Health insurance after 26: Got it!

One of the more popular posts on the Cinder Cone has been this one about health insurance for young people with disabilities. As the debates about health insurance swirled around Washington this year I wondered whether I’d need to “repeal and replace” the post’s content with whatever scenario emerged from that mess. At this writing, no change is needed.

In related news, we were able to keep Nathan on my medical, dental, and vision insurance after he turned 26 this year. Because a couple of surprises occurred along the way, our story is worth sharing here as a cautionary tale.

Nathan had been on my husband’s insurance from infancy. But when I started working for a large employer last year, it made sense to move Nathan from his dad’s insurance (through a very small business) to my insurance.

Last fall, while Nathan was still 25, I filed the forms to add him to my coverage.

His eligibility was verified by a third party, not by the insurance companies. I provided a scan of his birth certificate, and also had the option of submitting paperwork to prove that he has an ongoing disability.

It was my understanding that filing the proof of disability at the time of enrollment would lead to smooth sailing when Nathan turned 26 several months later. They’d already know he was disabled. No further hassle.

Since earlier in the year we had received the letter from Social Security stating that Nathan was eligible to continue receiving SSI payments, I scanned and uploaded that sucker! What better proof of disability?

A few weeks later, the third party agreed that Nathan was my son. He was added to my medical, dental, and vision coverage. Yay.

Three months prior to Nathan’s birthday this year, imagine my surprise to receive a letter from my dental insurer. It pretty much said, Hey, your son is turning 26 soon, and we’ll drop him unless you can submit “a letter from a medical provider verifying that your dependent is disabled.” Have a nice day.

I was perturbed for two reasons.

First, I thought I’d already covered this with the SSI letter at the time of enrollment.

Second, Nathan no longer has a medical provider familiar with his diagnosis. It’d been years since he’d seen a psychiatrist (= physician). And he’d stopped going to a psychologist (= not a physician) in 2015.

I told the health care facilitator (HCF) for my employer about this puzzling turn of events.

She couldn’t really respond about the third party verification issue, but affirmed that I’d have to come up with the requested documentation now.

But, she added that although I’d received a letter from the dental insurer, I should file proof of disability with the medical insurance provider. If they accepted that Nathan is disabled, the dental and vision insurers would follow suit.

She emailed me the disabled dependent certification form I’d need to submit to my medical carrier.

It was only one page (hooray) but the key section was “to be completed by attending physician.” Dang.

I explained our no-physician situation to the HCF, who checked with the medical carrier. She found out that “if the main provider diagnosing your son is a psychologist, that provider can complete the certification form.”

Yay. I’d had a good rapport with Nathan’s last psychologist, so I didn’t feel too awkward asking him to fill out the form.

I left a voicemail. Two weeks went by with no response. Had he retired, and neglected to shut off the “You have reached the voicemail of Dr. K____. If this is a life-threatening emergency, please hang up and dial 911” message?

I left another voicemail. Another week went by before Dr K called back.

He’d be happy to fill out the paperwork; “I’d do anything for Nathan,” he emphasized. He recapped for several minutes how much he’d enjoyed their sessions, and why he felt Nathan was unlikely to ever hold a job for long. I thanked him profusely, and that night sent him the certification form with a self-addressed stamped envelope.

Two weeks went by. I left another voicemail.

Finally, the sought-after envelope showed up in our mail a week later. Retaining a copy, I sent the filled-out form to the HCF via interoffice mail, and she sent it to my medical insurer.

A few weeks went by, until she emailed: my insurer had accepted Nathan as a disabled dependent. He would continue to be covered.

End of story? Not quite.

I had to contact the HCF one more time a few weeks later, because we’d received another pleasant letter from my dental plan. It was a repeat of the initial letter, except now it noted that Nathan’s 26th birthday was a month away. Had the dental and vision plans gotten word of the medical plan’s decision?

In response, the HCF updated my records in the system to show that Nathan was an approved disabled dependent. That information would be transmitted electronically to my dental and vision carriers.

The whole process was now finished, three weeks before Nathan’s birthday. Whew!

And everything has been fine.

I sent a note to Dr K and an email to the HCF, thanking them for their efforts that resulted in our family’s peace of mind.

Here are a few lessons learned from this mini-saga:

Disability documentation provided to a benefits eligibility verification outfit doesn’t mean that the insurers themselves will automatically be on board.

It doesn’t hurt to clarify the terms used on a disabled dependent certification form. I would have been scrambling even more if I’d assumed we truly needed input from a physician. However, I’m not sure all health plans will include psychologists or counselors under their umbrella of “medical provider.” Best to verify such things early on.

Don’t delay in taking action! I started doing stuff three months before Nathan’s birthday, but as you saw, we only got things finalized with a few weeks to spare. Two months prior to his birthday, my medical carrier had also sent me a letter about my dependent turning 26. Since it ended up taking 2 1/2 months to get everything in place, I’m glad the dental carrier’s letter had arrived at three months prior.

Have you been through disabled dependent certification for your neurodiverse 26-year-old? What was the outcome? Let us know!






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About janet565

I've lived in the Inland Empire of Southern California since 1982. My profession involves maps and geography. I hope you find the blog useful, and wish you well....

3 responses to “Health insurance after 26: Got it!”

  1. Kim Drury says :

    Thank you for this information. We are starting this process right now, 10 months prior to my sons birthday.


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