How Do I Add Dependents to My Health Plan?
Adding dependents to your health insurance plan can be done directly through your insurance company's website, marketplace plans, or employer if you have job-based insurance coverage. For job and employer-based insurance, policyholders can only add dependents during the respective open enrollment period or if the insurance plan has a special enrollment time frame.
How To Add Dependents
Overall, adding dependents to your health plan is fairly simple. However, it's essential to be aware of your plan's dependent requirements, restrictions, and enrollment period. Policyholders can only add dependents during open enrollment periods or special enrollment time frames for both marketplace and employer-based plans. Open enrollment is the yearly period in the fall when people can enroll in health insurance plans for the following year; this period typically goes from November 1 to January 31. Special enrollment periods fall outside the traditional time frame and only allow those who meet the criteria to enroll in a health insurance plan.
When you add dependents to your health plan (be it employer-based or from the marketplace), you are essentially enrolling in a new health plan as you go from individual to family coverage and therefore fall under the enrollment period guidelines.
With marketplace plans, you can only add dependents during the yearly enrollment period starting November 1 or during the special enrollment period if you have a qualifying life event. The chart below explains what is classified as a life event.
Qualifying Events for Special Enrollment Period
|Qualifying Life Event(s)||Event Specifics|
|Changes in the Household|
If you or anyone in your household:
|Changes in Residence|
|Loss of Health Insurance||Anyone in your household loses qualifying health insurance in the past 60 days OR expects to lose converge in the next 60 days|
|Becoming a United States Citizen||Newly eligible for marketplace plan after becoming United States Citizen|
Like marketplace health insurance, employer-based plans only allow you to enroll in a new plan and add dependents during the open or special enrollment period. Those time frames are determined by the individual plan, so it's best to check with your employer's benefits department for specifics on when the enrollment periods occur and the criteria for qualifying for special enrollment.
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Medicare and Medicaid
It's important to note that federal health insurance programs such as Medicaid and Medicare have special limitations in terms of dependent coverage. With Medicare, individuals cannot receive additional coverage for dependents; dependents must be individually eligible for medicare insurance coverage. With Medicaid, coverage is determined by household income level. Although dependents cannot be added to individual Medicaid plans, CHIP, which is insurance coverage designated for children under the age of 18, is the extension of Medicaid services.
For both employer-based and marketplace plans, it's crucial to understand who can be classified as a dependent. According to Healthcare.gov, a 'household' that can be added as a dependent includes tax filers, spouses, and children under the age of 26. The chart below illustrates each classification of relationship and if they are deemed as part of a household, eligible for dependent coverage
Household Relationship Criteria
|Relationship||Are they part of a household?|
|Dependent children||Yes. Dependent children including foster and adopted children are a part of your household|
|Children you share custody with another parent||Depends on custody arrangements. Only the parent who claims the child on their taxes can count the child in their household|
|Children under the age of 26 that are not dependents||Can be included as part of your household|
|Children under the age of 21 that you care for||Every child under the age of 21 that you are taking care of can be included as part of your household|
|Unborn children||No. Newborn children can be enrolled up to 60 days after birth|
|Dependent Parents||If parents are claimed as dependents on your taxes, they can be claimed as dependents with health insurance|
|Dependent siblings or other dependent relatives||Siblings and other relatives can be claimed as dependents on health insurance if they are dependants on your taxes|
|Spouse||Your legal spouse is a part of the household|
|Spouse you are not living with||As long as you are legally married, your spouse can be claimed|
|Legally separated or divorced spouse||If you are divorced or legally separated, you cannot claim your spouse|
|Unmarried domestic partner||You can include an unmarried spouse if you have children together or claim them as a dependent on your taxes.|
|Roommate||Roommates cannot be included as part of your household|
Requirements for Adding Children As Dependants
- Age: child under the age of 26
- Relationship: biological child, your stepchild, adopted child, and/or foster child
- Length of Residency: lived with you for at least six months
- Income Contributions: a child is not their own primary source of income or support. They can be working and contributing to their own expense while being tax dependent. Child income must be less than half the cost of their support to qualify as a dependent.
- Tax Filings: Cannot be a dependent if child files a joint tax return
- Other Claims: child cannot be claimed as a dependent by more than one household
Limits of Traditional Health Plans
Although adding dependents and upgrading to a family insurance plan does render protection for all qualifying members of your family, there are some limitations with the traditional dependent additions, such as the cost of plans and criteria for defining household members.
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With all health plans, there are typically three items to examine that affect your bottom line cost: premiums, deductibles, and associated plan costs. Premiums are the monthly payment you make to remain enrolled in your family health insurance plan. A deductible is an amount you pay out of pocket before your insurance plan kicks; typically, the cost for family deductibles and premiums are higher than the individual plan cost. Below is a chart comparing the average deductible and premiums for family and individual plans.
Premiums and Deductibles Individual vs. Family Plans
|Type of Plan||Premium||Deductible|
Source: Kaiser Family Foundation
Although family plans expand coverage for your household, the sheet cost alone could cause more harm than good, especially if you're on a tight budget and trying to save money on your healthcare cost. If you calculate the annual premium cost for both plans, the individual plan is about $5,268 per year, whereas the family plan is about $13,824 per year.
Dependent Criteria Restrictions
Both marketplace and employer-based plans have established strict guidelines as to who in your household would qualify as your dependent. As this system relies on an older definition of who is considered family or within your household, traditional plans will not allow you to add an individual that is not a blood relative. In this day and age, family units are not simply defined as blood relatives, whereas your friends or roommates can be considered your established family household; The traditional marketplace and employer-based plans do not offer and update dependent criteria to expand coverage to chosen family members.
Mira Providing Modernized Dependent Coverage
Although marketplace, employer-based, and federal-funded plans are the standard trifecta for health care plans, there are other options that provide more flexibility with dependent coverage as well as more affordable plans. Mira is a subscription-based care plan that is about ten times cheaper than traditional health plans. Mira costs between $25 - $60 per month and includes urgent care, virtual primary care, behavioral therapy, psychiatry, lab testing, prescriptions, and gym discounts. In terms of family and friend-dependent coverage, Mira allows subscribing members to add up to 10 family members, friends, and even roommates to the paid plan without additional restrictions and criteria to be met.
Regardless if your plan is from the marketplace or through your employer, if you want to add dependents to your health insurance, you must upgrade your plan from individual to family coverage during the open enrollment period or if you qualify for special enrollment. Additionally, you must ensure that the individuals you want to add as dependents meet the household criteria.
With the sheer cost of upgrading to a family plan and restrictions that limit who can be on your health plan, simply adding dependents might not fit in your budget and work for your family dynamic. Mira is here to transform traditional health plans by not only lowering costs but expanding coverage to friends, family, and even roommates. For as little as $45 per month, you and those on your plan get access to low-cost urgent care, virtual primary care, and discounts on over 8,000 prescriptions. Sign up Today!
Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!