Finding affordable health insurance for children can be difficult. Between understanding the special rules regarding children and the cost of adding them to your plan as dependents– making sure you have health insurance for children is harder than you think.
The right to participate in an insurance plan may vary depending on different members of the same family, which only complicates the issue. In some cases, children may be eligible for subsidized coverage, while their parents are not.
The good news is that there are a number of ways to get health insurance for children in the United States, from employer-sponsored plans to government Medicaid programs. And since everyone’s marital and financial situation is different, we describe the full range of options for children’s health insurance.
How Does the ACA Law Affect Children?
Most insurance plans must offer the following benefits to children:
- Young people under the age of 18 must receive dental care and children’s eye care (but they are not required to pay for it).
- In most states, low-income youth are eligible for the children’s health insurance program (CHIP), even if their parents do not qualify for it.
- Young people can reside under the policy of one of the parents or guardians until the age of 26.
- Large employers (defined as companies employing 50 or more people full-time) must provide insurance coverage to the dependents of workers under the age of 26 (TRICARE is the only exception to this rule, which has unique rules).
- All ACA Marketplace plans must cover most online prevention services for children free of charge, even if the annual deductible has not been paid.
Important ACA Rules & Guidelines
Here are the basic pieces of information you need to know regarding the ACA and coverage for your child:
- You and your child cannot be refused due to pre-existing circumstances: if you take out health insurance for yourself or your child during the open registration period, your application for health insurance cannot be refused because you or your child previously had a medical condition.
- You must obtain insurance coverage for your child during the open enrollment period: In addition to the annual open enrollment period, it may not be possible to purchase comprehensive health insurance for your child unless you have an appropriate life event (ELQ).
- The birth or adoption of a child is considered an appropriate life event (ELQ): Examples of suitable life events may include the birth or adoption of a child, marriage or divorce, loss of employer insurance coverage, or moving to a new place of insurance coverage. Relevant life events will trigger a special sixty-day registration date for you and/or your child.
- You have 60 days to take out insurance after the birth of your child: if you have a child while you are not insured, you have 60 days to take out an insurance policy for you and your child. If you receive insurance coverage after the birth of your child, your plan usually starts within 30 days.
- Simple conception is not considered ELQ: although the birth of a child is considered an appropriate life event, conception is not. If you are uninsured and become pregnant, this will not allow you to sign up for a new health insurance plan. You must apply for insurance coverage during the open nationwide enrollment period or within sixty days of the relevant life event, such as birth. However, you may be eligible to receive the CHIP even if you were pregnant before insurance coverage began. You can apply for a chip at any time of the year.
- Children cannot be insured under the grandparents’ health insurance policy: grandchildren are not eligible for insurance coverage under the grandparents’ policy (exceptions to this rule arise when grandparents have legal custody of their grandchildren).
1. Adding Your Child to Your Health Insurance as a Dependent
How does your divorce affect your child’s health insurance?
Some health insurance plans charge additional premiums to continue to provide for the health of children or ex-spouse if one of the members of the newly divorced couple has health insurance from the employer October, the other does not. Fortunately, group health insurance plans may allow divorced adults to continue to insure family members. (Note: If one of the spouses remarries later and wants to include his new family in the policy, this may change later).
State and federal laws protect families at risk of losing health insurance, and neither the insurer nor the employer can refuse insurance by court order if it is a child.
2. Health Insurance for Children Only
“Children alone” health plans are individual plans offered to children under the age of 19. Health insurance plans for children that do not include an adult in the policy are not uncommon and are available on many health insurance websites. This category of health insurance does not include health insurance policies sold to adults with Dependent Children. On the contrary, child policies are often sold to parents whose employers do not provide dependent care coverage, or to grandparents on Medicare who are the primary caregivers for children who do not qualify for public programs such as CHIP or Medicaid.
Plans For Children Alone: What Is Covered?
Children-only health plans are ACA compliant (with the exception of short-term health policies that cover children), so children-only health insurance plans must cover essential health benefits and are covered by a guarantee, which means that your child cannot be denied coverage due to pre-existing conditions. In addition, the plans intended only for children should cover October:
- Preventive care, at no cost;
- Behavioral and oral health risk assessments;
- Certain medications (fluoride chemoprevention supplements, gonorrhea preventive medication for newborns, and iron supplements);
- STI testing;
- Screenings;
- Immunizations;
- And more.
Who sells health insurance only for children?
Most health insurance companies – both on the market and not on the market – offer health insurance for children. Under the Affordable Care Act, any insurer offering an individual adult health care plan must also provide this plan for an individual child, provided that the child is under 21 years of age at the beginning of the plan’s validity year.
