Despite being an essential component of everyday well-being, most are not aware of the intricacies of health insurance. Typically, for elderly individuals, there are Medicare plans, which are policyholder only. Alternatively, there are employer-sponsored group health plans and Marketplace insurance plans that provide coverage for dependents.
While you can claim dependents on your health insurance plan, many individuals are not properly informed of various eligibility requirements.
This spurs the question, “Can you put non-family members on your insurance plan?” In this article, we will answer that question and provide additional information about who can be added to health insurance plans and its effects.
Can You Put Someone on Your Health Insurance Who Is Not a Family Member?
To answer the primary question, no, individuals who are not family members do not qualify as dependents. In general, you may only add an individual to your insurance plan if you are related by blood, marriage, or adoption. Otherwise, it can become quite difficult to add someone who does not meet those qualifications. Quite frankly, it would be nearly impossible to add your friend to your health insurance plan.
In fact, the room of eligible family members is quite small as well. Oftentimes, unless they are an immediate family member, you may not be able to add them to your coverage plan. You may be able to add your niece, nephew, or grandchild if you are their legal guardian and are financially responsible for them.
While this may seem unfair, insurance companies implement these rules for protection against fraud and coverage abuse. For example, an individual could use someone else’s insurance card. Now, not only are they receiving services they are not eligible for, but the person whose card they used must now pay out-of-pocket expenses. It should be noted that insurance fraud is a felony and can result in hefty fines, community service, or sustained jail sentences. Also, the risk of insurance leads to higher costs for the consumer in the form of costly monthly fees and yearly deductibles.
To fully understand these complex factors, it’s beneficial to speak with an insurance professional. They can provide completely accurate and up-to-date information.
What to Do When Adding Non-Family Members to Health Insurance Isn’t an Option
Although you cannot add non-family members or non-immediate family members to your insurance, there are several ways to ensure quality health insurance for them. Depending on their age or financial status, there are readily available plans that can provide comprehensive coverage at affordable prices.
To start, you may have elderly relatives who require health insurance. Luckily, they are most likely eligible for Medicare, a federal health insurance program. Established in 1965, Medicare provides quality health coverage for qualifying individuals at an inexpensive price. To be eligible, an individual must be over the age of 65. Furthermore, those with disabilities or an end-stage renal disease such as permanent kidney failure or ALS (Lou Gehrig’s Disease) automatically qualify, regardless of age.
Medicare has four different parts. Part A and B, otherwise known as Original Medicare, provides hospital insurance and medical insurance. Both parts have monthly premium costs, but individuals who paid at least 10 years of Medicare taxes are exempt from Part A monthly fees. Furthermore, to help manage out-of-pocket expenses, they can also enroll in Medigap, a supplemental insurance plan. With all this being said, it should be clear that there are easily accessible and extensive health insurance options for your elderly relatives.
In addition to Medicare, another public health insurance program is Medicaid. Unlike Medicare, there is no age requirement needed to qualify. Instead, it is meant to be a resource for those within 133% of the federal poverty level who require health insurance. Along with financial eligibility for coverage, qualifying pregnant women and those who receive Supplemental Security Income are among the mandatory eligibility groups.
Although it is regulated by the federal government, Medicaid is administered through individual states. Therefore, each state has flexibility with coverage options and plan types. So, to better understand your potential benefits, it would be wise to speak with an insurance professional who is well-informed on this topic. Depending on your state of residence, you may also receive prescription drug coverage and adult dental care.
Also, elderly individuals who are Medicare beneficiaries can enroll in Medicaid to help pay for out-of-pocket expenses. In fact, Medicaid may provide long-term care services. With this benefit, individuals can live independently at home instead of in an assisted living facility. As stated by the Kaiser Family Foundation, around 1 in 5 Americans receive health insurance from Medicaid. So, if you have a non-family member who requires health coverage and meets those requirements, Medicaid can be a reliable and quality option.
