FAQ

What Is Child-Only Health Insurance and How Do I Get It? – ValuePenguin

Child-only policies are health insurance policies that insure children and single children. Most child-only policies exist as part of larger health systems or plans in the public and private sectors, providing a variety of options for parents seeking child-only policies.

most people in the us. uu. — adults and children — access health insurance through employer-based plans. But in many cases, children, defined here as people under the age of 19, lack any kind of health insurance. (The federal government generally defines children as ages 0-17, although most state programs define children as ages 0-18 or 0-19.)

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Children may reside in a household where no one is covered or where their parents or guardians cannot afford policies that cover their dependents. In other cases, an employee health plan may cover only the employee or the employee and the employee’s spouse, leaving the children uninsured.

As a result, parents are forced to look for kid-only policies. Although there are many child-only insurance options in both the public and private sectors, these options are often determined by the financial situation of the parents. options include the following:

types of insurance for children only

When looking for health insurance just for kids, there are many different types of plans on the market to choose from. This will all depend on your specific needs and your financial situation. Here are the specific differences based on cost, eligibility, coverage, and enrollment:

medication

Medicaid covers low-income and indigent populations, providing comprehensive care to poor adults and children. recipients must meet certain income and eligibility requirements, which vary from state to state.

Pros: Medicaid offers comprehensive insurance that generally does not charge copays or deductibles to cover children, making it a highly desirable form of coverage. Unlike ACA plans, eligible beneficiaries can enroll in the program at any time during the year without waiting for an open enrollment period. Only four Medicaid programs (California, Maryland, Michigan, and Vermont) charge premiums or enrollment fees for children.

Cons: Medicaid is an insurance program for indigent and very low-income populations, and not everyone qualifies for the program. Some doctors may be reluctant to accept Medicaid patients due to low reimbursement rates. Medicaid coverage can take up to 45 days to become effective in some states after an application is approved.

children’s health insurance program (chip)

chip is a program that provides comprehensive health care coverage to children only, under the age of 19 in most states. chip recipients are not poor enough for medicaid but cannot afford private insurance. As with Medicaid, eligibility requirements vary from state to state. In some states, such as Massachusetts, the chip is integrated into the state’s Medicaid program, and the Medicaid program administers the chip’s benefits, operating like a children’s Medicaid program.

Pros: The chip provides comprehensive coverage at higher rates than Medicaid, but the chip rates are cheap, making coverage affordable. As with Medicaid, eligible chip recipients can enroll in the program year-round without waiting for an open enrollment period. Plus, routine doctor and dentist visits are free under the chip.

Disadvantages: Chip income limits are higher than Medicaid income limits, but still low, making many children ineligible because their household income is too high. In addition, coverage is not as extensive as it is with Medicaid, and coverage can take up to 90 days to take effect in some states after an application is approved. Twenty-one state programs charge a deductible or copay, or both. more than half (26 programs) charge premiums or an annual enrollment fee.

Note that some states, such as Massachusetts and California, have different names for Chip and Medicaid, while other states, such as Texas and Delaware, do not.

state programs that charge premiums or enrollment fees:

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state programs that charge copays, deductibles, or both

affordable care act (aca)

The aca allows individuals and families to access health insurance through health insurance marketplaces, which are regulated and subsidized by the federal government. To qualify, people must enroll in a plan during an open enrollment period, which usually occurs in the fall, or during a special enrollment period. Beneficiaries may also qualify for a plan if they have a qualifying life event, including the birth or adoption of a child, marriage or divorce, loss of employer coverage, or moving to a new coverage area.

Advantages: Many people looking for plans here qualify for subsidies to help defray the cost of premiums, deductibles and copays. plans here can’t turn people away based on pre-existing conditions, and all plans must cover the 10 essential health benefits.

Cons: To qualify, beneficiaries must enroll in the plans during an open enrollment period, which typically begins in the fall. exemptions are made for people with qualifying life events. even with subsidies, the costs of aca plans are higher than the costs of chip and medicaid plans.

private plans

Private plans are health insurance policies purchased outside of ACA marketplaces that provide comprehensive coverage.

