Alyssa Lane
There are several options for insuring your child, including through your employer's insurance plan, Medicaid, the Children's Health Insurance Program (CHIP), the Health Insurance Marketplace, or through a private insurer. The first option, and the easiest, is to add your child as a dependent under your employer's insurance plan, if this is offered. If your employer does not offer this option, you can look into Medicaid and/or CHIP plans on the Health Insurance Marketplace, or through a private insurer. The cost of your insurance plan will depend on how much coverage you need and what you can afford. For example, you may want to include vision, dental, or hearing coverage, or you may want to include sports injuries.
| Characteristics | Values |
|---|---|
| Type of insurance | Health insurance |
| Who is it for? | Children and young adults under 26 |
| What does it cover? | Doctors' visits, treatments, emergencies, hospitalizations, mental health, outpatient services, prescriptions, pregnancy and maternity, preventive care, dental and vision care |
| Cost | Varies depending on the plan and provider; can be low-cost or free for low-income families |
| Providers | Medicaid, Children's Health Insurance Program (CHIP), Health Insurance Marketplace, private insurers (e.g., employer-sponsored or Cigna Healthcare) |
| Eligibility | Based on household income, state of residence, and age; some plans have additional requirements |
| Application and enrollment | Can be applied for at any time; coverage may start immediately but can take up to 90 days in some states |
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What You'll Learn
Child-only health insurance
There are several options for child-only health insurance:
- Government-sponsored programs: The Children's Health Insurance Program (CHIP) is a government-sponsored program that provides free or low-cost health coverage to millions of children and pregnant women in families with low incomes. CHIP benefits vary by state, but all states provide comprehensive coverage, including routine "well child" doctor and dental visits. To enrol in CHIP, you can apply to your state agency for Medicaid coverage and find out if your children qualify.
- Private insurers: Many private insurance companies offer child-only health plans, providing parents with flexibility and choice when selecting coverage for their children's well-being. These plans can be more comprehensive but may also be more expensive. Examples include Cigna Healthcare and MyPriority.
- Employer-provided insurance: If you have insurance through your employer, your child can often be added as a dependent under your plan. However, some employers may not offer this option.
- Family plans: Instead of a child-only plan, you can consider a family plan that covers all family members.
When choosing a child-only health insurance plan, it is important to carefully review 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 costs, and you may even qualify for financial assistance from the government. Additionally, it is essential to consider the eligibility requirements and application processes for different programs and plans, as they can vary by state and income level.
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Children's Health Insurance Program (CHIP)
If you are based in the US, your child may be eligible for the Children's Health Insurance Program (CHIP). CHIP provides free or low-cost health coverage to millions of American children and pregnant women in families with low incomes who do not qualify for Medicaid. Each state offers CHIP coverage, but each state program has its own rules about who qualifies for CHIP. For example, routine "well child" doctor and dental visits are free under CHIP in some states, but you may have to pay a copayment for other services.
CHIP plans are designed to offer an affordable healthcare option to lower-income families that do not qualify for Medicaid. However, you will still need to meet certain financial and non-financial Medicaid requirements to qualify for CHIP. You can apply for CHIP coverage at any time of the year, and your coverage can start immediately, although some states may take up to 90 days for your coverage to begin. If you apply to your state agency for Medicaid coverage, you will also find out if your children qualify for CHIP. If they qualify, you won't have to buy an insurance plan to cover them.
If you are interested in CHIP coverage, you can apply at the Health Insurance Marketplace. You can also call 1-877-KIDS-NOW (1-877-543-7669) to find out more about CHIP enrollment and renewal.
Short-term health insurance is another option if you need coverage quickly or if you need to bridge a gap in coverage due to unemployment. These plans are month-to-month, so you can cancel at any time, but they are limited in their coverage. If your child has a pre-existing health condition, they will not qualify for short-term health insurance.
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Medicaid
Each state has its own rules and benefits for CHIP, and you can apply at any time of the year. Routine "well-child" doctor and dental visits are typically free under CHIP, but you may have to pay a copayment for other services. The cost of CHIP coverage is based on your family's income, and you won't have to pay more than 5% of your family's annual income.
If your child has a disability, you may be able to get coverage through the Medicaid Buy-In for Children (MBIC) program, even if your income is too high to qualify for traditional Medicaid. The MBIC program allows families of children with disabilities to make a monthly payment to receive Medicaid coverage. Children with disabilities can also receive long-term services and supports through Children's Medicaid, including home care, personal care, and help with daily activities.
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Employer-sponsored insurance
The Affordable Care Act (ACA) requires that plans and issuers offering dependent child coverage make this available until the child reaches the age of 26. This rule applies to all employer plans, regardless of whether the child is married or unmarried. It's important to note that while employers with 50 or more full-time employees are mandated by the ACA to offer health insurance to their employees and their children, there is no requirement for employers to fund any portion of the premiums for dependents. This means that while you can add your children to your employer-sponsored insurance plan, you may be responsible for paying the full cost of their premiums.
Prior to 2023, if an employer's offer of self-only coverage was deemed affordable, none of the family members were eligible for subsidies in the exchange. However, starting in 2023, the IRS fixed the "family glitch," making employees' family members potentially eligible for subsidies in the exchange if the cost of covering them under the employer's lowest-cost plan exceeds 9.12% of the family's household income. This change means that your children may qualify for premium subsidies in the exchange, even if you have family coverage through your employer.
It's worth noting that if your child is covered under your employer-sponsored plan and they have a pre-existing health condition, short-term health insurance may not be an option for them. Additionally, if your employer does not offer the option to cover your child, or if you are unable to afford the premiums, you can explore other alternatives such as Medicaid and the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to children and pregnant women in families that meet certain income and eligibility requirements.
Overall, employer-sponsored insurance can be a convenient and comprehensive way to ensure your child has access to the healthcare they need. However, it's important to carefully review the plan's documentation and consider the cost of premiums to ensure it aligns with your family's needs and budget.
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Short-term health insurance
It is important to note that short-term health insurance is not a substitute for comprehensive major medical coverage. These plans typically only cover emergencies, and you may need to pay out-of-pocket for other health-related expenses. Therefore, if your child has a pre-existing health condition, a long-term ACA-compliant health insurance plan may be more suitable, as these plans cover pre-existing conditions and include no-cost preventive care services.
When considering short-term health insurance for your child, it is advisable to research various plans and providers to find the best fit for your needs. Plans offered on the Health Insurance Marketplace will vary in cost, and you may qualify for financial assistance from the government. Additionally, Medicaid and the Children's Health Insurance Program (CHIP) offer free or low-cost health coverage, depending on your financial situation and your state's specific requirements.
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Frequently asked questions
Options for kids' health insurance include Medicaid, the Children's Health Insurance Program (CHIP), the Health Insurance Marketplace, or through a private insurer.
CHIP provides low-cost health coverage to children and pregnant women in families that earn too much money to qualify for Medicaid but still need financial assistance.
CHIP offers comprehensive coverage, including routine "well child" doctor and dental visits, treatments, and other medical services.
If your insurance plan covers dependents, your child can be added to your plan. You can also add your child to your employer's insurance plan during their yearly Open Enrollment Period or during a Special Enrollment Period.
The least expensive options are typically Medicaid and CHIP plans. However, eligibility is dependent on financial qualifications and your state of residence.
