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Medicare Eligibility for Children

Medicare is a federal health insurance program designed for Americans age 65 and older. However, in some cases, people younger than age 65 are eligible for Medicare benefits. Children, defined by Medicare as anyone under age 22 and unmarried, can receive Medicare benefits if they meet certain eligibility criteria.

  1. Eligibility

    • To qualify for Medicare benefits, a child must be disabled according to Social Security Administration definitions for at least two years, or have End Stage Renal Disease, a kidney condition that requires dialysis or a kidney transplant. Medicare will pay for hospital and doctor's services provided for the treatment of those conditions, as well as general medical care, hospice and home health services as necessary. Parents are responsible for paying the Medicare monthly premiums, co-payments and deductibles for the child covered by Medicare. Children who meet these conditions are eligible for Medicare even if they have other insurance.

    Working Credits

    • Children who are disabled or have ESRD are only eligible for Medicare if their parents meet certain requirements as well. Medicare will only extend benefits to your child, legally adopted child or grandchild. A stepchild can receive Medicare benefits if you have been a stepparent for at least one year. You must have earned at least six Medicare credits in the past three years through work; in general, you earn one Medicare credit for each $1,120 you earn from work, as of 2011. Alternatively, if you're eligible for Social Security or Railroad Retirement Board benefits, your child can qualify for Medicare.

    Time Limits

    • If your child has End Stage Renal Disease, Medicare benefits are time limited. In general, coverage ends 12 months after the last month of dialysis treatment, or three years after a kidney transplant. In some limited cases, coverage can be extended. If your child is disabled, she'll be able to keep her benefits as long as she is disabled. The law allows anyone over age 22 to qualify for Medicare if the disability began before age 18, even if the individual did not have any working credits.

    Other Options

    • Children who are eligible for Medicare Parts A and B are also eligible for a Medicare Part D plan, a standalone drug plan offered by a private insurance company. There may be restrictions on the drugs that the Part D plan will cover. In addition to Medicare, though, there are other programs that can help you pay for the care your child needs. In most states, children with disabilities qualify for state Medicaid programs. Depending on your household income, your child may qualify for free services or for a discount health insurance plan that will cover necessary medical care.

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