Everything You Need to Know About Child-Only Health Insurance
Child-only health insurance might seem strange, but a lot of youths need it. Here's everything you need to know about these plans to get the best coverage for the best price. (If you have to pay for it at all.)
Child-only health insurance probably sounds kind of odd if you've never needed it yourself, or if you've never needed to buy it for a loved one.
The fact is, though, the circumstances that push people to need or buy child-only health plans aren't as unusual as you may think.
Some parents or guardians simply can't afford to buy health insurance that covers both themselves and their children. Others get health insurance through an employer that doesn't cover children or other dependents. Or their job-based plan offers that sort of coverage, but it isn't affordable.
And then there are the parents or guardians who enroll in Medicare, which doesn't provide dependent coverage.
How many Americans find themselves in one of those situations at any given time is anyone's guess. A few years ago, however, The Washington Post reported that between 100,000 and 700,000 youths benefit from these child-only plans, so there's definitely a market for them.
As for who serves this market, how they do so, and what that means for the children their plans cover, all of that and more is explained below.
What Are Child-Only Health Plans? What Do They Cover?
Child-only health insurance does exactly what you'd think it would do: it covers children--and only children.
That's opposed to most other health plans, which focus on covering just adults, or adults and their dependent children.
As for what child-only health insurance covers, well, that's not as easy to summarize. The reason: people looking to buy or obtain this coverage can do so in a couple of different ways.
One way is to buy a child-only plan through the private market. Another is to buy a plan through one of the state health insurance exchanges set up by the Affordable Care Act. Medicaid is another option, depending on your circumstances, as is the government-run Children's Health Insurance Program (CHIP).
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Children's Medicaid Coverage
The best-case scenario for anyone who needs child-only health insurance is for them to qualify for Medicaid coverage.
Why? Because you may not have to pay anything for it. And if you do have pay for it, you probably won't pay much.
The catch, of course, is that not everyone is eligible for it. To be eligible for Medicaid, you have to meet certain financial and non-financial criteria. Generally, though, your monthly income needs to be below a specific limit. (This amount changes depending on the size of your family.)
Medicaid eligibility requirements differ from state to state. Thankfully, you don't have to jump through a lot of hoops to figure out what the requirements are in your state. If you apply for coverage through healthcare.gov, it will let you know if you qualify for Medicaid--or CHIP, for that matter. And if you do qualify for either of those forms of coverage, it'll send your information to your state agency, which will then contact you about enrollment.
Two things to keep in mind here:
- 1. Your state may or may not call its program "Medicaid." Some, like Alabama and Delaware, do. Many others, like California and Massachusetts, don't. That won't matter if you apply through the federal marketplace site, but if you want to apply directly through your local agency, check healthcare.gov before you do so.
- 2. Although state Medicaid programs have to follow federal guidelines, the coverage they offer and how much they charge for it--if they charge anything--often differs from state to state, too.
Children's Health Insurance Program Coverage
Don't fret if you or your child or dependent aren't eligible for Medicaid. You may still qualify for CHIP, depending on your age, income, and a couple of other variables.
Much like Medicaid, CHIP provides Americans with low-cost health coverage, although CHIP focuses entirely on providing it to children.
Also like Medicaid, CHIP fully pays for some services while charging for others. For example, routine doctor and dental visits usually are free under CHIP.
Any copayments or other fees you might have to pay are based on yearly income and should be affordable. A case in point: lower-income children enrolled in Texas' CHIP program pay $3 to $5 for doctor visits and prescriptions. Higher-income children pay $20 to $35 for those services.
Some states charge a monthly premium for CHIP coverage, too. If yours does, it won't cost more than five percent of your family's annual income.
So, what do you get for those premiums, copays, and other fees? Again, it depends on where you live. That said, all states' CHIP programs cover the following:
- Routine check-ups and doctor visits
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
To find out if you or your child or dependent are eligible for CHIP coverage, contact your local agency or apply through the federal marketplace site.
Marketplace Child-Only Health Plans
If neither Medicaid nor CHIP are an option for you in terms of obtaining child-only health insurance, make a beeline for the government-run marketplace.
Depending on your yearly income and a few other details, you (or your child or dependent) may qualify for a subsidy that makes the coverage you buy from the marketplace a lot more affordable. (Learn more about this topic in our article, "What is the Health Insurance Subsidy and How Do I Qualify for It?")
Nice, right? Even nicer: you don't need a Ph.D. to figure out if you or your child can take advantage of one of these subsidies. As you enroll, the site will tell you if you qualify or not.
Aside from the cost-saving subsidies, there are a few other reasons buying a child-only policy via the online marketplace is a good idea if you can't get CHIP or Medicaid coverage. One is that, thanks to the Affordable Care Act (or the ACA or Obamacare), marketplace plans--and private ones, too, actually--have to provide continuous coverage even if you have pre-existing conditions.
