Pediatric doctor age limit

When Your Child Outgrows Pediatric Care

Choosing Health Care Coverage

If your child is a dependent under your health care coverage, the Affordable Care Act (ACA) allows your child to be covered until age 26. It doesn’t matter if your child is in college, living at home, employed, or even married. Your child still can be on your policy.

If your child is a dependent on your job-based health care plan, coverage will expire on the day your child turns 26. So begin looking for new coverage well before this date. If covered through an ACA Health Insurance Marketplace plan, your child can keep the insurance until December 31 of the year he or she turns 26.

What Options Are Available?

Many employers offer group health care coverage as part of their employee benefits package. It lets employees customize a plan that may include dental care, vision care, emergency care, and routine medical care. Long-term disability insurance offers medical benefits for those who are out of work for a long period of time. If offered, it’s at an added cost.

If insured through an employer, your child will pay:

  • a monthly fee (premium), based on the number of exemptions claimed
  • any co-pays and out-of-pocket fees that go to health care providers like doctors or pharmacists

What if your adult child is no longer covered under your insurance plan and health coverage is not offered by an employer or spouse’s plan? Then, they 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.

COBRA does not kick in automatically. Your child must apply for coverage and should do so quickly, as the eligibility period 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 through the Marketplace on HealthCare.gov. Most plans are based on your adult child’s income. Many are subsidized to make them more affordable.

Special Considerations

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

Those who are disabled before age 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. Kids whose parents have died, are retired, or get disability benefits themselves may qualify for benefits. After getting SSDI for 24 months, they’re also eligible for the U.S. government’s Medicare insurance plan.

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

Adult health care is based on patient responsibility. With that comes control. So, your child will make all medical decisions and is entitled to privacy about all medical conditions. You won’t get that information unless your child chooses to share it with you.

It’s important for young adults to share their medical information with all their health care providers. This includes previous illnesses, operations, medicines, and immunizations. They should also mention any allergic reactions to medicines, and any family history of disease, like cancer or heart disease.

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

And while it’s important to see a doctor with a health concern, it’s also important to go for regular checkups and screenings. Recommended health screenings are based on your child’s personal and family medical history.

Before Your Child Is an Adult

Help your kids start “co-managing” their health care during the teen years. Little by little, encourage teens to take an active role. They can schedule appointments and refill prescriptions, for example. This builds self-confidence and also shows parents that their kids can take care of themselves.

The move to adult health care won’t happen overnight. But planning ahead and talking about what to expect will help kids manage their medical care when the time comes.

Reviewed by: Cory Ellen Nourie, MSS, MLSP Date reviewed: October 2019

When to Transition Your Child From a Pediatrician to a Primary Care Doctor

Parents know the bittersweet feeling of watching their grown children finally fly the coop. Turns out doctors who specialize in treating young children have their own version.

“As a pediatrician, it gives me a great joy to see my patients as newborns and care for them all the way into adolescence, and that makes it hard sometimes to see them leave the practice,” said Dr. Hirut Dagnew, a pediatrician at Beaumont Pediatrics, Southgate. “However, it is part of caring for them as I prepare them to leave the pediatric office nest.”

When should you make the transition from a pediatrician to a primary care physician? Let’s first clear up any confusion over the different medical specialties.

Pediatricians and primary care providers

As it turns out, pediatricians are simply primary care providers who receive training in internal medicine but do their residencies focused on caring for children. They are experts in all aspects of a child’s development, and they have to pass a pediatric board exam before they can legally practice.

“So when adolescents and young adults transition their health care from us pediatricians, they see either a family practice or internal medicine doctor,” Dr. Dagnew said.

When to make the transition

Depending on their circumstances, adolescents and young adults typically transition from a pediatrician to a primary care doctor between the ages of 18 and 21, Dr. Dagnew said.

“Most children who do not have major medical problems can transition at 18 years, while those with multiple health concerns usually take loner to coordinate their follow up care and may still stay under the care of their pediatrician until age 20 to 21,” she said. “Pediatricians usually do not see young adults who are older than 21 years of age.”

Of course, some adolescents, in particular, aren’t content to sit in a waiting room with infants and toddlers and the toys and books that cater to them, and are ready to make the transition well before they turn 18. In this case, Dr. Dagnew said she recommends they go to a family medicine doctor.

“Mostly, these children are healthy, with no chronic medical problems, and overall are doing very well in all areas of their life,” she said.

