Health Insurance for Children
Medical Health Insurance for Children
Medical health insurance for children has become a hot topic with passage of the Affordable Care Act. The first place to look is always employer sponsored coverage. But many growing families find themselves without this option. Here are some points to ponder:
Government programs sometimes have unintended consequences. One such consequence is lots of change, and perhaps a need to cobble together coverage. You may find that your offspring fall into a gaping hole: no group or individual options, and you earn too much for the CHIP programs.
Child Health Insurance Only
Child health insurance only policies have been in the news lately. The Affordable Care Act contained provisions directly addressing guidelines for children. But like many government programs the unintended consequences hurt the people the program was intended to help – uninsured kids.
Under the Affordable Care Act insurers cannot deny coverage or limit benefits to anyone under the age of nineteen only because they have a pre-existing medical condition. The rule went into effect on September 23, 2010. The immediate response from the majority of insurers: withdraw from the child only health insurance market. Overnight the market disappeared.
The concern was that parents would delay buying coverage when their kids were healthy, waiting until they became seriously ill before opting for mandated coverage. The only parents buying coverage would be those with very sick children, driving premiums through the roof.
The debate surrounding child only plans continues. Meanwhile, parents needing coverage must turn to the government sponsored plans described below, purchase policies covering at least on adult.
Medical Health Insurance – Dependents to Age 26
Medical health insurance for adult offspring to age 26 was also addressed by the Affordable Care Act. Beginning on September 23, 2010, most health plans that cover children must make coverage available up to age 26.
Your child is covered even if they are married or single, not living with you, not enrolled in college, not financially dependent with you, and eligible to enroll in their own employer sponsored plan. Students are often required to purchase a policy by their college or university unless they can validate coverage under their parent's plan. This market is evolving rapidly as the new government guidelines roll out.
Children Health Insurance Program (CHIP)
Children’s Health Insurance Program (CHIP) is a federally funded plan that provides free and low cost coverage for teenagers up to the age of 19. Low income families with incomes as high as $44,100 per year (for a family of four), may qualify for coverage.
Each state designs own program so plans will vary for factors such as: eligibility, premium cost, co payments, deductibles, etc. Contact your state office for more details.
Children with Pre-existing Medical Conditions
As mentioned above the Affordable Care Act requires that health insurance plans must accept any youngster up to age nineteen as a new plan member regardless of any pre-existing health condition. The health plan may not limit benefits surrounding these existing conditions. But these government guidelines raise a few questions for parents seeking to help their child:
What happens after age nineteen? Beginning in January of 2014 all health plans must cover pre-existing condition, and cover adult children to age twenty six, whether they live at home at not. Child only plans really don’t exist as described above, so keeping them on the parent’s plan is one option. The second option is government sponsored Medicaid, which is available to disabled adults over the age of eighteen who are receiving social security supplemental disability income (SSDI).
What happens after age twenty six? After age twenty six your disabled adult dependent can no longer continue under the parent’s plan. Your adult dependent can purchase an individual policy with government subsidies through an exchange. As most disabled people have low incomes, the subsidy may cover much of the premium.
What about special needs: – Autism, Down’s syndrome, or other limitations? While pre-existing conditions can no longer be used to deny coverage, the new law does not guarantee that every treatment for every condition will be eligible for benefits. Check the list of essential health benefits in your state. There are federal guidelines for what should be included, but any state mandate that is more specific may be included. For example, a handful of states have mandates requiring coverage of autism therapies.
Sources: Healthcare.gov: children's pre-existing health conditions