Most children in the US are automatically covered by the health plan of their parents or caregivers. Under the Affordable Care Act (ACA), all plans must also include basic pediatric services, including oral and vision care for children.
But what about those kids whose parents don’t have insurance coverage, or whose health plan doesn’t extend to their children? Is there health insurance for kids?
Yes, there is kids’ health insurance in the US. To learn more about what it is, and how it works, read our guide to child-only health insurance below.
What Is Child-Only Health Insurance?
Child-only health insurance is any health insurance plan that specifically covers the medical needs of children. Usually, this means children aged 18 or under.
But other than that, child-only health insurance plans operate just like other plans. That means they include coverage for preventative care, illness, injury, chronic disease management, mobility devices, and more.
Like ordinary health insurance plans for adults, kids’ plans are also subject to upfront and out-of-pocket costs. These include deductibles, copayments, and coinsurances. The ACA’s Cost-Reduction Subsidies are designed to lower such costs.
Eligibility Requirements For Child-Only Health Insurance
The only universal eligibility criteria for child-only health insurance on the part of the kids themselves is their age. In some states, and on some types of insurance, they must be 18 or under. For others, the maximum age is 19.
However, depending on which child-only health insurance you choose, there may be affordability and other criteria too. This means that the parents or caregivers of the children in question have no insurance that would cover the children and they have no or low income.
This low-income requirement only applies to state or federally-sponsored health insurance like Medicaid or CHIP and ACA subsidies. Private insurance without ACA subsidies and short-term insurance don’t have this requirement.
Types Of Insurance For Children
Millions of children in the US have no health insurance coverage. This has been an ongoing problem, but the government’s CHIP, Medicaid, and ACA programs have seen this number reduce dramatically. According to the US Census Bureau, this number had fallen to 3.9 million by 2021.
But that is still a very high number of children living at risk, without the peace of mind of health insurance. If your child is one of them, these are your best options for child-only health insurance,
ACA health insurance plans for children provide the same types of coverage that adult ACA plans do. Should you need a subsidy to afford your child’s health insurance through the ACA, your income must be 100-400% of the Federal Poverty Level. This is the same as for adults’ plans on the ACA.
To enroll for any plan on the ACA marketplace, you must do so in the Open Enrollment period between 1 November and 15 January each year. This is the rule regardless of whether you’re applying for yourself or a child.
In the case of a major life event making you unable to sign up in time, you may qualify for an extension. This can differ from state to state, but typically includes situations like a birth or death in the family, and possibly also relocations.
Children’s Health Insurance Program (CHIP)
If you want your children to have health insurance coverage, but you earn too much to qualify for Medicaid, consider the Children’s Health Insurance Program (CHIP). It is a child-only program that operates like Medicaid.
CHIP offers health insurance coverage to children from low-income households at low or even no cost. But like Medicaid and ACA plans, this is dependent on meeting certain eligibility criteria, especially financial stipulations.
The level of medical care covered is not reduced because of this. In fact, CHIP is probably the best option for quality healthcare for children at a low cost.
If you have missed the Open Enrollment period for ACA plans, or need only temporary coverage for your child, short-term insurance is sometimes the answer.
Unlike ACA plans, you can sign up for short-term plans at any time. Most short-term insurance plans are affordable and easy to apply for. The approval waiting period is also usually very brief.
The downside is that short-term insurance plans are not subject to the same rules as ACA plans. Therefore, benefits may be very limited, and pre-existing conditions may not be covered.
The availability of short-term insurance plans for kids differs between the states and not every state will have the child-only option.
If you are requiring medical coverage for your children due to travel, then travel insurance plans are the way to go. They are essentially short-term insurance. However, their coverage is very limited. Medical emergencies like accidents are usually the main focus of travel insurance plans.
Also known as fixed-payment plans, these are your next best bet if you require health insurance for your child. Some of them will include pre-existing medical conditions, and some will not. You’ll need to do your homework and research the best one for your needs.
It’s not a good child-only insurance alternative for everyone, though.
If your child has no serious medical conditions and rarely needs a visit to the doctor, these plans can be affordable. But when the reverse is true, it can get expensive very fast. With a fixed daily limit on how much they’ll pay for any medical situation, these insurance plans are usually not a viable long-term solution.