Tips for making the switch

  • Start the discussion early. Dr. Dagnew said she typically initiates the discussion about transitioning away from the pediatric office when the child is in middle school or beginning high school, and generally during annual wellness visits, as part of discussions about developmental changes.
    “I explain that, just like how they advance from middle school in to high school and then post-high school training, there will come a time that they will transition to an adult health care provider,” she said. “I invite them to ask questions and then answer the questions raised by patient and parents.”
  • Encourage the child to self-manage their health care needs. Dr. Dagnew offers as an example asthmatic children, saying she lets patients with asthma carry their rescue inhalers after they turn 12. She also asks them whether they take their daily controller medication without a parent reminding them. Parents could also follow this model.
  • Work closely with the pediatrician when your child has special needs. If your child needs things like occupational or physical therapy, mental health counseling or respite care, talk with your child’s pediatrician well ahead of time to find available services before you make the switch.
    Dr. Dagnew said she advises parents and caregivers to get guardianship or power of attorney before the child turns 18, depending on how much support their child will need from them.
  • Ask about your child’s health records. Your child’s new physician will need them. The good news is that electronic health records have made this transfer between doctors much easier.
    “For a few of my patients who have multiple and complicated medical problems, I prefer to make a summary of both past and current problems and hand it to the parent or caregiver, so they have something comprehensive at hand for a quick review,” Dr. Dagnew said.

What will the new doctor need to know?

  • You will need to get health records transferred from your pediatrician to the new practice. If you child is 18 or older, he or she will have to make this request, not you. Ideally, request all of the records, perhaps on a disc or thumb drive. What the new doctor needs most are the last few notes in the record (including the last physical, and the latest specialty notes), the vaccination record, and an updated medication and allergy list.
  • Make sure your teen knows their family medical history. Write down any medical problems in the family, particularly those of your teen’s parents, siblings, grandparents, and other close relatives. It’s not something families often talk about, and it’s crucial information for your teen’s new doctor.
  • See if your pediatrician is willing to reach out to the new primary care provider to do a “warm handoff.” Most are willing and it could make all the difference, especially if there are any special health care needs.

This may seem like a lot, but it’s really not. The key is to start early, and work at it throughout your child’s high school years. If you do, by the time they make the transition from a pediatrician to a new primary care doctor, everyone will be ready — not just your child, but also the new doctor, which puts your child in the best position possible as they take on life — and health care — on their own.

Doctors Your Child Needs

Depending on your child’s health, they could see many other medical professionals. Someone who struggles with allergies, for instance, may see an allergist. Recurring throat or ear infections could lead them to an ear, nose, and throat (ENT) doctor. Generally, your child’s pediatrician or family doctor will refer you to the medical professionals your child needs to see, if any.

Allergist

If your child develops asthma or has frequent allergic reactions that impair their daily life, they may be referred to an allergist. An allergist will perform specific tests to determine whether your child has allergies or sensitivities to their environment. They can recommend treatments and medications to make breathing easier as well.

Endocrinologist

An endocrinologist is a doctor who specializes in understanding the body’s metabolism and production of hormones. If your child is diagnosed with type 1 diabetes or a hormone imbalance, you will need to bring them to a doctor specializing in endocrinology. Thyroid and adrenal issues, though unlikely to occur in babies, are often discovered as a child approaches puberty. An endocrinologist can diagnose and treat these conditions.

Dermatologist

A dermatologist diagnoses and treats diseases of the skin. Birthmarks and inherited skin disorders may need to be addressed by a dermatologist after your child is first born. As your child approaches puberty, they may need a dermatologist to help them deal with hormonal acne and other skin changes that occur as they get older. Although there are dermatologists who specialize in pediatric medicine, most dermatologists can assess skin problems in any age group.

Child psychologist or psychiatrist

A child’s mental health is just as important as their physical health. Sometimes a traumatic event, the death of a loved one, or big changes in family life will mean that your child needs to speak with a psychologist or psychiatrist. Whether mental health symptoms are behavioral or emotional, it’s important to address the way your child feels and make sure that they know they have someone to talk to. Sometimes attention deficit hyperactivity disorder (ADHD), dyslexia, or other learning challenges make a mental health professional an essential part of your child’s academic success as well. If your child needs to be prescribed medication for a mental health diagnosis, then they will need to see a child psychiatrist. Learn more about maintaining your child’s health “

Children’s hospital

If your child is diagnosed with a serious and ongoing medical condition, they may need to be treated in a children’s hospital. The advantage of a children’s hospital is that the equipment and treatment options are tailored to the needs of children, and the staff have been specially trained to communicate with and be sensitive to children. Only 1 in 20 hospitals in the United States is a children’s hospital, so traveling to one is not always convenient. But if your child is in a situation where specialized care is required, going to a children’s hospital might make for a better and more effective experience.

He’s 26 years old but still sees a pediatrician: Why some young adults don’t move on

“Actually, I think it impacts them more in a positive manner, because I think pediatricians are very thorough in their assessment,” she says.

It’s certainly more thorough than an urgent care center, which is where many 20- and 30-somethings wind up when they don’t have insurance and are no longer seeing their pediatrician, Alfonzo says.

The American Academy of Pediatrics (AAP) attempted to address the issue of transition from pediatric care into adult care in a policy statement in 2017 and concluded “the age of transition” should be based not on a number but on the patient’s individual needs.

