Families who have children or young adults with disabilities or special health care needs know the importance of good health insurance. When a child becomes an adult at age 18, their health insurance coverage may change and eligibility for some programs may end. Start learning about your child’s options early so needed medical care and prescriptions are covered when these changes happen.

For example, if a child with disabilities qualified for Wisconsin Medicaid through the Katie Beckett Program, they will lose this coverage at age 19. Or, a child who has Medicaid through SSI, will need to re-apply at age 18 to see if they are eligible as an adult.

 Private Insurance Options

• • • Staying on a Parent’s Plan: If parents have private insurance, they can keep their child on their health plan until they are 26 years old. The Affordable Care Act (ACA) requires that health plans allow parents to add or keep a child on their private health plan even if they are married, not living at home, enrolled in college or not financially dependent on their parents.
    • Disabled Dependent Provisions: Some private plans allow a child with a disability to stay on their parent’s plan as long as the parent has that plan. In most cases, parents will need to apply and their child must have a disability determination by the state of Wisconsin.
    • College/University Health Plans: College or technical school students may qualify for a student health plan.
    • Employer-Sponsored Plans: If a young adult has a job, they may be eligible for employer sponsored health coverage.
    • HealthCare.gov: A young adult can purchase private insurance through the federal Health Insurance Marketplace, healthcare.gov. As an adult, a young person may be eligible for help to reduce their out-of-pocket costs. Those under age 30 can enroll in a “catastrophic” health plan which is a lower cost policy with limited coverage.

Public and Government Options

• • • BadgerCare: Starting at age 18, a young adult may qualify for BadgerCare Plus, a Medicaid Program for those with low income. This is based on the young adult’s own income and not consider their family’s income.
    • SSI: A young adult with a disability may qualify for Supplemental Security Income (SSI), which automatically makes them eligible for Wisconsin Medicaid. For more information on SSI go to socialsecurity.gov or call 1-800-772-1213. 
    • MAPP: Adults with disabilities who work, or want to work, may be able to purchase coverage through Wisconsin Medicaid, called the Medicaid Purchase Plan or MAPP. To learn more, see MAPP Fact Sheet.
    • Medicare: For those who work and have a disability, Medicare coverage may be an option. An adult who qualifies for Social Security Disability Income (SSDI) will automatically receive a Medicare card after two years. (See Medicare Information | Disability Research | SSA) Contact your county’s Aging and Disability Resource Center with questions.