Families who have a child or teen with special needs know how important good health insurance is for their family. When a child becomes an adult (at age 18) his/her health coverage may change and eligibility for certain programs might end.
For example, children with disabilities who qualify for Wisconsin Medicaid through the Katie Beckett Program will lose this coverage at age 19, and those who have Medicaid through SSI will have to re-apply at age 18 to see if they are eligible as an adult.
The following gives families options and resources to learn more about how their child (age 18 to 26) can get health coverage and continue to get the medical care and prescriptions they need.
Private Insurance Plans:
- If parents have private insurance, they can keep their child on their health plan until their child is 26 years old. The Affordable Care Act (ACA) requires that health plans allow parents to add or keep a child on their Adult children can stay on even if they are married, not living at home, enrolled in college or not financially dependent on their parents.
- College or technical school students may qualify for a student health
- If a young adult has a job, he/she may be eligible for coverage through their employer.
- A young adult can purchase private insurance through the Marketplace. As an adult (age 18 and older) a young person with income below 400% FPL (federal poverty level) 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 that protects you from very high medical bills.
Wisconsin Medicaid and BadgerCare Plus:
- A young adult with income below 100% FPL may qualify for BadgerCare Plus – remember this is his/her own income and not the family’s income.
- A young adult with a disability may qualify for Supplemental Security Income (SSI) and will automatically be eligible for Wisconsin Medicaid. For more information on SSI go to socialsecurity.gov or call 1-800-772-1213.
- Adults with disabilities who work (or want to get a job) may be able to purchase coverage through Wisconsin Medicaid, called the Medicaid Purchase Plan or MAPP. To learn more, go to wisconsin.gov/medicaid/medicaid-purchase-plan.htm
Health Insurance Dates to Remember
November 1 – December 15 of each year: Marketplace Open Enrollment – sign up for the first time or change plans. Go to healthcare.gov for details.
Special Enrollment Period – if you have a qualifying life event (start or loose a job, get married, move or have a big change in your income) you may be able to sign up outside of the Marketplace open enrollment period – see healthcare.gov/glossary/special-enrollment-period/
Any Time! Enroll in Wisconsin Medicaid, BadgerCare or apply for Supplemental Security Income (SSI) – there is no specific open enrollment
Resources to Learn More
- ABC for Health, including their Consumer’s Companion: A Guide to Health Reform –safetyweb.org/resources.html
- Health Transition Wisconsin – http://www.healthtransitionwi.org
- BadgerCare Plus – dhs.wisconsin.gov/badgercareplus/
- SSI and benefits in Wisconsin – dhs.wisconsin.gov/ssi/benefits.htm
- Medical Assistance Purchase Plan (MAPP) – dhs.wisconsin.gov/medicaid/Publications/p-10071.htm
- The Marketplace and Young Adults – healthcare.gov/young-adults/coverage/
- Paying for Health Care in Wisconsin – dhs.wisconsin.gov/guide/pay.htm