Subsidies for child protection schemes
Parents and guardians whose income is below a certain level and who do not have access to employer-funded health insurance can apply for subsidies to cover their children’s health insurance costs. In almost all cases, a parent or guardian can apply for a subsidy provided that this parent meets the financial requirements and offers insurance coverage to the legitimate dependent. Adults who have employer-sponsored insurance cannot qualify for subsidies to cover the costs of a children-only health insurance program, even if the parents’ income is (theoretically) low enough for them to qualify for it.
Children’s health insurance only: Cost
Whether it makes financial sense for parents to purchase insurance only for children and not for dependent children will depend on the individual financial situation of the parents, their eligibility for tax subsidies and the cost of the health insurance options available to them. However, it is important to note that a parent insured under an employer-sponsored program usually cannot apply for subsidies to compensate for insurance premiums and personal expenses of the children’s health insurance program.
- Public Health Insurance For Children
In the United States, government health insurance for children consists of two programs. These two programs work together to provide health insurance to children from low- and middle-income families: Medicaid and the Children’s Health Insurance Program (CHIP).
Medicaid for children
Medicaid is administered by individual states and funded by state and federal funds. Medicaid provides affordable coverage for people with limited incomes, including children, adults, pregnant women, people with disabilities, and the elderly.
In most cases, children may be eligible for Medicaid coverage if they are U.S. citizens or legally authorized immigrants, even if their parents are not. Children who are “aging out” in foster care may also be eligible for Medicaid coverage up to the age of 26; these young people are eligible for Medicaid coverage regardless of their income.
Children’s Health Insurance Program (CHIP
The Children’s Health Insurance Program (CHIP) provides health insurance to children whose parents earn too much money to qualify for Medicaid. CHIP often helps families whose income is too large to qualify for Medicaid, but who are still struggling to pay for their children’s health insurance.
Keep in mind that each state has its own name and terminology for CHIP and Medicaid programs and coverage options. For example, Ohio’s Medicaid program for uninsured children (up to the age of 19) is called Healthy Starts. In Wisconsin, the Medicaid program for low-income residents is known as BadgerCare Plus. If you are unsure of the name of the chip and Medicaid programs in your state, you can use this list to find out.
CHIP and Medicaid eligibility criteria: income/family size
CHIP and Medicaid eligibility are determined by family size and income, and eligibility guidelines vary from state to state. In most states, children under the age of 19 earning up to about $30,000 a year in a family of four are likely to qualify for children’s health insurance.
Medicaid expansion under the Affordable Care Act
While the Children’s Health Insurance Program (CHIP) is being created to serve children, several states are extending CHIP coverage to parents and adults without children. federal laws passed in 2000 and 2001 allowed states with remaining CHIP funds to use those funds to provide health care coverage to low-income, uninsured adults who were ineligible for Medicaid. Currently, nine states offer CHIP-funded coverage to parents (Arizona, Arkansas, Idaho, Minnesota, Nevada, New Jersey, New Mexico and Wisconsin), and three states allocate funds to cover adults without dependent children (Idaho, Michigan and New Mexico).
In addition, several states, including Arizona, Illinois, New Jersey and Wisconsin, use CHIP funds to cover parents so that all family members can enroll in one plan. Oct.
CHIP and Medicaid eligibility criteria: citizenship status
Federal law prevents many legally resident immigrants from qualifying for Medicaid or CHIP coverage, or requires immigrants to wait five years before gaining access to coverage.
However, some states offer Medicaid or CHIP coverage to pregnant women and/or children residing legally:
Dec, Sa, CO, CT, DE, DC, HI, ME, MD, MA, mn, NE, nj, NM, NY, NC, NV, OH, PA, SC, VT, WA and WI offer coverage to legally resident pregnant women and children.
WY provides Medicaid/CHIP coverage only to legally existing immigrant pregnant women.
FL, MT, IA, IL, LA or RI, tx, ut and VA offer Medicaid/CHIP coverage to legally promote young immigrants.
Currently, deferred action for Childhood Arrivals (DACA) is not an eligible immigration status to apply for health insurance, as federal law prohibits undocumented immigrants from enrolling in Medicaid or CHIP programs or shopping on state Sundays.
CHIP and Medicaid eligibility criteria: pregnant women
Pregnant women who earn incomes below certain levels are eligible for Medicaid and/or CHIP coverage. In addition, federal regulations require states to extend coverage to women for at least 60 days beyond Oct.
The Unborn Child option (funded by CHIP: the “unborn child option” allows states to consider a fetus as a child eligible for CHIP coverage, regardless of the mother’s immigration or citizenship status.
