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Health Insurance for Children

Here are the main options available to you if you’re a parent looking to obtain health insurance for one or more of your children.

doctor check up with child

Although some of the specifics are sure to differ based on a person’s employment situation and the state in which they live, in general, there are only a handful of choices available to those who are looking to obtain health insurance for one or more of their children.

For most folks, the main option for them and their children is to gain access to this kind of coverage through an employer, although many others acquire it by buying a private plan of one sort or another (usually via the government’s health insurance “marketplace,” although not always), Medicaid, or the Children’s Health Insurance Program.

Which of these paths will be the best one for you and your child or children to take? That depends on quite a few different factors, too, though the information that follows should help to clarify matters at least a bit.

Employer-Based Health Insurance

If you’re like the average American, the most efficient way for you to secure health insurance for your children is to do so via a job. After all, this is how the majority of people in this country procure health insurance, according to a number of sources like Gallup, the Robert Wood Johnson Foundation, and even the U.S. Census Bureau.

That said, business owners aren’t offering health insurance to their employees as often as they have in the past. Plus, although it remains the option that’s most often turned to in situations such as this, there are still a lot of Americans who, for one reason or another, are unable to access health insurance in this way and have to do so using other avenues (such as the three that are described below).

If employment-based health insurance is made available to you, though, it’s very likely to be the most cost-effective way for you to secure coverage for your child or children. Plus, if it’s considered by the federal government to be “affordable” and you turn it down, you probably won’t be allowed to take advantage of the tax credits or other forms of savings you otherwise would (because of your income) when you go to buy a plan through the so-called marketplace or one of the related exchanges.

Other Private Health Insurance Plans

Should attaining health insurance for your children through a job prove to be an impossible task for whatever reason, you can always turn to private plans of various sorts.

Usually, this will mean using the federal health insurance marketplace or one of the state exchanges, but that’s not always the case.

For example, if you fail to procure a plan during the open enrollment periods that are tied to the marketplace and exchanges, your only option is to qualify for a special enrollment period or to pick up this type of insurance elsewhere.

A few words of warning: qualifying for a special enrollment period--which last for 60 days following certain life events that involve a change in family status (marriage or birth of a child are two good examples) or loss of other health coverage--is likely to be a better bet for most parents than acquiring coverage elsewhere.

That’s chiefly due to the fact that purchasing a plan outside of open enrollment and outside of the marketplace that meets the government’s definition of “minimal essential coverage” can be a challenge. (Thankfully, the insurance companies selling these plans will be able to tell you if a particular one reaches this threshold. A plan’s summary of benefits and coverage will include this information, too.)

If you decide to go with a marketplace or exchange plan, though, and if you need any help in terms of filling out the related paperwork, be sure to read our article, “Everything You Need to Know to Apply for Health Insurance.”

An Introduction to Medicaid and CHIP

And what are you supposed to do if neither employer-based nor marketplace plans are a possibility? Checking to see if you and your kids qualify for either Medicaid or Children’s Health Insurance Program (CHIP) coverage would be a good start.

Together, these programs, both of which are run jointly by federal and state governments, help protect a lot of low-income children. In fact, according to a recent report from the Henry J. Kaiser Family Foundation, they combine to provide health insurance to more than one in three American youths. (Specifically, more than 28 million children were found to be enrolled in Medicaid as of 2013, while nearly 6 million were enrolled in CHIP during the same time frame.)

Another feather in the caps of both CHIP and Medicaid: due in large part to their existence, the portion of uninsured children in this country dropped from 14 percent to 7 percent between 1997 and 2012.

As nice as that probably is to hear, the Henry J. Kaiser Family Foundation says that more than seven million children in the U.S. are still without health insurance--and over five million of them are eligible for either Medicaid or CHIP assistance.

That last statistic is especially sad, as no enrollment periods are attached to either of these programs. (Parents can enroll their children at any point in a given year.) Also, very little guesswork is required when it comes time to apply for them, as someone with HealthCare.gov will tell you which one you qualify for--assuming you qualify for one or the other-- based on the size of your household, your income, and other factors like age and disability, after you enroll.

Similarities and Differences Between CHIP and Medicaid

Although it’s true that CHIP and Medicaid differ in a number of ways--despite the fact that both are jointly run by the federal and state governments and both work to provide health coverage to in-need children (as well as other segments of the population)—to most Americans they’re going to seem pretty similar.

Take the benefits that tend to come along with gaining access to these programs. Both CHIP and Medicaid provide enrolled children with a comprehensive set of healthcare services including dentist, doctor, and hospital visits (including check-ups, immunizations, and prescriptions); vision care; mental health care; various types of therapy (all CHIP programs cover physical, occupational, as well as speech and language therapies); and more.

Unfortunately, not all states provide the same quality or quantity of benefits to their Medicaid or CHIP recipients. That’s because although the federal government sets the guidelines for these programs, individual states are allowed some amount of flexibility in administering and designing them—which results in benefits packages that can vary quite a bit from state to state.