The Benefits Of Child-Only Health Insurance
Although each state may have different rules governing child-only health insurance, CHIP offers comprehensive coverage across the US. This includes doctor visits, routine check-ups, vaccinations, essential dental care, and also vision care. Both inpatient and outpatient procedures are covered.
Although they have youth on their side, children are just as prone to medical emergencies as adults. Perhaps even more so, as the natural curiosity of children can lead to falls and accidents. Their involvement in sports at school compounds these risks.
There are also several vaccinations that children must get at different ages to protect them from common childhood illnesses. Your child’s school may require proof that certain immunizations have been received, and child-only health insurance can help meet this need. Child-only health insurance helps to cover the costs of these medical necessities and gives you, as a parent or caregiver, peace of mind.
The Cost Of Child-Only Health Insurance
The monthly costs for child-only health insurance depend on many factors. These include the type of insurance plan, the state you reside in, and even your child’s age.
Generally speaking, you can expect to pay a little over $300 for a Silver plan on the ACA. However, if you are a low-income household, you may be eligible for further subsidies.
CHIP programs are federally and state-sponsored and therefore are typically low-cost. This may be your best option if you are in a low-income bracket as the average cost is just over $150 per child per year.
How To Apply For Child-Only Health Insurance
You can apply for ACA or CHIP coverage for your child on the federal ACA marketplace website or your state’s health insurance online marketplace.
Alternatively, you can apply for children’s health insurance through us. Here at Enhance Health, we assist anyone looking for affordable health insurance coverage, no matter your circumstances. We make it easy for you to find suitable options, compare them, and choose the right health insurance for your family’s needs.
How To Renew Child-Only Health Insurance
If you have obtained child-only health insurance through the Health Insurance Marketplace, you’ll receive a letter or email with all the particulars of your policy, including the renewal dates. You may also receive a reminder ahead of that date.
Renewals can be done via the same channels as enrollment on the Health Insurance Marketplace website. Bear in mind that you may need to prove your household’s eligibility again like you did when you first enrolled your child in the plan.
How To Appeal A Denial Of Child-Only Health Insurance
For an application for child-only health insurance to be denied, it means that you have not met the criteria.
Check if the child you are applying for meets the age requirement – this can differ from one state to another.
The age requirement is up to 18 or 19, in most cases. If your child is above this age, they are considered old enough to apply for their own health insurance. This applies regardless of whether or not your child is still in school or college or is working full-time or not.
Does your household meet the income criteria? ACA plans and subsidies, as well as CHIP programs, are dependent on meeting income eligibility requirements. Get your financial records in order, as you may be required to provide proof of your employment (or unemployment) status, as well as proof of income.
You have the right to appeal denials on ACA plans, and information about this appeals process is available on the marketplace.
How To Change ACA Coverage On Child-Only Health Insurance
Have you recently welcomed a new member of the family? If you want to include your baby in your children’s health insurance plan, you can do so quite easily.
Even the ACA enrollment period doesn’t apply here, as this life event qualifies you for a special enrollment period. But you have to apply within 60 days of the child’s birth.
All changes to the type of ACA coverage you signed your child up for must otherwise be done during the enrollment period.
How To Cancel Child-Only Health Insurance
What if you want to cancel your child-only health insurance? This is often subject to the rules in your particular state. Call the Medicaid offices to enquire about CHIP coverage cancellations in your state.
For cancellations of ACA coverage, you’ll need to talk to one of the ACA representatives on the Healthcare.gov site.
If your children are growing out of their child-only insurance, our insurance advisors at Enhance Health can help them find an affordable plan to suit their needs and guide them through the process of applying for coverage.
Alternatives To Child-Only Health Insurance
There are some other options for health insurance that are not traditional insurance plans. An example of this is cost-sharing.
Cost-sharing services are privately run and some of them are ministry-based. They are generally affordable and easy to apply for but typically don’t cover pre-existing medical conditions. They also don’t always have child-only options.
Child-only health insurance is not only available in the US but it is relatively easy to apply for. You have several options open to you when looking for health insurance for your kids.
The ACA marketplace plans and CHIP programs are the most suitable options for low-income households. But there are alternatives, like short-term insurance, fixed-payment plans, and even cost-sharing systems.
Whatever one you choose, we’re here to give you accurate and easy-to-understand advice about affordable health insurance. So if you are looking for coverage for the whole family, or your children only, contact us today.