Does Medicare Cover My Children?

Medicare Benefits Solutions
Jul 30, 2020

Although Medicare is generally associated with health insurance for seniors 65 and over, there are many people under the age of 65 who receive Medicare benefits due to a qualifying disability.

Medicare for anyone with end-stage renal disease (ESRD)

The only way a child under the age of 20 will receive Medicare benefits is if they are diagnosed with ESRD, or permanent kidney failure. This is the final stage of chronic kidney disease when dialysis or a kidney transplant is required for survival. Sadly, children can be afflicted with this condition. Medicare can help. 

For your child with ESRD to be eligible for Medicare, one of the following conditions must be met by you or your spouse:

• Earned a minimum of six credits within the last three years via employment and payment of Social Security taxes.
• Currently receiving or are eligible to receive Social Security or Railroad Retirement Board (RRB) benefits. 

Additionally, one of the following conditions must be met by your child:

• Needs regular dialysis.
• Needs a kidney transplant.

If your child qualifies for Medicare solely due to permanent kidney failure, the coverage will terminate either 12 months following the last month of dialysis treatment or 36 months following the month of the child’s kidney transplant.

Consider enrolling your child in Medicare even if he or she is enrolled in another medical insurance plan. If the current coverage ends for some reason, benefits may change. Enrollment in Medicare may provide consistency in coverage during treatment. 

Adult children with a disability (not ESRD)

If your adult child is a recipient of disability benefits from Social Security or RRB, enrollment in Original Medicare should be automatic after 24 months of receiving these disability benefits. Even if your child has never worked, they will still be eligible for Medicare if they were determined disabled before the age of 22.

Additional resources

Millions of children are enrolled in State Children’s Health Insurance Program (CHIP), available to children under the age of 19 whose family doesn’t qualify for Medicaid. Although benefits may vary by state, there are services required by the government to be included, such as immunizations, prenatal care, doctor services, and hospital care.