Affordable Care Act
Health Insurance for Kids
Published on November 17, 2018
Last updated November, 2018.
Health Insurance Options for Kids
At eHealth, we literally get hundreds (sometimes thousands) of phone calls every day. One of the questions we hear all the time is, “can I just get health insurance for my child?”
The short answer is always, yes. The longer and much harder answer is, what type of insurance does your child qualify for?
What Are My Child’s Health Insurance Options?
If you have to buy health insurance for your child on your own (no employer is offering it) here is a brief rundown of your options:
You can find longer, more details descriptions below, or hyperlinked here:
- Major Medical Health Insurance: Also known as Affordable Care Act (ACA/Obamacare) insurance. This is always the best coverage, but it can also very expensive, and not always available year-round. To make the plans affordable, you may qualify for a QHP with a tax credit. To qualify to enroll, you either need a qualifying event, or to apply during open enrollment.
- Short-Term Health Insurance: These plans are the most like major medical, but you can apply for your child at any time throughout the year. They’re affordable, and, if you need a fast approval, some will approve you in as little as 48 hours. The downside is, these plans usually don’t take people with pre-existing conditions, and their benefits are limited. They’re also not available in every state.
- Fixed-Payment, or Fixed-Indemnity Plans: These are your alternative when short-term plans are not an option. While also affordable, these plans often will take people with pre-existing conditions. But, they also have a daily limit on how much they’ll pay for any medical situation, like $5,000 for a hospital visit, etc.
- Cost-Sharing Services: There are a handful of faith-based medical cost-sharing services. These plans are typically affordable, and cover most medical problems, but they won’t cover pre-existing conditions – at least not for the first few years you or your child is on the policy.
- Children’s Health Insurance Program (CHIP or Medicaid): Every state has CHIP as an option, but every state has its own rules on who qualifies. You typically need to be low-income to qualify.
What Types of Scenarios Would Require Child-Only Insurance?
There are a few different situations that come up, and the types of coverage you can or should pursue will really depend on the situation you’re in.
Most Common Reasons to Buy Health Insurance For Kids:
- My child needs health insurance to play a sport.
- My child needs health insurance to go to school.
- My child needs health insurance before a trip.
- My child needs health insurance because they’re sick.
- My child needs health insurance because I missed open enrollment.
- I don’t want to put my child on Medicaid.
My child needs health insurance to play a sport: Many school sports programs require your child to show proof of health insurance before they will allow them to participate.
- Your Best Option: Major medical health insurance (ACA/Obamacare)
- Your Fastest, Most Affordable Option: Short-term health insurance. If you need it Monday, in some cases you can apply as late as Friday (but don’t push your luck).
- When ACA & Short-Term are not an option: Look at fixed-indemnity plans, cost-sharing plans and CHIP.
My child needs health insurance to go to school: Many private schools, vocational programs or other types of non-public school environments will kids to show proof of health insurance.
- Your Best Option: Again, major medical health insurance (ACA/Obamacare), is typically your best option. If you’re not in an enrollment period, or priced out…
- Your Fastest, Most Affordable Option: Again, short-term health insurance is typically the next best option.
- When ACA & Short-Term are not an option: Here, you may see if the school offers some form of association-based coverage to If that’s is not an option, weigh fixed-indemnity products in your area against cost-sharing plans and CHIP.
My child needs health insurance before a trip: If your child wants to study abroad, go build houses in Mexico on a church mission trip, or travel out of state for a school event, they may be required to provide proof of health insurance.
- Your Best Option: Like a broken record, major medical health insurance (ACA/Obamacare), will be the most comprehensive option if you qualify.
- Your Fastest, Most Affordable Option: Look into travel health insurance. In some instances, a travel health insurance plans may be enough to get your child through the trip. Just be aware, than many travel insurance policies require you to have some other form of primary coverage that picks up the tab once your travel benefits run out.
- When ACA & Travel Insurance are not an option: Here, again, short-term insurance will be your next best option. Absent access to major medical or short-term, consider the fixed-indemnity and cost-sharing plans you have available in your area.
My child needs health insurance because they’re sick. If your child is uninured, and they get sick, you’re in a tough spot.
- Your Best Option: If you can qualify, major medical health insurance (ACA/Obamacare), is what you’re going to want for your child long-term. If you have to, wait until the next open enrollment period and sign them up.
