healthcare Benefits. National Conference of State Legislatures. http://www.ncsl.org/research/health/dependent-health-coverage-state-implementation.aspx 
  3. Domestic Partnership. Center for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/domestic-partnership/ 
  4. FAQs Health Insurance Marketplace and the ACA. Kaiser Family Foundation. https://www.kff.org/health-reform/faq/health-insurance-marketplace-aca/  
  5. Getting Health Insurance Coverage for Spouse/Partner. United Way. https://www.unitedway.org/my-smart-money/financial-planning/starting-a-family/getting-health-insurance-coverage-for-spouse-partner 
  6. How to Get or Stay on a Parent’s Plan. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/young-adults/children-under-26/ 
  7. Publication 501 (2018), Dependents, Standard Deduction, and Filing Information. Internal Revenue Service. https://www.irs.gov/publications/p501#en_US_2018_publink1000220868 
  8. Unmarried Domestic Partner Benefits. Bureau of Labor Statistics. http://www.bls.gov/ncs/ebs/benefits/2016/ownership/civilian/table44a.htm 
  9. Who to Include in Your Household. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/income-and-household-information/household-size/
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