Medicaid And Private Insurance: Navigating Dual Coverage For Children

Yes, a child can have both Medicaid and private insurance. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. Eligibility for children is based on the child's status, not the parent's.

Eligibility: Children can be eligible for Medicaid if they are U.S. citizens or lawfully admitted immigrants

Yes, children can be eligible for Medicaid if they are U.S. citizens or lawfully admitted immigrants. Eligibility for children is based on the child's status, not the parent's. You should tell your Medicaid worker about your private insurance and provide a copy of your health insurance card for your Medicaid record. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services. Medicaid can pay the premiums under certain circumstances if you currently pay for health insurance or Medicare coverage or have the option of getting that coverage, but cannot afford the payment. Medicaid/CHIP covers almost half of all U.S. children with special health care needs, though the share varies by state. Medicaid/CHIP-only children with special health care needs are more likely to have greater health needs compared to those with private insurance only. Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs, allow them to see needed providers, and meet their behavioral health needs, reflecting Medicaid’s robust benefit package.

Income: Low income is a key factor in eligibility for both Medicaid and private insurance

Yes, if your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. You should tell your Medicaid worker about your private insurance and provide a copy of your health insurance card for your Medicaid record. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services. If you currently pay for health insurance or Medicare coverage or have the option of getting that coverage, but cannot afford the payment, Medicaid can pay the premiums under certain circumstances.

Eligibility for children is based on the child's status, not the parent's. In general, you should apply for Medicaid if your income is low and you match one of the descriptions below:

• You need nursing home care.
• If you are leaving Temporary Assistance for Needy Families (TANF) and need health coverage.
• If you are a family with children under 19 and have very low or no income.

Medicaid/CHIP covers almost half of all U.S. children with special health care needs, though the share varies by state. Children with special health care needs covered by both Medicaid/CHIP and private insurance have the greatest health care needs, and children with Medicaid/CHIP only are more likely to have greater health needs compared to those with private insurance only. While families of Medicaid/CHIP-only children with special health care needs are more likely to face financial difficulty, they find their health care more affordable than those with private insurance only due to Medicaid’s cost-sharing protections. Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs, allow them to see needed providers, and meet their behavioral health needs, reflecting Medicaid’s robust benefit package.

Benefits: Medicaid offers more comprehensive benefits for children with special health care needs

Medicaid offers more comprehensive benefits for children with special health care needs. Medicaid/CHIP covers almost half of all U.S. children with special health care needs, though the share varies by state. Children with special health care needs covered by both Medicaid/CHIP and private insurance have the greatest health care needs, and children with Medicaid/CHIP only are more likely to have greater health needs compared to those with private insurance only. Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs, allow them to see needed providers, and meet their behavioral health needs, reflecting Medicaid’s robust benefit package. Medicaid’s cost-sharing protections also make health care more affordable for those with Medicaid/CHIP-only. Medicaid can pay the premiums under certain circumstances if you currently pay for health insurance or Medicare coverage or have the option of getting that coverage, but cannot afford the payment.

Affordability: Medicaid can make healthcare more affordable for children with special health care needs

Medicaid can make healthcare more affordable for children with special health care needs. Medicaid/CHIP covers almost half of all U.S. children with special health care needs, though the share varies by state. Children with special health care needs covered by both Medicaid/CHIP and private insurance have the greatest health care needs, and children with Medicaid/CHIP only are more likely to have greater health needs compared to those with private insurance only. While families of Medicaid/CHIP-only children with special health care needs are more likely to face financial difficulty, they find their health care more affordable than those with private insurance only due to Medicaid’s cost-sharing protections. Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs, allow them to see needed providers, and meet their behavioral health needs, reflecting Medicaid’s robust benefit package.

Private Insurance: Children with private insurance may still be eligible for Medicaid

Yes, children can have both Medicaid and private insurance. If your income is low and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid. You should tell your Medicaid worker about your private insurance and provide a copy of your health insurance card for your Medicaid record. If you have both private health insurance and Medicaid, you should show both your Medicaid card and your private health insurance card to your medical provider each time you receive services. While families of Medicaid/CHIP-only children with special health care needs are more likely to face financial difficulty, they find their health care more affordable than those with private insurance only due to Medicaid’s cost-sharing protections. Even though children with special health care needs covered by Medicaid/CHIP-only have greater health care needs, they are more likely than those with private insurance alone to report that their benefits are always adequate to meet their needs, allow them to see needed providers, and meet their behavioral health needs, reflecting Medicaid’s robust benefit package. Medicaid/CHIP covers almost half of all U.S. children with special health care needs, though the share varies by state.

Frequently asked questions