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Advantages: Private plans can be purchased immediately from an insurance company without having to go through the market here. Unlike ACA plans, beneficiaries do not have to wait for open enrollment periods to apply. Private plans must also adhere to the same protections that apply to ACA plans. coverage can begin immediately.

cons: private plans are more expensive than chip and medicaid plans, as well as aca market plans. Unlike an ACA plan, a parent cannot access subsidies to help pay for coverage with a private plan.

short-term plans

Short-term health insurance plans are typically purchased directly from a health insurer that provides coverage for a year or less, closing gaps in coverage.

Pros: Short-term plans are good for closing gaps in coverage while providing cost protection against catastrophic events like a broken leg. These plans also tend to be less expensive in premiums than others because they provide short-term coverage, anywhere from three months to a year. coverage can begin immediately.

Disadvantages: Short-term plans do not have to adhere to the protections provided by the ACA, making it possible for insurers to deny coverage based on pre-existing conditions or limit dollar amounts . Similarly, short-term plans don’t need to cover all 10 essential health benefits, which means there could be gaps in coverage.

what is the best health insurance coverage for children only?

valuepenguin rated the options based on three criteria: cost, scope of coverage, and eligibility criteria. cost considerations are the no. 1 factor blocking access to care, playing a predominant role in determining which options parents should seek first. coverage and eligibility requirements are also important considerations.

first option: medicaid

Medicaid is the nation’s largest source of children-only health insurance, serving more than 40 million children. For any parent looking for a child-only health insurance policy, Medicaid should be the first option to consider.

The program, funded through a combination of state and federal funds, covers all types of health care: regular medical services, preventive services, prescription drugs, dental and vision care, as well as long-term care. In addition to providing comprehensive benefits, Medicaid is also the cheapest form of health insurance available.

Medicaid programs do not charge deductibles, and most state Medicaid programs do not charge anything to cover children. The challenge with Medicaid is that not everyone qualifies for the program. State Medicaid programs are intended to cover low-income and indigent populations, and eligibility is primarily determined by income requirements.

For most Medicaid programs, the family income limit for children is 100% to 150% of the Federal Poverty Level (FPL), or about $30,000 to $45,000 a year for a family of four. For example, a child and family might be eligible for Medicaid coverage in one state but not in another due to differences in FPL guidelines and how that state administers its Medicaid program.

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In georgia, a family of three with an annual household income of $43,846 would qualify for the state’s medicaid program, but that same family of three would not qualify for medicaid in texas, where the annual income limit for a family of three household members is slightly less than $43,481.

Similarly, a family of four in Florida with an annual income of $35,245 qualifies for Medicaid. But that annual income exceeds the annual income limit for a family of four in Michigan, which is $33,000 a year.

An excellent source for determining Medicaid eligibility is insurekidsnow.gov, or you can call your state Medicaid office for eligibility requirements.

second option: chip

The chip should serve as a second option for parents who want child-only health insurance policies. Like Medicaid, the chip is funded through a combination of state and federal funds, and has its own eligibility requirements that vary from state to state.

Unlike Medicaid, the chip only covers children, generally under the age of 19. the chip’s income limits are set above the income limits of state medicaid programs, making it possible for the chip to fill in the gaps and provide coverage to children whose parents are not poor enough for medicaid but cannot pay private insurance.

In many states, chip income limits go up to 250% fpl: about $75,000 a year for a family of four. Although costs differ from state to state (some state programs charge copays and deductibles, for example), any family contribution to the cost of coverage cannot exceed 5% of family income.

Like Medicaid, the chip provides comprehensive health coverage. all state programs cover the following:

Some chip programs may cover additional services not listed above, but this will vary by state. For more information on how to apply for the chip, see “Medicaid and Chip Coverage” on healthcare.gov or call your state’s chip office.

third option: the affordable care law

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the health plans offered by the aca represent the best option for parents whose children do not qualify for medicaid or chip. Parents can purchase child-only policies through ACA Marketplaces during open enrollment, which usually takes place in the fall, or during a special enrollment period. they can also purchase child-only policies outside of open enrollment if they have a qualifying life event.

