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Doctor & Hospital Visits

When Your Child Outgrows Pediatric Care

It might seem like only yesterday that you stepped into the pediatrician’s office for your child’s very first visit. And you might have been a little nervous as you got to know the person who’d be caring for your little one.

But after years of interaction (complete with late-night phone calls, last-minute appointments, and trustworthy advice), your pediatrician probably feels like part of the family. So when the time comes for your child to transition into adult health care, it can be hard to say goodbye.

Done abruptly, this change can be overwhelming and anxiety-inducing for you and your child. But if you’re both prepared and plan accordingly, it can be a smooth step on the path to adulthood.

Finding a New Doctor

Once kids become legal adults at age 18, they can visit an adult primary care physician (PCP), such as an internal medicine doctor (internist), a general practitioner, or a family medicine doctor.

Your pediatrician, who is specifically trained to care for kids and teens, might be able to provide care for a little longer if your child is in college (usually until college graduation or age 21). But this varies from doctor to doctor, so be sure to ask.

Ask your pediatrician for a referral if you don’t have a family doctor that your child wants to see or if your child has a chronic condition that will require an adult specialist’s care.

If your child has a rare condition, disability, or pediatric-onset condition (one that only develops in childhood), it may be challenging to find a PCP or adult specialist who is knowledgeable and comfortable caring for these complex needs. In this case, start searching for doctors early on, during the teen years.

Ask if your child can see a new doctor for a trial period; then, follow up with the pediatric specialist to discuss how things went and put both doctors in touch to plan for the transition of care. Allow plenty of time for this process — that way, if there is an issue your child can continue seeing the pediatric specialist until you find an adult provider who is a better fit.

Choosing Health Care Coverage

If your child is a dependent under your health care coverage, the Affordable Care Act allows your child to be covered until age 26, regardless of whether he or she is in college, living at home, or even married. Your child can be employed and still on your policy, as long as he or she is not eligible for health insurance benefits through an employer.

Coverage will expire on the day your child turns 26, so he or she should begin looking for new coverage well before this date.

Options Available

Many employers offer group health care coverage as part of their employee benefits package, which lets employees customize a plan that may include dental care, vision care, emergency care, and routine medical care. Long-term disability insurance (insurance that offers medical benefits for those who are out of work for an extended period of time) also might be offered by the employer, but at an added cost.

If insured through an employer, your child will have to pay a monthly fee (premium), based on the number of exemptions your child claims. He or she is also responsible for any co-pays and out-of-pocket fees that go directly to health care providers like doctors or pharmacists.

If no longer covered under your insurance plan and health coverage is not offered by an employer or spouse’s plan, your child might be eligible for coverage under COBRA, the Consolidated Omnibus Budget Reconciliation Act. This U.S. mandate requires all health insurance carriers to temporarily extend coverage in a group plan to former dependents for up to 36 months.

Since COBRA does not kick in automatically, your child must apply for coverage (and should do so quickly, since time of eligibility is limited). Premiums will be higher than what your child paid as a dependent on your plan.

Your child also can opt for individual health coverage (rather than through a company group plan), but premiums will be higher.

Special Considerations

If your child has a pre-existing condition, insurance companies can’t turn him or her down or charge more for coverage. If your child has special health care needs, your insurance plan may have an adult disabled child clause, which allows adult children with disabilities to stay on a parent’s plan indefinitely. Check with your insurance company to see if this is offered.

Those who are disabled prior to turning 22 also may be eligible for Social Security Disability Insurance (SSDI). These benefits are offered to disabled children whose parents paid into Social Security throughout their careers. After a child has SSDI for 24 months, he or she is also eligible for the U.S. government’s Medicare insurance plan.

Kids whose parents are deceased, retired, or receiving disability benefits themselves may qualify for benefits. Adult children who are disabled also may receive coverage through the government’s Medicaid program if their incomes fail to cover the cost of medical services, or if they qualify for and/or receive Supplemental Security Income (SSI).

Being a Responsible Patient

Unlike pediatric care, adult health care is based on patient responsibility — and with that responsibility comes control. So, your child will have the authority to make all medical decisions and also is entitled to privacy regarding all medical conditions, unless he or she opts to share information with you.

Once responsible for their own health care, it’s important for young adults to relay medical information — such as previous illnesses, operations, medications, and immunizations — to all health care providers. Be sure your child mentions allergic reactions to medications (like penicillin), and whether or not there’s a family history of disease, like cancer or heart disease. This information should be shared with all doctors, especially those working together to treat an illness or chronic condition.

Encourage your son or daughter to keep copies of all medical records and an up-to-date list of medicines and dosages.

And while it’s important to see a doctor with a health concern, it’s also important to visit regularly for checkups and screenings. Health care providers will make recommendations about when to undergo screenings based on your child’s personal and family medical history.

Before Your Child Reaches Adulthood

Since kids will be responsible for managing their own health care as adults, it makes sense for them to start “co-managing” their health care during the teen years. So, little by little, encourage your teen to take an active role — scheduling appointments and refilling prescriptions are good places to start. This builds self-confidence and also gives parents a sense of relief knowing that their kids can take care of themselves.

The transition into adult health care won’t happen overnight. But by planning in advance and talking about what to expect, you’ll help your child successfully manage his or her own health care when the time comes.

Reviewed by: Cory Ellen Nourie, MSS, MLSP
Date reviewed: January 2014