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Generally, most people age 65 and over are eligible for Medicare as long as they are American citizens or legal permanent residents for at least five continuous years. There are also some situations where you might be eligible for Medicare before you turn 65. Medicare coverage is a bit different from private health insurance plans, which often cover spouses and children. There are usually no provisions for Medicare dependents, and both you and your spouse must enroll in Medicare separately.
However, there are some very specific situations when Medicare may cover dependent children. Here’s what you need to know.
What if I retire and have dependent children?
Many workers receive health insurance through an employer that also covers their spouse and children. Under current law, according to the Department of Health and Human Services, you can keep your children on your health insurance policy until they turn 26 years old. For example, if you are a 66-year-old retiree with a 24-year-old child, your son or daughter may have had coverage through your employer plan, but in most cases Medicare won’t cover your child. If you have Medicare, your child may be able to get COBRA coverage or coverage through the Health Insurance Marketplace.
When does Medicare cover children?
Below are three situations in which dependent children could be eligible for Medicare:
- If you have end-stage renal disease (ESRD) and need regular dialysis treatments or a kidney transplant, and are currently receiving Social Security or Railroad Retirement Board benefits, your spouse and dependent children may qualify for Medicare coverage as Medicare dependents.
- If your child has ESRD requiring regular dialysis or a kidney transplant, he or she may qualify for Medicare coverage.
- If your child has a disability that entitles him or her to Social Security Disability Insurance (SSDI) payments, he or she may qualify for Medicare. Your child must have received SSDI benefits for at least 24 months in order to receive Medicare benefits.
Can Medicare dependents enroll in Medicare Advantage plans?
If your child qualifies for Medicare because of end-stage renal disease (ESRD), he or she will most likely have to enroll in Original Medicare (Part A and Part B) because enrollment isn’t automatic in this case.
Your child might not be eligible for a Medicare Advantage plan. However, in some cases, depending on where you live, your child may be able to enroll in a Medicare Advantage Special Needs Plan (SNP) for people with ESRD.
Medicare Advantage SNPs are only available to individuals who meet one or more of certain eligibility criteria. Different types of SNPs have different eligibility criteria, such as:
- You have a specific chronic or disabling disease or condition (in this case, ESRD).
- You’re institutionalized in a long-term care or other health facility.
- You are also eligible for Medicaid.
However, if your child has had a successful kidney transplant but still qualifies for Medicare due to a disability or other qualifying situation, he or she can generally join any Medicare Advantage plan available in your area.
It’s important to remember that Medicare Advantage SNPs may not be available in all locations. You must also continue to pay your Part B premium as long as you are enrolled in a Medicare Advantage plan plus any additional premium required by your plan.
Can I get Medicare Part D prescription drug coverage for my children?
Again, in order to get Medicare Part D coverage for prescription drugs, your child typically must qualify for Medicare under one of the situations described above. Anyone who is eligible for Medicare can enroll in a Medicare Part D Prescription Drug Plan, either as a stand-alone policy to go alongside Original Medicare or as part of a Medicare Advantage plan with coverage for prescription drugs. However, there are only certain periods when you can enroll.
If your child qualifies for a Medicare Advantage SNP, prescription drug coverage is automatically included in the plan. Medicare Advantage SNPs are specifically designed to include coverage for medical treatments and medications necessary to manage a particular condition such as ESRD.
Still have questions about Medicare coverage for dependent children?
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