Turning 26 is a major milestone when it comes to health insurance. Under most group health plans, this is the age at which dependent children typically “age out” of coverage under a parent’s policy. For many, this means exploring options to temporarily extend coverage. But what happens when the young adult has a disability?
Ongoing Coverage for Young Adults with Disabilities
For young adults with disabilities, New Jersey offers a long-term solution. If a child is disabled and dependent on a parent for care and support, they may remain on a parent’s fully insured group health plan indefinitely, even after age 26.
To qualify:
- The young adult must be incapable of self-sustaining employment due to a mental or physical disability.
- They must remain primarily dependent on the parent(s) for support.
- The parent must provide proof of disability to the insurance company before the child turns 26.
It is important to note that the insurer may require ongoing verification of the dependent’s condition and reliance on the parent. Importantly, this coverage may be maintained in conjunction with Medicaid, allowing families to utilize private insurance as primary coverage while Medicaid fills secondary gaps — a significant advantage for care continuity and cost control.
If you have questions about dependent health coverage, continuation rights, or eligibility for the disability exception under New Jersey law, we’re here to help. Our Special Needs team at Mandelbaum Barrett PC can guide you through the process, assist with documentation, and ensure your loved one maintains the coverage they need.