- Your Fastest, Most Affordable Option:… There really isn’t a great second option. You can see if you qualify for CHIP, and you may. But, most of the other forms of coverage you can apply for won’t cover a pre-existing condition.
My child needs health insurance because I missed open enrollment. Very often, new parents are so tired from taking care of their little ones that they completely forget to add their child to their employer-based insurance during the 90-day special enrollment window (actually happened to the author of this articleJ) .
- Your Best Option: Ask your H.R. department to call you, email you, and stop by your desk when your company’s next open enrollment period begins so you canyou’re your kid on your company plan.
- Your Second-Best Option: Get them on a major medical health insurance (ACA/Obamacare) plan. The challenge you’re likely to have is that Obamacare’s open enrollment period typically aligns with most employer’s open enrollment period.
- Your Next, Best Option: Try a short-term plan. If your child qualifies, the plans will cover new medical conditions that pop up. You’ll have a deductible and cost-sharing, but you’ll have coverage (hopefully until open enrollment begins).
- When short-term is not an option: Again, look at your fixed-indemnity options as well as cost-sharing plans and CHIP.
What do I do if I don’t want to put my child on Medicaid? This is a question we hear all the time in our call center. Sometimes people have a bad impression of Medicaid, or they may have had a bad experience with the program.
You can look at some of the other options listed here, like short-term, or cost-sharing services, but if you need a long-term solution, make sure you understand how CHIP works.
Detailed Breakout of Your Health Insurance Options for Kids
Major Medical Health Insurance
These plans cover the 10 essential health benefits mandated by the Affordable Care Act (Obamacare).
- Qualified Health Plans (QHPs) can be purchased with a subsidy for those who qualify on private exchanges like eHealth. com or a government-run marketplace.
- “Off exchange plans” – Insurers offer additional major medical plans only on marketplaces like eHealth.com.
Catastrophic Plans – These plans provide the bare-minimum ACA-level benefits for people under age 30 (New legislation may extend these all ages under 65)
Healthcare Sharing Services
These programs are commonly known as cost-sharing ministries or faith-based cost-sharing services.
- Healthcare sharing services are usually groups of like-minded people that agree to help each other pay medical bills. Most are organized around a common ethical or religious belief.
- Healthcare sharing services are typically cheaper than an ACA plans. Most, however, can decline applicants who don’t subscribe the group’s belief system.
Short-term Health Insurance:
Short-term policies have limited benefits and are traditionally used to provide coverage for a fixed period of time.
- Short-term plans provide many key benefits most consumers want,, but don’t typically cover specific benefits like maternity care, mental health, substance abuse, and pre-existing conditions.
- Short-term plans are typically 80% cheaper than major medical plans.
- The terms of coverage on short-term plans can range from three months to three years.
Fixed Payment Plans or Fixed Indemnity Plans:
Fixed Payment Plans or Fixed Indemnity Plans, as well as some “GAP” plans will pay a set cash benefit per specified hospital or physician service provided.
- Unlike major medical or short-term coverage, that pay all qualified expenses after the deductible is met, fixed indemnity plans pay a flat fee for each service provided.
- GAP plans are typically used with short-term or major medical plans to pay for out-of-pocket expenses related to an accident or critical illness.
Multi-Policy Plans (what eHealth calls Medical Insurance Packages) are being offered by a growing number of insurers and brokers and typically include a combined package of insured and non-insured benefits.
- These combinations provide more complete coverage than a non-major medical plan can provide.
- Combinations usually include short-term for medical, GAP for deductible protection and association memberships for Rx discounts and mobile office visits.
Medicaid or the Children’s Health Insurance Program (CHIP)
Determining whether or not you qualify for CHIP will depend on the state you live in, because every state has its own rules.
Typically, you can apply, any time of year and find out pretty quickly if your child will qualify.
If you’re applying for Medicaid for yourself as well, your state’s Medicaid office will let you know if your children will also qualify for CHIP.
The great thing about CHIP, is that you typically don’t have to pay for it to get your kids covered.
There are a couple of ways you can apply for CHIP:
- You can fill out an application online at your states Health Insurance Marketplace. If the marketplace determines that you’re likely to qualify for CHIP or Medicaid they’ll have your state agency contact you to help you enroll.
- You can also call 1-800-318-2596 (TTY: 1-855-889-4325).