Definition of Dependent for Health Insurance

The peace of mind that health insurance can provide is a wonderful thing, and like any other wonderful thing, it's only natural to want to share it with the people you love. Unfortunately, it's not as simple as sharing your Netflix account with your friends and family. Whether you have individual coverage through the Affordable Care Act, or group coverage through an employer or other organization, your insurer will only extend coverage to specific groups of dependents.

Definition of Dependent for Health Insurance
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Children Up to Age 26

Before the Affordable Care Act was passed in 2010, dependent children were usually only covered until they reached adulthood, which insurers generally defined as 19 or 20 years of age. Students could continue to receive coverage, but only as long as they lived with their parents. The ACA changed that, requiring health insurers to continue extending coverage to young adults right up to their 26th birthdays. That's true even if the children are completely independent by any other measure, including living on their own, holding down a full-time job and being married.

A Few State-by-State Exceptions

The federal statute sets out a minimum standard, and at their discretion, the state legislatures can require a more generous definition of a dependent child. Illinois law, for example, permits parents of military veterans to keep them as dependents up to the age of 30 for insurance purposes. Children in New Jersey can remain on their parents' plan up to the age of 31, but only if they're unmarried and have no dependents of their own. Unmarried dependents in Wisconsin can be covered up to the age of 27. To know for sure who's covered, check your own state's statutes.

Dependents Other Than Children

The federal Healthcare.gov website has a pretty clear and brief definition of a dependent: If you can claim a personal tax exemption or deduction for someone, then that person is a dependent. This makes perfect sense because your kids aren't the only people who might depend on you. You might also take care of your elderly parents, or an extended family member who has no one else, or perhaps you've taken on responsibility for people who aren't related to you at all. Under some circumstances, these individuals can all legitimately be classed as dependents, if they meet the tests set out by the Internal Revenue Service.

Who Qualifies

The IRS has a laundry list of potential dependents other than your own children under the age of 26: Any adopted children, stepchildren, foster children and grandchildren, as well as your half-siblings or step siblings and their children, may qualify. Permanently disabled children, or children totally disabled at any point during the year, are always considered dependents. Another whole group of potential dependents includes children who don't meet any of those previous descriptions, members of your extended family, and non-relatives who live with you. To consider these individuals as dependents, they must either live with you all year as members of your household, or be on the list of extended family members – siblings, parents and grandparents, half-siblings and step siblings and their children, and your in-laws – who can be considered dependents even if they don't live with you. These less-conventional dependents will also have to meet two other main criteria.

Gross Income and Support Tests

The IRS refers to these two criteria as the Gross Income and Support tests. The Gross Income test requires that the person in question must have a gross income of less than $4,050 each year to be considered a dependent. To pass the Support test, you must be responsible for at least half the cost of that person's living expenses for the year. There are a number of other details to get right, in these less-obvious cases, so take the time to research the requirements before you try to add someone to your coverage. You may have to make a case to the insurer to get that coverage, and you'll want to be certain of your facts before you make that call.

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