They also have to cover a wide array of preventive care. Specifically, they have to cover various assessments, tests, screenings, immunizations, and medications. (Looking for examples? See our article, "Health Insurance and Preventive Care.")
As you probably already know, you can't buy a child-only health plan--or any other health plan--from the federal or state marketplace whenever you want. You can only do so during the yearly open enrollment period or during a special enrollment period. (Note: you don't have to wait for these periods to enroll in Medicaid or CHIP.)
Other than that potential hurdle, though, buying child-only health insurance through the marketplace probably is the way to go if you can't get coverage via Medicaid or CHIP--especially if you're eligible for a subsidy.
Private Child-Only Health Plans
If you're struggling financially to any degree, you should consider buying a child-only policy directly from an insurance company to be your last resort.
That's because, as you've already heard, you'll likely pay less--and maybe nothing at all--if you go with marketplace, Medicaid, or CHIP coverage instead.
Still, not everyone is eligible for those forms of coverage. And some people who are eligible for them can't fully benefit from them. If you get health insurance through an employer, for instance, you can't qualify for a subsidy if you buy a marketplace plan for your child--even if your job-based policy doesn't offer dependent coverage.
So, before you start talking with insurance agents, see if your child or dependent can get coverage through CHIP or Medicaid. After that, check out the health insurance marketplace in your state (or the federal one, if your state lacks its own site).
Should you come up short with those options, go ahead and approach insurers. They don't all sell this kind of coverage as "child-only health insurance," by the way. A few do, but many don't differentiate between it and the health coverage they offer to adults.
As such, if a quick scan of an insurer's website doesn't make it clear which of their plans are "child-only," pick up the phone and ask. Or shoot off an email. In other words, don't be shy.
Three Things to Keep in Mind While Shopping for Child-Only Health Insurance
If you need a child-only health plan, or if you're the parent or guardian of a child who needs one, start by seeing if you qualify for Medicaid or CHIP coverage. After that, turn to the online marketplace. Don't go directly to an insurance company until you've exhausted these other options.
The only way to benefit from a health insurance subsidy is to buy coverage through the federal or state exchange. If you buy a plan directly from an insurance company, you won't be able to take advantage of a subsidy.
Some of the child-only health coverage options described here cover dental and vision care, but many do not. If that's important to you or your child or dependent, do your research and don't be afraid to ask questions.
Frequently Asked Questions
Q: Why would someone need to buy health insurance that only covers a child?
A: There are a lot of situations that may cause someone to need a child-only plan. Maybe you can't afford health coverage for both yourself and your child. Or the insurance you get through your job doesn't allow you to cover your child.
These circumstances aren't common, but they're common enough that hundreds of thousands of children currently benefit from one of this type of coverage.
Q: What makes child-only health insurance different from other kinds of health insurance?
A: Generally speaking, the two usually aren't all that different. That's especially true when it comes to private and marketplace plans.
The Medicaid and CHIP programs often provide more coverage, or at least a wider range of coverage, than marketplace or private plans. As an example, Medicaid and CHIP cover various kinds of dental and vision care. That's not always the case with coverage bought on the marketplace or directly from an insurer.
Also, CHIP and Medicaid coverage usually cost less than marketplace or private child-only plans--if they cost anything at all.
Q: What kinds of medical care, treatments, or services do child-only health plans cover?
A: It depends on the type of plan or coverage. For specific examples, check out the sections above that focus on Medicaid, CHIP, marketplace coverage, and private plans.
Q: Do child-only health plans cover dental or vision care?
Some, but not all, marketplace plans include dental and vision coverage. The same is true of private plans.
Q: Where can you buy child-only health insurance?
A: You can buy this type of plan through the federal or state marketplaces. Or you can buy it directly from most health insurance companies.
Q: Can you get child-only coverage through the federal or state insurance marketplaces?
A: Yes, you can. As a bonus, those sites will tell you if you qualify for CHIP or Medicaid coverage when you fill out an application.
If so, why would someone do that rather than buy a private plan? Or why would they buy a private plan and not get coverage from the government?
Q: How much does child-only health insurance usually cost?
A: At the risk of sounding like a broken record, it depends. Children's Medicaid coverage often costs nothing. CHIP coverage sometime is free, too. Even when it's not, it doesn't cost much.
What you pay for a child-only marketplace plan depends on whether or not you qualify for a subsidy. If you do, it could cut the cost by quite a bit.
As for private plans, so many insurance companies offer them and their offerings are so different that it's impossible to say how much you should expect to pay for one.
To pay as little as possible, though, shop around. Do your homework and compare rates from a number of insurers before settling on one if you decide to go this route.
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