Haris Ashley
The cost of medical insurance for a child in North Carolina depends on several factors, including the family's income, the age of the child, and the type of insurance plan selected. North Carolina offers two programs that provide medical coverage for eligible children: NC Medicaid, funded by the federal Medicaid program, and NC Health Choice, funded by the federal Children's Health Insurance Program (CHIP). NC Health Choice is a state-supported insurance program that covers children aged 6 to 19 from working families with incomes too high for Medicaid but who cannot afford private health insurance. The cost of adding a child to an existing insurance plan typically ranges from 5% of the parent's gross income, according to North Carolina law. The cost of health insurance also varies by state, with Indiana having a lower average monthly premium of $431 compared to Arkansas' $798 average.
| Characteristics | Values |
|---|---|
| Programs offering medical coverage for children in North Carolina | NC Medicaid, NC Health Choice |
| Funding for NC Medicaid | Federal Medicaid program |
| Funding for NC Health Choice | Federal Children's Health Insurance Program (CHIP) |
| Eligibility for NC Medicaid | Low-income families |
| Eligibility for NC Health Choice | Working families with income too high for Medicaid but cannot afford private health insurance |
| Age eligibility for NC Health Choice | 6-19 years old |
| Enrollment fees for NC Health Choice | None |
| Co-pays for NC Health Choice | None |
| Coverage for NC Health Choice | Medical and dental care |
| Cost of coverage | Depends on factors such as family size, age, income, and location |
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What You'll Learn
Income-based eligibility for Medicaid and CHIP
Medicaid provides free or low-cost health coverage for those with lower incomes, including children, pregnant women, the elderly, and people with disabilities. CHIP, or the Children's Health Insurance Program, is a similar program that provides coverage for children in families with slightly higher incomes who do not qualify for Medicaid.
In North Carolina, parents with dependent children are eligible for Medicaid with a household income up to 45% of the poverty level. Children are eligible for Medicaid or CHIP with incomes up to 211% of the poverty level. For context, in 2024, a single adult in North Carolina with an annual income of up to $20,782 (138% of the federal poverty level) was eligible for Medicaid.
CHIP qualifications differ in each state and are typically income-based. In North Carolina, the family contribution to the cost of coverage cannot exceed 5% of family income annually. Additionally, states can allow families with incomes above the upper income eligibility limit to pay the full cost of purchasing coverage for their uninsured children through CHIP.
To determine eligibility for Medicaid and CHIP, you can create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies, your information will be sent to your state agency, which will contact you about enrollment.
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NC Health Choice and Medicaid
North Carolina has two programs that offer medical coverage for eligible children: NC Medicaid and NC Health Choice. NC Medicaid is funded through the federal Medicaid program, while NC Health Choice is funded through the federal Children's Health Insurance Program (CHIP).
NC Health Choice is a state-supported insurance program that provides health insurance for children aged 6 to 19 from working families. These are families with incomes too high to qualify for Medicaid but who cannot afford private health insurance. As of April 1, 2023, NC Health Choice beneficiaries have automatically moved to the Medicaid program. This transition comes with additional benefits, including the elimination of enrollment fees and copays for medical visits and prescriptions. Beneficiaries will also have access to enhanced behavioral health services not previously covered by NC Health Choice.
NC Health Choice beneficiaries will keep their Medicaid ID number and will receive a new Medicaid ID card in the mail. They can continue using their current ID card until the new one arrives. This transition is automatic, and beneficiaries do not need to take any action.
NC Medicaid provides comprehensive health coverage for low-income children in North Carolina who do not qualify for other health insurance programs. It ensures that eligible children have access to the necessary healthcare services without incurring financial barriers.
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Employer-sponsored insurance
The cost of employer-sponsored insurance for a child in North Carolina will depend on a number of factors, including the company providing the insurance, the type of insurance plan, and the number of dependents.
The ACA's employer mandate requires businesses with 50 or more full-time employees to offer health insurance to their full-time employees and their children. However, while the coverage must be affordable for the employees, there is no requirement for the employer to fund any portion of the premiums for dependents. The average employer funds the majority of premiums even for family coverage, but they are not mandated to do so, and smaller businesses are less likely to cover the cost of adding dependents to the plan.
In North Carolina, the maximum percentage of deductions for child support and health insurance premiums is 65%. Employers must also comply with federal regulations, which require Child Support Services (CSS) to seek medical support as part of all child support orders and to exchange this medical insurance coverage information with the Division of North Carolina Medicaid.
If you are a parent in North Carolina, you have a few options for medical insurance coverage for your child. North Carolina has two programs that offer medical coverage for eligible children: NC Medicaid, funded by the federal Medicaid program, and NC Health Choice, funded by the federal Children's Health Insurance Program (CHIP). NC Health Choice is a state-supported insurance program that covers the children of working families who have too high an income for Medicaid coverage but cannot afford private health insurance. It provides health insurance for children aged 6 to 19. If your child is not eligible for these programs, you may be able to add them to your employer-sponsored insurance plan, although you will likely have to pay the full cost of their premiums.
The cost of employer-sponsored insurance for your child will depend on the specific plan offered by your employer and the number of dependents you have. It's important to consider all the costs and different coverage options to find the right insurance plan for your family.
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Court-ordered insurance
In North Carolina, the court may order one or both parents to provide medical support for their child. This support includes doctor, hospital, dental, and other healthcare-related expenses. The court may also require parents to maintain health insurance for their child if it is available at a reasonable cost. According to North Carolina law, the cost of health insurance is considered reasonable if it does not exceed 5% of the parent's gross income. This 5% could cover the cost of adding the child to the parent's existing coverage or the difference between a "self-only" plan and family coverage if new coverage is required.
When a court order or agreement for health insurance is in place, either parent's signature is sufficient for the insurer to process a claim for their child. The parent responsible for providing health insurance must notify the other parent in writing of any changes to the insurance coverage. This is also the case when a non-custodial parent ordered to provide health insurance changes jobs and insurance is available through their new employer. In this situation, the new employer must be notified of the obligation to enrol the child in their health insurance plan.
If a parent ordered to provide medical support fails to maintain health insurance, they are liable for any medical costs the child incurs that would have been covered by insurance. They may also face consequences such as contempt of court charges and wage garnishment. To facilitate communication between agencies, employers, and group health plan administrators, North Carolina uses the National Medical Support Notice (NMSN), a standardised federal form. This form is used when a court orders a non-custodial parent to provide employment-related healthcare coverage for their child.
It is important to note that determining which parent is responsible for medical bills can depend on various factors, and the non-custodial parent is typically assigned the responsibility for medical support. Both parents must agree on how to handle deductibles, co-pays, prescriptions, adaptive devices, and other out-of-pocket medical expenses.
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Family plan considerations
The number of members covered under a family health insurance policy depends on the insurance provider and the specific plan chosen. Usually, family health insurance plans cover spouses and dependent children. Some plans also allow for the inclusion of ward guardians, dependent parents, siblings, parents-in-law, grandparents, grandchildren, sons- and daughters-in-law, and siblings-in-law. It is important to ensure that all family members are insured, especially if you live in a large city, as medical facilities tend to be more expensive in urban areas.
The type of coverage offered by the plan is another key consideration. Almost all family health plans provide coverage for day care expenses, hospitalization expenses, ambulance charges, and pre- and post-hospitalization expenses. Some plans also cover maternity expenses, non-medical expenses, and preventive health check-ups. It is important to check the specific coverage offered by each plan to ensure it meets the health needs of your family.
The cost of family health insurance plans varies depending on the number of family members, their ages, and their medical conditions. Monthly premiums and out-of-pocket maximums tend to increase with the number of people covered. However, it is possible to find affordable plans that offer comprehensive coverage and additional benefits, such as tax savings or discounts for wellness and fitness programs.
When considering a family health insurance plan in North Carolina, it is worth noting that the state offers two programs that provide medical coverage for eligible children: NC Medicaid, funded by the federal Medicaid program, and NC Health Choice, funded by the federal Children's Health Insurance Program (CHIP). As of April 1, 2023, families with children enrolled in NC Health Choice will automatically transition to NC Medicaid, eliminating enrollment fees and copays for medical visits and prescriptions.
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Frequently asked questions
The cost of medical insurance for a child in North Carolina depends on a variety of factors, including the family's income and the age of the child. North Carolina has two programs that offer medical coverage for eligible children: NC Medicaid and NC Health Choice. NC Medicaid is funded through the federal Medicaid program and is available for children from low-income families. On the other hand, NC Health Choice is a state-supported insurance program for children from working families who have an income too high for Medicaid but cannot afford private health insurance. This program covers children from ages 6 to 19.
When determining the cost of medical insurance for a child in North Carolina, the court considers factors such as the parent's income, the availability of employer-sponsored health insurance, and the cost of adding the child to the existing coverage. The coverage is considered reasonable if the cost does not exceed 5% of the parent's gross income.
To enroll your child in a medical insurance program in North Carolina, you need to find and check with your state's Medicaid agency to see if your child is eligible and what documentation they require. You can also apply for the Children's Health Insurance Program (CHIP) by creating an account with the Health Insurance Marketplace and filling out an application. If your child is eligible, your information will be sent to your state agency, and they will contact you about enrollment.