Find out if you qualify for CHIP or Medicaid
What health services are covered by the chip?
No matter where you live, all CHIP programs should offer the following benefits for children’s health:
- Doctor’s visits and routine examinations;
- Free vaccinations;
- Prescription drug coverage;
- Inpatient care (inpatient and outpatient treatment);
- Laboratory studies and X-rays; and
- Emergency and emergency services.
- How Much Does Chip Coverage Cost?
The cost of chips varies from state to state and also depends on your household’s annual income. This tool can give you an accurate prediction. Many families can benefit from free health insurance for their children – it all depends on your household income. Some families may have to pay registration fees or modest premiums, as well as additional payments for certain services.
Once a child is enrolled in CHIP, preventive care, such as exams and vaccinations, are exempt from co-insurance costs. If your child gets sick or gets injured, you may have to pay a small coinsurance in exchange for medical services.
How To Register For Chip?
Unlike other health plans on the market, Chip does not have an open enrollment period. Eligible people can apply for tokens at any time of the year to obtain coverage for their children.
There are two ways for parents, grandparents or legal guardians to apply for chip coverage:
- Register for chip by phone by calling +1 (800) 318-2596 [TTY: (855) 889-4325] or
Fill out an online chip application through a government health insurance website.
Health insurance for young people in foster care - Former foster youth are eligible for Medicaid until the age of 26, as long as they turn 18 (or are older under their state’s child welfare plan) and are enrolled in Medicaid while in foster care.
- Short-Term Health Plans: Temporary Health Insurance for Children
Short-term medical plans (STMs) are temporary medical policies and offer consumers a convenient way to pay for their health care for a short period of time, for example, when they encounter a gap in coverage or expect to be uninsured for a short period of time.
When does it make sense to have short-term health Insurance for children?
There are some situations in which it would make sense for a parent or guardian to purchase short-term health insurance for children. Parents can use short-term health insurance to ensure that their children have health insurance if they are between jobs or waiting for help at a new job. Dec. Short-term health insurance can also serve as a temporary coverage solution for your child while they are waiting to be accepted into CHIP or another medical plan.
One of the reasons short-term health insurance plans are advantageous: coverage can take effect immediately. Therefore, since applications for STM plans can be filled out and processed online, STM plans can be a great last resort or last-minute solution. When you apply for short-term coverage for your child, you will be asked to answer a series of questions about your child’s medical history, and your child’s coverage will begin as soon as your application is processed and accepted. Parents can use our plan comparison tool to determine which short-term policies are available in their area.
Not everyone is eligible for short-term coverage
True, short-term plans may be economically inexpensive, but not everyone is eligible for them. Insurers are not required to cover pre-existing conditions with these plans, so it will be difficult to qualify for this type of coverage if your child is sick or suffers from chronic health problems. In October, short-term health insurance is not intended to cover the cost of your child’s health care for a long period of time, and these plans are not a viable alternative for more comprehensive insurance coverage.
These Plans Are Not ACA Compliant
Because short-term medical plans do not meet the minimum insurance coverage standards set by the ACA, it is unlikely that short-term plans will cover all the care your child needs. While major ACA-compliant health policies should cover ten essential categories of health benefits, including maternity care, prescription drug coverage, vaccines, and mental health services, short-term plans to cover these categories of care for your child are not required.
- Dental insurance for children
Pediatric dental coverage is considered “mandatory” under the ACA, but not “mandatory”.
With the exception of Kentucky, Nevada and Washington (the three states that require parents to purchase standalone dental insurance for their children), major ACA medical plans must offer pediatric dental insurance – but parents are not required to purchase it.
If you check the plans online, there are two different ways to get dental insurance: 1.) as part of a health plan or 2.) alone, through a separate and autonomous dental plan. However, it’s important to note that consumers can’t buy a stand-alone dental plan on their own; to buy a stand-alone dental plan, you need to buy a health plan at the same time.
What you need to know about the Affordable Care Act and children’s dental coverage:
Pediatric care is an essential health benefit: Pediatric dental care is among the 10 essential health benefits of the ACA and should be included in all major health insurance plans listed on federal websites and sold on private websites.Dec.;
Dental care should be offered to people aged 18 and under: Since this is an important health benefit, dental care coverage should be offered to children aged 18 and under as part of a large health insurance plan or a stand-alone plan; and
Parents do not necessarily need to buy dental insurance for their children: Parents (except those who live in Kentucky, Nevada and Washington) do not need to buy dental insurance for their children. It is optional and there is no penalty for going without it; however, as mentioned above, many health insurance plans include dental insurance coverage.