“People should be aware that there are restrictions on some of the benefits,” says Gail Cavanaugh, an agent with Columbia, South Carolina-based Colonial Life. “For instance, if they need eyeglasses, they may have a choice of one or two ophthalmologists and opticians in their town. They may not have a choice as to frames when being fitted for eyeglasses.”

Families enrolled in Medicaid and CHIP can run into issues with dental care, too, depending on which state they call home. Some programs only cover extractions and exams, Cavanaugh says, while others are limited or restricted in ways that cause people to “have to attend a dental clinic which treats patients with no dental coverage and offers a sliding fee scale.”

Even more differences can be seen when you look at how children become eligible for these programs. CHIP, for example, covers children and teens up to age 19 who find themselves above Medicaid income eligibility thresholds—which for children younger than six is up to 133 percent of the Federal Poverty Level (or FPL, $29,700 for a family of four in 2011, according to medicaid.gov), and for children six and older is up to 100 percent of the FPL (or $22,350 for a family of four in 2011).

In most states, this means that children up to age 19 whose parents make up to $48,500 per year (for a family of four), and sometimes more, can qualify for one of these programs.

Medicaid, on the other hand, covers youths up to age 21, in most circumstances, although that number jumps to 26 for young adults who have “aged out” of foster care.

Given the aforementioned flexibility with which states are able to design these programs, it should come as little surprise to hear that the eligibility rules that are tied to them also can differ quite a bit depending on where you live.

If you live in Texas, for example, the related thresholds are 100 percent of the FPL for Medicaid and 200 percent of the FPL for CHIP, according to Carolyn Goodwin, CBC, SGS, principal at Goodwin Benefits Group in Dallas.

Also, “income is tested along with the family size, so the numbers are different for a family of four than they are for a family of eight,” Goodwin says, adding that for these purposes, family members include “custodial parents and any non-adult siblings living in the household” and do not include in-laws, uncles, aunts, or cousins.

The Costs Associated with Medicaid and CHIP Coverage

It’s difficult to say how CHIP and Medicaid differ when it comes to how much parents are likely to be charged for making use of them because this component of the programs varies depending on factors like income and the rules of the state in which the family lives.

What can be said is that some children will be able to make use of some services for free (there’s no charge for routine doctor and dental visits under CHIP, for example), while others will be asked--or their parent or parents will be asked--to pay low copayments, enrollment fees, or even monthly premiums for some forms of care.

A Primer on Applying for Marketplace, Medicaid, or CHIP Plans

As was mentioned earlier, if your goal is to obtain health insurance for your child or children via the federal or state “exchanges,” you’ll usually have to do so during a specific “open enrollment period” that tends to cover the last two months of one year and the first month of the next. (The open enrollment period for next year will last from Nov. 1 of this year through Dec. 15 of 2017.)

Outside of this period, you’ll only be able to purchase an exchange or marketplace plan by qualifying for a “special enrollment period,” which will mean proving you lost coverage for one reason or another or you were prevented from taking advantage of the open enrollment period because of one or more of a handful of “life events.

(Note: to see if you’re eligible coverage, go to See if you can get 2015 health coverage.)

If you’re looking to get CHIP or Medicaid coverage for your child or children, on the other hand, you can apply at any time of the year by going directly to your state Medicaid agency or by filling out a Marketplace application at healthcare.gov.

One aspect of the CHIP and Medicaid online application process that’s sure to appeal to a lot of potential enrollees is that “the system will tell them whether or not they are eligible for [either program] based on their income,” Cavanaugh says. “If they do not qualify, a plan is recommended from the many health insurance carriers who are authorized to provide insurance for the state.”

To apply in our state, the applicant must provide documentation of immigration status (not the parents’, but the child’s).  That would include a birth certificate if born outside the state or proof of legal immigration, current visa or certification of legal residency.  There is also an income test, 100% of FPL for Medicaid and 200% for CHIP.

Frequently Asked Questions

Q: Can my children still qualify for Medicaid or CHIP if I have a job?

A: Yes, as long as your income is below the eligibility thresholds that have been established for these programs in your state.

Q: What happens if my child is eligible for Medicaid or CHIP but I’d prefer to buy a plan through the exchange instead?

A: In that case, you likely wouldn’t be able to take advantage of any tax credits or other forms of savings that otherwise might be made available to you because of your income.

Q: Am I only allowed to apply for Medicaid or CHIP coverage at certain times of year?

A: No, you can sign up your children in either of these programs at any time, as there are no enrollment periods associated with them like there are with marketplace or exchange plans.

Q: How can I apply for CHIP or Medicaid plans?

A: The easiest method may be to use the online application that can be accessed at healthcare.gov, although you also can apply by phone (call 1-877-543-7669), by mail, or even in person.

Q: Do I have to renew my kids’ Medicaid or CHIP coverage? If so, how do I do that

A: You do have to renew it, but the good news here is that whichever program your children are enrolled in will let you know when it’s time to renew their coverage.

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