For those who have dependents, CHIP (Children’s Health Insurance Program) can be quite beneficial. Typically, it is meant for families whose household income is too high to qualify for Medicaid. But, their income is not enough to purchase a plan from the Health Insurance Marketplace. The income range starts at 170% of the federal poverty level. Depending on the state, families within 400% of the FPL may qualify. As stated by the official Medicaid website, for a children's separate CHIP plan, families within 211% may be eligible.
Furthermore, there are different enrollment methods states can implement to ensure that children are receiving proper health coverage. For example, ELE (express lane eligibility) is a helpful way to determine and re-determine if a family qualifies financially. With continuous eligibility, children may receive coverage from both Medicaid and CHIP for 12 months.
CHIP offers a plethora of healthcare benefits.
Routine checkups
Doctor visits
Immunization
Dental and Vision Care
Prescription Coverage
Emergency Services
Inpatient and Outpatient Services
Laboratory Services
Understandably, CHIP is meant to be affordable. Therefore, routine doctor appointments and dental visits are fully covered. However, families may have copayments (a fixed amount you must pay) for various services. While this amount may vary depending on the state, no family should pay more than 5% of their yearly household income for healthcare expenses.
Finally, there are short-term health insurance plans to choose from. If a non-family member requires immediate coverage, this option may be right for them. These plans are generally more affordable as there is a limited window of coverage time. Furthermore, depending on the state, individuals can choose to receive insurance anywhere from 3 months to a year. This is a great option for those who may anticipate upcoming life changes.
In addition, it can be helpful for those who missed the Open Enrollment Period for the Health Insurance Marketplace. Now, they can receive comprehensive temporary coverage for the time being. However, these cannot be Affordable Care Act insurance plans. You may have difficulties enrolling if you have a pre-existing medical condition.
Who Can You Add to Your Health Insurance Plan?
You are allowed to put individuals on your health insurance plan if they are immediate family members. This includes your spouse and eligible children. As stated by the Affordable Care Act, domestic partners generally do not qualify as dependents in family insurance plans. So, if you are living with your boyfriend or girlfriend, you most likely will not be able to add them to your plan. However, this can vary based on where you live.
For example, California is required to offer unmarried partners the same benefits they would marry couples. Also, you will most likely be able to add your domestic partner under your employer’s group health plan. Again, this is specifically for California residents. Therefore, it is important to understand the regulations mandated by your state and to speak with your insurance company.
Understandably, certain individuals do not have a traditional family structure. Thankfully, health insurance companies are reasonable and accommodating towards different family circumstances. You are allowed to add a biological child, step-child, and foster child as dependents under your coverage plan. Furthermore, children under your care and grandchildren who you are financially responsible for quality as well. Newborn babies and recently adopted children must be added to your insurance plan within 60 days of birth or adoption, respectively.
It is important to note that there is a specific eligibility requirement that pertains to dependent status. Dependent children may be covered under their parent’s health insurance plan until the age of 26. Afterward, they must purchase an individual coverage plan or receive insurance through their employer. If your child received insurance through their employer but lost their job, they can be added back to your plan. This can only take place if your adult child is under 26 years old. However, there are exceptions to eligibility limits. For example, an adult child older than 26 who has a disability may remain under their parent’s insurance plan.
With a variety of options available, there are important questions you should ask before deciding on a health insurance plan. By adding dependents, you will have greater out-of-pocket expenses. In addition, certain plans may limit your selection of healthcare providers. These are all necessary questions to ask and answer before you make a choice.
What Is a Qualified Family Member of Health Insurance?
As previously stated, there is a slim group of qualifying family members who are allowed to be added to a health coverage plan. It’s important to note that different insurance companies may have varying thoughts about family member qualifications. In some cases, nieces and nephews can count as dependents, although it is quite rare. However, in general, a qualified family member is someone from your immediate family. For example, your spouse and children can be automatically included in your health insurance plan. This also extends to any step-child, foster child, and adopted child.
Now, qualification becomes tricky when considering domestic partnerships. Depending on the state, domestic partners may or may not be able to share a health insurance plan.
What are the Benefits and Drawbacks of Adding Someone to Your Health Insurance Plan?
When you choose to add someone to your health insurance plan, this will usually cause a ripple effect. Primarily, this will result in financial changes. In the following sections, we will discuss the benefits and drawbacks of adding someone to your health insurance plan.
