Medicare and Children: How Do I Get Medicare for My Child?

Medicare typically provides healthcare coverage for seniors, but kids who have disabilities or who've been diagnosed with end-stage renal disease may be eligible for benefits, too, if they meet certain criteria. Here’s what you should know about Medicare and children.

Can a Child Qualify for Medicare Coverage?

Medicare defines a child as an unmarried individual under the age of 22. Children up to this age may qualify for Medicare coverage if they've been diagnosed with end-stage renal disease or Lou Gehrig’s disease (amyotrophic lateral sclerosis), or who have a qualifying SSDI disability.

Medicare for Children With End-Stage Renal Disease

Children under 20 years of age may be eligible for Medicare if they’ve been diagnosed with end-stage renal disease. To qualify, they must require maintenance dialysis or need a kidney transplant, and have one or more parents who receive or are eligible to receive Social Security retirement benefits.

Coverage for children diagnosed with ESRD starts at the beginning of their fourth month of dialysis. However, the government may backdate coverage to pay for prior treatments. If a child with ESRD shows signs of improving and no longer meets the above criteria, or has successfully received a kidney transplant, Medicare may be discontinued. 

Medicare for Children With Lou Gehrig's Disease

Beginning at age 18, a child may be eligible for Medicare if they've been diagnosed with amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease. To qualify, the child must have one or more parents who receive or are eligible to receive Social Security retirement benefits. Medicare coverage may begin immediately for kids diagnosed with ALS as long as they meet all other criteria.

Medicare for Children With Disabilities

Children aged 20 and over may qualify for Medicare if they’ve received SSDI benefits for at least 24 months. Children with no employment history may qualify for SSDI payments if they:

• Became disabled prior to age 22
• Are unmarried
• Have a parent who gets Social Security retirement benefits

How Do I Get Medicare for My Child?

The process for enrolling a child in Medicare depends on whether they're eligible through a qualifying disability, ESRD or Lou Gehrig's disease.

Children With a Qualifying Disability

Children aged 20 to 22 who have a qualified disabling condition are automatically enrolled in Medicare after receiving SSDI payments for 24 months and should receive enrollment information in the mail. At that time, they may add on a Part D prescription plan or opt for a Medicare Advantage policy, if a suitable special needs plan is available in their area. 

Children With an ESRD or Lou Gehrig’s Disease Diagnosis

You can get Medicare for a child diagnosed with ESRD or Lou Gehrig’s Disease by enrolling through the Social Security Administration, either online or by visiting a local office.

Are Dependents Covered by Medicare?

No. Medicare doesn’t offer family plans, so dependents, including minor children, can't be covered under a parent or spouse’s policy. Dependents may only receive Medicare benefits if they meet the individual criteria for the program.

What Is the Youngest Age to Qualify for Medicare?

Individuals who've been diagnosed with Lou Gehrig's disease may qualify for Medicare as young as age 18.

Can You Enroll a Child in a Medicare Advantage Plan?

Children who qualify for Medicare due to a disabling condition may be eligible to enroll in a Medicare Advantage Special Needs Plan. SNPs limit enrollment to individuals who have specific diseases or medical characteristics, and may serve individuals living in an institution or receiving skilled nursing services at home. These plans typically tailor benefits, such as drug formularies and provider networks, to meet the needs of the population being served. The availability of SNPs generally varies by region.

What Costs Apply to Children Receiving Medicare?

Children who enroll in Medicare incur the same costs as adults in the program, including:

• Monthly premiums
• Part A and B deductibles
• Part A and B coinsurance
• Prescription drug (Part D) copays

Are There Other Healthcare Coverage Options Available for My Child?

Yes. If your child doesn’t qualify for Medicare, and you can’t afford private medical insurance, the following healthcare options may be available:

• Medicaid: Children aged 19 or older may qualify for healthcare coverage through Medicaid, which offers comprehensive healthcare benefits to low-income individuals and families. Because the program is administered by individual states, eligibility guidelines may vary. Applications for Medicaid are available through state Medicaid offices or online at the healthcare marketplace.
  
  
• Children's Health Insurance Program (CHIP): Children aged 18 or younger from low-income families may be eligible for benefits through CHIP. This joint state-federal program is designed to provide low-cost healthcare coverage to kids whose families don’t meet their state’s Medicaid income requirements but can't afford private insurance. Eligibility is based on a family’s modified adjusted gross income.
  
  
• The Healthcare Marketplace: Families may find affordable coverage options for children through the healthcare marketplace. Low-cost, high-deductible plans are available, and children over 18 who hold jobs and aren't claimed as dependents may qualify for savings based on their income. 

Additional information on state-specific healthcare options, including Medicaid and CHIP, can be found online at InsureKidsNow.gov.