Affordable Health Insurance for Children: A Parent's Guide


Finding affordable health insurance for children can be a challenge--you have to balance your financial needs with your family's need for health care. However, HealthMarkets can take the guesswork out of the search and find you the insurance plan you need.  Let's look at how HealthMarkets's approach makes your life simpler. 

The ACA and Child-Only Health Insurance Plans

Health insurance plans covering only children, with no adults included in the policy, are not uncommon and can be found on private and public health insurance exchanges. The Affordable Care Act (ACA) mandates that any qualified health insurance plan sold on the public marketplace must have an equivalent plan for those who have not turned 21 before that plan year’s coverage begins. Because the plan must be equivalent, child-only plans are also qualified health insurance plans and must include:

  • Guaranteed issue during open enrollment periods: During the annual open enrollment period, insurance companies must offer coverage to anyone who applies.
    • Continuous coverage regardless of pre-existing conditions: This means that if you child has or develops an illness or disease, health insurance companies cannot deny, discontinue, or charge more for his or her coverage.
  • Free preventive care: In health insurance plans for children, free preventive services include:
    • Alcohol and drug use, behavioral, and oral health risk assessments
    • Certain medications (fluoride chemoprevention supplements, gonorrhea preventive medication for newborns, and iron supplements)
    • Tuberculin and STI testing
    • Screenings
 
  • Autism
  • Blood Pressure
  • Cancer
  • Cervical Dysplasia
  • Congenital Hypothyroidism
  • Depression
  • Development
  • Dyslipidemia
  • Hearing
  • Height, Weight, and Body Mass Index
  • Hematocrit or Hemoglobin
  • Hemoglobinopathies or sickle cell
  • HIV
  • Lead
  • Obesity
  • Phenylketonuria (PKU)
  • Sexually Transmitted Infection (STI)
  • Vision
    • Immunizations
 
  • Tetanus
  • Diphtheria
  • Pertussis
  • Haemophilus influenzae type b
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza (Flu shot)
  • Measles
  • Mumps
  • Rubella
  • Meningococcal
  • Pneumococcal
  • Rotarvirus
  • Varicella
  • Coverage for 10 essential benefits
    • Pediatric services (including dental and vision care up to age 18)
    • Preventive and wellness services and chronic disease management
    • Emergency services
    • Ambulatory patient services
    • Hospitalization
    • Laboratory services
    • Prescription medications
    • Mental health and addiction services
    • Pregnancy, maternity, and newborn care
    • Rehabilitative and habilitative services and devices

It is of note that the ACA also mandates that all individual and group health insurance plans must offer dependent coverage until children turn 26. This coverage does not include Medicare, but it does include health insurance plans sold on and off of the public exchange. If you are interested in health insurance plans that can affordably cover your entire family, contact HealthMarkets at (800) 658-0912 today. 

Employer health insurance for children

Only 48 percent of American households use employer plans to insure their children. Why? Maybe because some employer plans offer dependent coverage that seems unaffordable. Or maybe because some guardians are enrolled in Medicare, which doesn’t offer any dependent coverage. If you’re trying to find out if you can get a health insurance policy just for your children, you’re not alone. HealthMarkets can help you find affordable health insurance for children.

Subsidies and Child-Only Plans

Guardians who do not have employer-sponsored health insurance plans, or whose plans do not meet value and affordability standards, can apply for subsidies. Even if only one child is on a health insurance plan, a guardian can apply for subsidies as long as 1) he or she meets financial eligibility standards and 2) the coverage is for a legal dependent. A licensed health insurance agent can help you determine if you qualify for a subsidy and help you apply.

If you are on an employer-sponsored plan, you most likely cannot apply for subsidies to help cover the premiums and out-of-pocket costs of a child-only health insurance plan. Why? Because subsidies are only available to those who do not have access to employer-sponsored plans, those whose employer plans 1) don’t provide minimum value and 2) don’t meet affordability standards, and those who are within 100 percent and 250 percent of the federal poverty line.

To learn more about affordable health insurance for children only and find out if you are eligible for any subsidies, call us today at (800) 658-0912 to talk to a licensed insurance agent.

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Sources:

http://kff.org/other/state-indicator/children-0-18/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

https://www.hhs.gov/sites/default/files/ppacacon.pdf  

 

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