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Life in the Trenches of the Health Insurance Business: Part 4 in a Series

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The situation: We received a call last week from a client whose daughter recently told him she hates her insurance “because it does not cover anything.” He phoned me to see if she had a real gripe, and if I could help him find another policy with better coverage for her.

The problem: It turned out that her policy had a $5,000 deductible, which did not include coverage for dental or vision doctor visits. Since she has an entry-level position and not a lot of extra spending money, I told her she had a choice.

She could choose to pay more per month to lower her out-of-pocket expenses, but her monthly premiums would be higher. Since her father was paying her premium, and was happy to do so, we decided the best policy for her was one with a higher premium and lower expenses.

The solution: The decision to pay for an adult child’s health care is a personal one that each family must make. The reality is that once a child turns the age selected on the policy by the plan administrator based on the rules of the state and the size of the employer, they are no longer considered a dependent.

In many cases, the age limit is 25, but it can be 19 or the time at which the child graduates from college. Many times, the insurance company does not notify the parent or the plan administrator that the student has been dropped. The student typically finds out when filling a prescription or when receiving services.

Although there is now a federal mandate in place to allow children to be included on their parent’s health plan until 26 years of age, it still may be less expensive to insure that child on their own policy themselves rather than remain on the parent’s plan. Obviously, the rates will be much lower for someone who is much younger.

Keep in mind that it is the parent’s responsibility to notify the carrier on whether the student is a full-time student and eligible for coverage. The student is responsible for having a student certification form completed and signed by the bursar’s office proving they are in school full time and carrying 12 or more credits.

If we were the health insurance ambassadors: We would require all students, up until age 26, to be on the parent’s coverage. All students would have to prove they had coverage or they could not attend school.

The painful truth: Parents can analyze the cost of coverage through the school or an individual policy versus the cost of keeping the child on their plan. If the parent has other children on the plan, it rarely saves to pull one child off the plan.

We encourage you to share your insurance nightmares with us! Send an email to [email protected].

Stephanie Cohen and Scott Golden are the co-owners of the health care benefits firm Golden & Cohen. Cohen can be reached at [email protected]. Golden can be reached at [email protected].

Want more? Check out past chapters in this series: