Orlando Harmon
If you are a parent in Florida, you have several options for getting medical insurance for your child. The state offers a program called Florida KidCare, which provides low-cost insurance for children under the age of 18. Eligibility for this program is based on income and family size. Additionally, Florida's Children's Medical Services (CMS) offers a range of programs that serve children with special healthcare needs, providing family-centered care using a network of qualified healthcare professionals. Another option is the Children's Health Insurance Program (CHIP), which provides low-cost health coverage to children in families that earn too much to qualify for Medicaid. Routine well child doctor and dental visits are free under CHIP, and there are no savings on Marketplace insurance if your children are eligible for CHIP.
| Characteristics | Values |
|---|---|
| Options | Medicaid, the Children's Health Insurance Program (CHIP), the Health Insurance Marketplace, or through a private insurer |
| CHIP Coverage | Medical and dental care for uninsured children and teens up to age 19 |
| CHIP Qualification | Qualification depends on the income of the family and the state they live in |
| Medicaid Qualification | Qualification depends on the income of the family and the state they live in |
| Benefits of Insurance | Routine check-ups, accidents, emergencies, surgeries, treatments, medications, immunizations, and other medical services |
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What You'll Learn
Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but too little to afford private coverage. CHIP is funded by states and the federal government and is managed by states according to federal requirements. Each state offers CHIP coverage, and works closely with its state Medicaid program. Each state program has its own rules about who qualifies for CHIP.
CHIP covers uninsured children and teens up to the age of 19. CHIP benefits vary across states, but all states provide comprehensive coverage, including routine "well child" doctor and dental visits for free. Some states may offer additional benefits. For example, some states cover pregnant women.
You can apply for CHIP at any time of the year, and there is no limited enrollment period. If you qualify, your coverage can start immediately. To apply, you must find and check with your state's Medicaid agency to see if you or your family members are eligible. Each state has its own requirements, but eligibility generally depends on income. You can also create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency. They will then contact you about enrollment.
If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. The costs for CHIP are different in each state, but you won't have to pay more than 5% of your family's yearly income. If your children are eligible for CHIP, they won't be eligible for any savings on Marketplace insurance.
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Medicaid
In the US, Medicaid provides free or low-cost health insurance for children and teens from low-income families. The eligibility criteria and coverage differ across states, but generally, children must be under the age of 19 and reside in the state where they are applying for benefits.
Each state has its own Medicaid agency, and they work closely with their state's Children's Health Insurance Program (CHIP). If your income is too high to qualify for Medicaid, your child may still be eligible for CHIP, which covers medical and dental care for children up to age 19. CHIP qualifications vary by state, but they generally depend on income. Some states offer CHIP coverage for pregnant women as well.
You can apply for Medicaid or CHIP at any time of the year, and there is no limited enrollment period. If you qualify, your coverage can start immediately. To apply, you must find and check with your state's Medicaid agency to see if you or your family members are eligible and to learn what documentation they require. You can also create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for Medicaid or CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
While specific benefits may differ across states, CHIP provides comprehensive coverage, including routine "well child" doctor and
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Private insurance
Before deciding on a private insurance plan, be sure to read all the plan documentation to ensure it provides the level of coverage your child needs. The Health Insurance Marketplace is a useful tool to compare plans and you may even qualify for financial assistance from the government. Plans offered on the Marketplace typically include preventive health services such as screenings, immunizations, and well-visits, as well as dental and vision coverage.
It is important to note that short-term plans offered by private insurers are an option but they only cover emergencies, and you may have to pay out-of-pocket for other health expenses. Additionally, if your child has a pre-existing health condition, they will not qualify for short-term coverage. Once you have selected a plan and paid the first month's premium, your child can start using the insurance. You should receive insurance cards with your policy number and other relevant information.
To manage the costs associated with private insurance, you can discuss expenses with your doctor. Being transparent about your financial limitations may allow the doctor to suggest less expensive treatments or procedures. You can also shop around for doctors or specialists who can provide quality care at a lower price. However, it is important to never compromise your child's health care quality for cost.
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Employer insurance
If you have employer-based insurance, your children can be added to your plan and remain on it until they turn 26. To add your children to your employer-based insurance plan, you should check with your employer or the plan provider about the steps to take during the yearly Open Enrollment Period. Some sources note that you may be able to add your children outside of the yearly Open Enrollment Period if you qualify for a Special Enrollment Period, which can be triggered by certain life events such as having a baby or adopting a child.
It is important to note that while your employer is required to offer you health insurance as a full-time employee, they are not mandated to cover any portion of the premiums for your dependents. This means that you may have to pay the full cost of your children's premiums to add them to your plan. However, if the cost of adding your children to the lowest-cost plan offered by your employer is more than 9.12% of your household income, your children may be eligible for subsidies in the exchange. Additionally, your children may be eligible for Medicaid or the Children's Health Insurance Program (CHIP) depending on your household income.
If you are eligible for the Federal Employees Health Benefits (FEHB) coverage, your employer will notify you if you need to provide health insurance benefits for your children. They will give you a deadline to enroll in an appropriate health insurance plan or provide documentation that your children are covered by another health insurance plan. If you do not comply with the court order, your employer is required to enroll you in the lowest coverage option of the Blue Cross and Blue Shield Service Benefit Plan.
In the case of disability, the employing office may approve coverage for your child for a limited period or without time limitation. If approved for a limited period, the employer must remind you to submit a new medical certificate or a statement that you will not be submitting a new one at least 60 days before the current certificate expires.
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Marketplace insurance
If you're looking to get health insurance for your child, you may be able to get an insurance plan through the Marketplace, with savings based on your income. Here's what you need to know about Marketplace insurance:
Eligibility
Application Process
To apply for Marketplace insurance, you'll need to create an account on the Health Insurance Marketplace website and fill out an application. If it appears that anyone in your household qualifies for Medicaid or CHIP, your information will be sent to your state agency, and they will contact you about enrollment. When you submit your Marketplace application, you'll also find out if you qualify for an individual insurance plan with savings based on your income.
Enrollment Periods
The Health Insurance Marketplace has an annual open enrollment period, typically from November 1 to January 15, when individuals can enroll in a Marketplace health insurance plan. However, special enrollment periods may be available for eligible individuals outside of this time frame. Qualifying life events for a special enrollment period include losing health coverage, moving, getting married, having a baby, or adopting a child. Changes in household income may also qualify you for a special enrollment period.
Tax Implications
If you purchase health insurance through the Marketplace and receive advance payments of the premium tax credit, you must file a federal income tax return and complete Form 8962 to reconcile these payments with the premium tax credit computed for your tax return. Form 1095-A, the Health Insurance Marketplace Statement, will be provided at the beginning of the tax filing season and contains information to help you complete your tax return, including the total monthly health insurance premiums paid and any premium assistance received.
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Frequently asked questions
CHIP stands for Children's Health Insurance Program. It provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. Each state has its own rules about who qualifies for CHIP.
Florida KidCare is the state's child health insurance program for children from birth to age 18 who do not have insurance. Eligibility is based on income and family size.
Florida Healthy Kids offers benefits such as $10 a month per child to buy certain personal care items and over-the-counter medicines, up to 50 round trips per year for non-urgent medical visits, and up to $50 for household items for members turning 19.