The decision “should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet those needs,” the policy statement said. In addition, it said that ‘the establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. Health care insurers and other payers should not place limits that affect the patient’s choice of care provider based solely on age.”

The statement was written and published because more pediatricians were seeing older and older patients, and because insurers and health-care providers had begun to draw arbitrary lines as to the age at which a patient should no longer be seen by a pediatrician, said Jesse Hackell, vice president of AAP’s New York chapter and a co-author of the statement.

“There are no official, legal rules,” Hackell says. “Sometimes the insurance companies will try and make rules. Sometimes the hospitals will make rules. But there’s nothing to say we couldn’t keep seeing them. We’re licensed as physicians, not pediatricians.”

Hackell, a pediatrician in Pomona, N.Y., says he has patients who definitely don’t want to leave, and most of their problems are ones he is equipped to deal with. Often, he’ll keep the patients through their college years. Why should they have to find a new physician if they get sick while they’re home on break? he asks.

“I won’t take on a new patient after about the age of 18 or 20, but I will certainly see my patients who I’ve seen since they were kids,” he says.

Once they graduate, though, he generally tells them it’s time to start looking for a general practitioner who treats adults, he says.

“We have to gently nudge them out,” he says.

Living at home and remaining on parents’ insurance policies aren’t the only reasons ­20-somethings stay with pediatricians. Medical advancements over the past decade are extending the life expectancy of those with chronic childhood illnesses, such as congenital heart issues, cystic fibrosis, hemophilia and diabetes, and the pediatricians who cared for children with these conditions sometimes remain with them as they get old, says Michelle Hofmann, medical director in pediatric services at NeuroRestorative in Riverton, Utah.

Hofmann says when she was training in a pediatric intensive care unit, she had to resuscitate a 50-year-old man who was in her children’s hospital because he’d had congenital heart disease since he was a child. When it was time to do heart surgery, he wanted to have it there.

“One of the things that I think they do really well in pediatrics is establish those lifelong relationships, because your visits are so frequent when you’re growing up. If you don’t move around a lot, you do tend to stay with the same doctor,” Hofmann says.

The care can also be different. Her patients with cerebral palsy, for instance, have neurological issues from birth that may require supportive technologies such as feeding tubes or ventilators, technologies that when used on adults are often not to prolong life but rather in the face of a traumatic accident or a life-ending illness. And who would a patient with cerebral palsy, caused by brain damage that occurred before birth or during a child’s first three to five years, see? Hofmann asks.

For those without major issues, though — a college student or graduate about to embark on working life — the transition can be abrupt, sometimes precipitated by a “Sorry, you’ve aged out” response when they call to make an appointment or by a sign in the waiting room.

Debra Blau Reicher, a school psychologist, says she continued to consult her childhood pediatrician about her health issues well after she began taking her daughter to see him. If her daughter had strep, the pediatrician would do a throat culture on Reicher as well.

“He would see me in his waiting room so he wouldn’t have to charge me,” she said. “But then one day he had a sign up,” she recalls, saying “I can no longer see parents.”

She was 30 when the sign was posted.

There are better ways than posting a sign for transitioning patients who need to move on, says Jonathan Trager, a pediatrician in Great Neck, N.Y., whose practice includes adolescent medicine.

“Throughout the teen years into the college years, you let your patients know that you are happy to see them as long as they are comfortable,” says Trager, who sees patients until age 30. When a patient is ready to switch to an internist, or is dealing with issues that may require an internist, Trager and the patient will make that transition decision together, he says. It should be a change that they gear up for over the years, he adds.

A pediatrician, Trager says, is the ideal person to guide the young patient through that transition into adult medical care.

“They know the patient,” he says. “They know the family, and they’re well equipped to handle issues of someone they have been seeing for a long time. Young adults are often extended adolescents. They still could benefit from seeing the pediatrician who knows them well.”

For older pediatric patients, it’s not the doctor so much as the waiting room, usually geared toward toddlers and young patients, that starts to feel awkward. “While the doctor may be equipped to see them medically and know them well, the patient may feel out of place and doesn’t want to come,” Trager says.

Jake Ambrosio, 21, is one of those patients. He has been seeing his pediatrician since he was born but has outgrown the office.

“There’s a lot of babies in the waiting room, and also all of the rooms have a theme. I’ll be getting a checkup and there’ll be like, the Candy Land room, this light pink room with these little candies all around, and I’m like, ‘Yeah, I think I’m ready to be in just a normal doctor’s office.’ ”

So why has he stayed with his pediatrician this long?

“I like her. And it’s a lot of work finding a real doctor. It’s just easier to stay,” he says. “But I know I have to stop going to the pediatrician eventually. I just feel like since I’m 21, it’s time for me to find an adult doctor. Even though I do really like my pediatrician. It’s part of growing up, I guess.”

For many millennials, primary care doctors aren’t so important — they want speedier and more convenient alternatives

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