Most of the time, Medicare is for individuals who are 65 years of age or older. However, there are exceptions to this rule. Sometimes, even children can qualify for Medicare. Learn more about Medicare for children so you can find out if anyone in your family fits the criteria for coverage.
In order to qualify for Medicare, children must meet certain relationship requirements with you, their parent or guardian. The child must be related to you by birth or adoption. If the child has been your stepchild for one year or more, they may also qualify for coverage. In addition, you have to have received Medicare credits through your work in past years.
Other Important Requirements
It takes more than meeting relationship requirements for your child to qualify for Medicare. If your child is over 20 years of age, they must be disabled and have been receiving disability benefits from the social security administration for at least two years before applying for Medicare. Even if your child has never worked, they can still get Medicare coverage because of their disability. The child must have been disabled before reaching age 22.
Adult children who qualify for Medicare will remain entitled to benefits as long as they:
- Remain disabled
- Remain unmarried
Even though your adult child is disabled, they may still be capable of working. If this is the case, they’ll go through a trial work period of nine months. If they keep working after those nine months, Medicare will continue to be provided for seven years and nine months. Then, your child will become a Medicare enrollee rather than a Medicare beneficiary, which means that your child will have to start paying for Medicare.
The only way a child under 20 can get Medicare is if they have end-stage renal disease (ESRD). ESRD, which is the final stage of chronic kidney disease, severely affects the ability of the kidneys to function. If your child has ESRD, in order to qualify for Medicare, they must:
- Need dialysis or require a kidney transplant
- Have at least one parent who qualifies for social security benefits
Understanding Medicare Benefits for your child
Medicare works in largely the same way for both children and adults. Your child can benefit from Part A and Part B, which cover hospital and medical services. Part B requires a monthly premium. For prescription drug coverage, your child may enroll in Part D.
Another option is to take advantage of Medicare Part C, otherwise known as Medicare Advantage. A Medicare Advantage plan is provided through a private insurer instead of the federal government, and it may have more robust coverage than Parts A and B.
It is also wise for you and your child to look into Medicare Supplement insurance, which can fill in the gaps that Medicare leaves wide open. Other supplemental insurance can help you pay for things such as eye exams, routine foot care, and dental services. Options for both Medicare Advantage and Medicare Supplement are likely limited for those under the age of 65.
Understanding Medicare coverage can be tricky, so be sure to do plenty of research and get advice from reliable experts. You don’t want to end up with surprise medical bills that will put a heavy financial burden on your family.
Alternatives to Medicare
Since very few children are eligible for Medicare, you should educate yourself on the alternatives that can provide free or low-cost health services for your little ones. According to Medicaid.gov, more than eight million children are enrolled in State Children’s Health Insurance Programs, otherwise known as CHIP.
CHIP is available to children under age 19 whose families make too much money to qualify for Medicaid. Each state determines its own income requirements for CHIP coverage and Medicaid, so you should look into local regulations to discover more about if your children qualify.
Benefits also vary between states, but you can reasonably assume that most screening, diagnostic, and treatment services are covered by your state’s CHIP. All states are required to offer the following services:
- Children’s immunizations
- Prenatal care
- Physician services
- Hospital care, both in-patient and out-patient
Of course, if your family is struggling financially, you may qualify for Medicaid rather than CHIP. In many states, the two programs provide the same coverage.
Medicare for minors and adult children can pay for necessary care and help your family manage the burden of caring for someone who is ill. If you think your child might qualify for Medicare, start the application process soon.