Healthcare for Adult Children Who Are Disabled

For parents with children who qualify for disability, navigating healthcare can be even more difficult than the process of signing up for Medicare.  Depending on status, children may qualify for Medicaid, Medicare, a combination of the two, or even qualify to be designated as a dependent on an employer plan if that’s available.  

Here’s a general overview of the options available as well as the pro/cons and catches of each:

1. Medicaid:

If your adult child does not have substantial income, they’ll likely qualify for Medicaid.  Medicaid is a program primarily funded by the state government to pay for health expenses.  Individuals qualify based on income.  The income threshold is typically 138% of the Federal Poverty Level which is approximately $17,000 for individuals in most states.

Pros: The good news is that there is no monthly cost for Medicaid (nor are there typically out of pocket expenses for covered services). 

Cons: The tradeoff is that Medicaid will limit you to providers who only take Medicaid, which often restricts out of state providers.

2. Medicare:

If your adult child qualifies for social security disability, they’ll be eligible for Medicare after 24 months of being on disability regardless of age.  Qualifying for Medicare can add additional benefits but may have significant trade offs as well.  When someone is collecting disability, they are automatically enrolled in Medicare Parts A (hospital) and Part B (outpatient) 3 months prior to their 24 month of disability.  

Pros: The benefit of qualifying for Medicare is the ability to choose from more health insurance options which may include additional benefits that Medicaid doesn’t cover as well as more providers. Typically someone who’s under 65 will only be able to choose from Medicare Advantage plans available (depending on state).  

Cons: However, the tradeoff is that Medicare will require recipients to pay the Part B premium ($174.70/mo, 2024) and with Advantage plans, there will be more co-pays and other out of pocket expenses that would otherwise be covered by Medicaid.  

3. Medicare/medicaid

Someone can also be eligible for both Medicare and Medicaid. The threshold for Medicaid when someone is eligible for Medicare drops significantly to approximately $1,094 per month (certain states may have different limits) and Medicaid will also take into consideration assets (property/savings) as well.  

Pros: If your adult child qualifies for both Medicare and Medicaid, they are considered dual eligible.  Medicare will be primary and Medicaid will be secondary.  Medicaid will cover the out of pocket costs not covered by Medicare.  Also, more Dual Medicare Advantage plans with rich benefits are available for individuals that qualify for both programs. 

Cons: Even though more plan options may be available to someone who is dual eligible, Medicaid will typically pay for only providers who take both Medicare and Medicaid.  

4. Employer coverage

If you’re in a situation where you have access to employer coverage, your child may qualify as a dependent on your plan provided that they’re under the age of 26.  

Pros: Most individuals will elect to have their adult children on their employer plan if the plan offers greater flexibility to providers otherwise not covered by Medicaid or Medicare.  

Cons: However, in most cases, if your adult children qualify for Medicare or Medicaid and their preferred providers are within the network, employer coverage may be redundant.

If your adult child is struggling with issues around navigating disability and you’re in RI, we partner with a great local non-profit: RIPIN (RI Parent Information Network).  RIPIN employs a team of well trained advocates to help you navigate through the maze of medicaid and disability. There’s no cost to you for their services since they’re publicly funded.  Please visit them at RIPIN.org for more information.