It might seem like only yesterday that you stepped into the pediatrician's office
for your child's very first visit. But the time will come when your child needs to
move into adult health care.
This change can be overwhelming for you and your child. But if you're both prepared
and plan ahead, it can be a smooth step on the path to adulthood.
Finding a New Doctor
Kids become legal adults at age 18. Then, they can visit an adult primary
care physician(PCP), such as an internal medicine doctor
(internist), a general practitioner, or a family medicine doctor.
Pediatricians are trained to care for kids and teens. Some still might provide
care for a little longer if a young adult is in college (usually until college graduation
or age 21). But this varies from doctor to doctor.
Ask your pediatrician for a referral if you don't have a family doctor that your
child wants to see or if your child has a chronic condition that will need an adult
It may be a challenge to find a PCP or adult specialist if your child has a rare
condition, disability, or pediatric-onset condition (one that develops only in childhood).
You'll want someone who's comfortable caring for these complex needs. So start searching
for doctors early, during the teen years.
Ask if your child can see a new doctor for a trial period. Then, follow up with
the pediatric specialist to see how things went and put both doctors in touch to plan
for the transition of care. Allow plenty of time for this process. That way, if there's
an issue your child can continue seeing the pediatric specialist until you find an
adult provider who is a better fit.
Choosing Health Care Coverage
If your child is a dependent under your health care coverage, the Affordable Care
Act (ACA) allows your child to be covered until age 26. It doesn't matter if your
child is in college, living at home, employed, or even married. Your child still can
be on your policy.
If your child is a dependent on your job-based health
care plan, coverage will expire on the day your child turns 26. So begin looking
for new coverage well before this date. If covered through an ACA Health Insurance
Marketplace plan, your child can keep the insurance until December 31 of the year
he or she turns 26.
What Options Are Available?
Many employers offer group health care coverage as part of their
employee benefits package. It lets employees customize a plan that may include dental
care, vision care, emergency care, and routine medical care. Long-term disability
insurance offers medical benefits for those who are out of work for a long period
of time. If offered, it's at an added cost.
If insured through an employer, your child will pay:
a monthly fee (premium), based on the number of exemptions claimed
any co-pays and out-of-pocket fees that go to health care providers like doctors
What if your adult child is no longer covered under your insurance plan and health
coverage is not offered by an employer or spouse's plan? Then, they might be eligible
for coverage under COBRA, the Consolidated Omnibus Budget Reconciliation
Act. This U.S. mandate requires all health insurance carriers to temporarily extend
coverage in a group plan to former dependents for up to 36 months.
COBRA does not kick in automatically. Your child must apply for coverage and should
do so quickly, as the eligibility period is limited. Premiums will be higher than
what your child paid as a dependent on your plan.
Your child also can opt for individual health coverage through
the Marketplace on HealthCare.gov. Most
plans are based on your adult child's income. Many are subsidized to make them more
Insurance companies can't turn down people with a pre-existing condition, or charge
them more for coverage. If your child has special health care needs, your insurance
plan may have an adult disabled child clause. This lets adult children with disabilities
stay on a parent's plan indefinitely. Check to see if your insurance company offers
Those who are disabled before age 22 also may be eligible for Social Security Disability
Insurance (SSDI). These benefits are offered to disabled children whose parents paid
into Social Security throughout their careers. Kids whose parents have died, are retired,
or get disability benefits themselves may qualify for benefits. After getting SSDI
for 24 months, they're also eligible for the U.S. government's Medicare insurance
Adult children who are disabled also may receive coverage through the government's
Medicaid program if their incomes fail to cover the cost of medical services, or if
they qualify for and/or receive Supplemental Security Income (SSI).
Being a Responsible Patient
Adult health care is based on patient responsibility. With that comes control.
So, your child will make all medical decisions and is entitled to privacy about all
medical conditions. You won't get that information unless your child chooses to share
it with you.
It's important for young adults to share their medical information with all their
health care providers. This includes previous illnesses, operations, medicines, and
immunizations. They should also mention any allergic reactions to medicines, and any
family history of disease, like cancer or heart disease.
Encourage your son or daughter to keep copies of all medical
records and an up-to-date list of medicines.
And while it's important to see a doctor with a health concern, it's also important
to go for regular checkups and screenings. Recommended health screenings are based
on your child's personal and family medical history.
Before Your Child Is an Adult
Help your kids start "co-managing" their
health care during the teen years. Little by little, encourage teens to take an
active role. They can schedule appointments and refill prescriptions, for example.
This builds self-confidence and also shows parents that their kids can take care of
The move to adult health care won't happen overnight. But planning ahead and talking
about what to expect will help kids manage their medical care when the time comes.