Turning 26: Health Insurance for Dependents


A recurring question about the ACA is when a dependent adult child turns 26, when does the coverage terminate? Is it on the dependent’s birthday? Or is it the end of the month of the dependent’s birthday?

In accordance with the ACA’s adult dependent child provision, coverage must be allowed to continue until the child reaches the age of 26. However, plan sponsors are free to elect more generous benefit designs, such as covering dependents until the end of the month or even the year in which the child attains the age of 26.

Some states have adopted provisions that grant coverage for a longer period, in some cases up to the age of 31 years old.

Fully-insured plans are subject to both the Employee Retirement Income Security Act (ERISA) and state mandated rules, whereas self-funded plans need only comply with the federal law.

Regulations clarify that for purposes of Internal Revenue Code § 4980H, a child is a dependent for the entire calendar month during which he or she attains age 26 for the purposes of the employer shared payment provision.

Ultimately, this depends on what is elected by the carrier. We recommend reviewing your Summary Plan Description for clarification.

If you would like a review of your employee benefits or to see how your plan affects you, your employees, and their dependents, The Greater West Chester Chamber of Commerce offers members access to the My Benefit Advisor (MBA) program. More information is available at: gwcc.mybenefitadvisor.com or by contacting Jim Pitts at (610) 537-1377.

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