Benefits of Adding Someone to Your Health Insurance Plan
Understandably, you should want to do your best for your immediate and qualifying family members. Therefore, one of the main benefits of adding them to your insurance plan is guaranteeing the right to comprehensive health coverage. When you add a family member or dependent, they will no longer have to worry about lacking medical coverage.
Furthermore, the insurance plan will provide benefits for covered healthcare services. So, they/you will not have to pay significantly expensive out-of-pocket costs. Instead, your insurance company will cover a majority of the costs. You will most likely have to pay a coinsurance rate or copayment.
Speaking of money, adding someone to your health insurance plan can result in a variety of tax benefits. Typically, if an insurance company recognizes your family member as a dependent, the federal government will too. Therefore, you may be eligible to receive a child tax credit or deductions for certain medical expenses.
To fully understand these different financial implications and variables, you should speak with a professional.
Drawbacks of Adding Someone to Your Health Insurance Plan
Unfortunately, there are certain drawbacks when you choose to add someone to your health insurance plan. Typically, these downsides are financial. While you may want to add every eligible family member to your plan, you should be aware of the monetary impacts it can have.
To start, you will most likely have significantly higher monthly expenses. Plans that cover multiple individuals instead of an individual policyholder will generally be more costly.
In addition, if the person you add has certain healthcare needs, you may need to change your plan type. For example, they may require medical services from an out-of-network provider. If you have a PPO plan (Preferred Provider Organization), you can visit those doctors, at the expense of higher copayments/coinsurance. However, you may have a plan that only features a limited selection of care providers. In this case, you may need to find a new plan that better accommodates your family’s medical needs.
What is the Cost of Adding Someone to Your Health Insurance Plan?
By adding someone to your health insurance plan, your out-of-pocket expenses will increase. Most individuals will typically receive coverage through employer-sponsored plans or Health Insurance Marketplace insurance plans. If these plans change from policyholder-only to multiple individuals, monthly premium costs will also change. In addition, your yearly deductible (the amount of money you must pay before the insurance company starts to provide coverage) will increase too.
As stated by Kaiser Family Foundation, the average monthly premium for family coverage in 2022 was $1,872. Alternatively, the average monthly premium for single coverage in 2022 was $659. Of course, if you can add a family member to your insurance plan, you should highly consider it. It is just important to understand the various financial implications, as missing payments can result in lapses of coverage or the plan being dropped altogether.
How Do You Remove a Dependent From Health Insurance?
If you want to remove a dependent from your health insurance plan, you can do so at any time of the year. You are not limited to the Open Enrollment Period. For those who receive insurance from their employer, you should contact human resources.
Alternatively, if you purchased insurance from the Health Insurance Marketplace, simply call your insurance company. They can provide steps and proper information about the removal process.
In addition, if you have gone through a divorce, you should contact your insurance company within 30 days. Divorced individuals are eligible for the Special Enrollment Period, so finding a new insurance plan quickly will be possible.
FAQs About Adding Non-Family Members to Health Insurance
How long can a dependent child stay on my health insurance?
Dependent children (biological, adopted, step-children, or foster child) may stay on your health insurance plan until they turn 26 years old. An adult child over the age of 26 can remain on their parent's insurance if they have a disability. Otherwise, an adult child older than 26 must find a new health insurance plan.
If I get married, can I add my spouse’s child to my health plan?
Yes, you are allowed to add step-children to your health plan.
Can I add my parents to my health insurance plan?
Typically, you are not allowed to add parents to your health insurance plan. Luckily, if they are over 65, they will qualify for Medicare.
Can my boyfriend or girlfriend’s child be added to my health plan?
Depending on the state, you may be able to add your boyfriend or girlfriend’s child to your health plan. However, any biological child, adopted child, or foster child may be added to your insurance plan.
Choose the Right Health Insurance Company for Better Coverage
If you are trying to find the right health insurance plan, Health Plans of NC can be quite helpful. Our team of licensed and knowledgeable health insurance agents would love to assist during this process. With their help, you may be able to find the best coverage plan for you and your family.