In many cases, members are eligible for subsidies through ACA to help pay premiums and copays, and to help meet deductibles. Before 2021, you wouldn’t qualify for premium tax credits if your income was over 400% FPL, about $87,840 a year for a family of three. however, the recently enacted US bailout raised income thresholds, so now a family of three, for example, can qualify for premium tax credits if their income exceeds the 400% threshold.

For many, the ACA plans are an attractive option because they provide a variety of benefits and are available to most people. individual and family plans under the aca are required to cover 10 essential benefits, which are:

In most states, Marketplace plans are divided into three metallic tiers, with each tier giving the consumer an idea of ​​how much they’ll have to pay out-of-pocket for coverage. the benefits for each level are the same.

But there are big differences in premiums, deductibles, and copays with each metal tier. higher tiers have higher premiums but lower deductibles and copays.

Bronze: These plans have the lowest premiums, but high out-of-pocket costs such as copays and especially deductibles. deductibles and copays could block or delay access to services if the parent has trouble paying them.

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Silver: These plans have more modest premiums, deductibles, and out-of-pocket maximums than bronze plans, possibly serving as the most affordable for low-income families, especially with subsidies to help lower premiums . , deductibles, and out-of-pocket maximums.

gold: These plans are usually the most expensive in the state markets. but the deductibles and copays are much lower than those of the bronze or silver plans.

Some state exchanges also offer platinum health insurance, which has relatively expensive premiums but the cheapest deductibles and copays. For any parent, the first choice with plans here should be a gold or platinum plan if he can afford it and it’s available in his state. Although premiums are higher, deductibles and copays are much lower, providing faster access to care.

cost is always a consideration, and not everyone can afford a gold or platinum plan, leaving the other two options, bronze and silver plans.

It’s always a good idea to log on to healthcare.gov when considering a plan here. By entering your ZIP code into the browser, you can shop and compare plans here in your state. ECA plans are required to provide lists of doctors in their provider networks, as well as covered medications or formularies, which allow parents to determine which medications a particular plan covers, as well as the doctors with whom it contracts. a parent may, for example, need a particular diabetes medication that is included in some but not all plans.

For information on how to apply for a Marketplace plan here, visit insurekidsnow.gov.

private plans and short-term options

Private insurance and short-term plans purchased outside of the ACA exchanges should be the last resort for any parent or parents looking for child-only policies. As a general rule, private long-term insurance is more expensive than Medicaid and CHIP, and unlike ACA plans, private plans don’t include subsidies to help defray out-of-pocket costs.

Private plans that sell comprehensive coverage outside of state exchanges still have to comply with the protections established in the aca, which provides guarantees for consumers.

Short-term medical insurance is another option for child-only policies. Short-term plans typically provide coverage for a year or less, sometimes for just 30 days, often filling gaps in coverage. Some states have placed three-month limits on short-term plans, while others have placed six-month limits on the length of plans. Ten states have banned the sale of short-term plans entirely: California, Colorado, Connecticut, Hawaii, Massachusetts, New Jersey, New Mexico, New York, Rhode Island, and Vermont.

Short-term plans do not have to adhere to the protections normally associated with qualified health care plans under the ACA. they may, for example, deny coverage based on pre-existing conditions. if a child has a pre-existing condition, such as asthma, short-term policies may not cover that condition.

Short-term plans are generally used for protection against catastrophic events until longer-term insurance becomes effective or can be found. If a child falls and breaks a leg, for example, the short-term policy should cover the cost of repairing the broken leg. Parents should always remember that short-term plans are a temporary solution, often purchased while trying to find a more permanent type of coverage or waiting for Medicaid, Chip, or an ACA plan to kick in.

Besides filling in the gaps, short-term plans have other benefits. they usually provide immediate coverage; you don’t have to wait for open enrollment or special enrollment periods, for example. The cost of children-only insurance in the short-term market also tends to be lower than the cost of other plans in the private market because the coverage is for a shorter duration.

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