Insurance Issues for Youth with Cystic Fibrosis During the Transition

Individuals with Cystic Fibrosis and their families face many challenges especially when the individual is a child transitioning to adult care. The cost of health insurance to pay for healthcare and the cost of co-pays for prescription drugs are two issues that have special importance for a young person with CF during the transition. Issues of government benefits may play an important role in the individuals ability to access needed medical care. Below is a brief discussion of some issues that may assist families planning for the transition of their child with CF.

General Considerations

When a child reaches 18 years of age or completes high school a parent's insurance policy may not provide for continuation of coverage. The insurance policy may have a limiting age for coverage of a young adult on their parent's policy. Each insurance policy has their own guidelines regarding coverage for a young adult on a parent's policy. Typically the policy provides coverage for a child until a certain age. If the child is a full time student at a college the insurance policy usually allows coverage to continue until college is completed. A young adult with CF who is not a full time college student or who is not pursuing additional education after graduating from high school will be faced with the possibility of no insurance coverage. There are a variety of options for the child to continue to be covered on the insurance plan or to obtain other coverage. No matter what option is appropriate it is important for parents and young adults to understand the possibilities for continuation of coverage and the conditions for such an extension of coverage. Planning for the time when coverage may lapse is crucial.

COBRA Extension of Benefits

According to the Consolidated Omnibus Reconciliation Act (COBRA), one of the qualifying events that will allow an individual to extend benefits, is when a child reaches a limiting age according to the policy. In such a situation the individual can extend coverage for 36 months. COBRA only applies to employers with 20 or more employees. In addition, the policyholder will have to pay the premiums for the child's coverage during the 36 month period. However, for the child who does not qualify for another extension of benefits, COBRA will provide much needed coverage for 36 months. During that time the family should be taking steps to secure other coverage for their child.

State Insurance Code Extension of Benefits

A child who reaches a limiting age on their parent's insurance policy may qualify for an extension of benefits according to a state insurance law. Most states have insurance laws that allow an extension of coverage for a child who reaches a limiting age on the policy but is unable to support themselves because of a physical or mental disability. The states that do not have such a provision include: Alabama, Alaska, Delaware, District of Columbia, Kansas, Maine, Oklahoma,Oregon and Rhode Island. California does have such a law which can be found at California Insurance Code Section 10277 or 10278.