Child Only Health Insurance Coverage
Do You Need Child Only Health Insurance
Child only health insurance is available in the US and has undergone some significant changes in recent years. But it’s not as widely available as private family plans, which include children on a parent’s health insurance plan for a small premium, or for free.
So, before we get any further, know that adding a child to your family plan is usually more affordable than a child only healthcare plan. If you can insure a child through that route, it’s the best option. But it’s not an option for every family, thus the need for child only coverage plans.
This article will explore everything you need to know about private health insurance for kids.
- ACA and HIPAA regulations that pertain to health insurance for kids
- Where to look for child only health insurance policies
- How to compare health insurance plans for child only
- What coverages must be included on all health insurance plans for children
- Who may need child only health insurance, and why
- Programs for child health insurance, like Medicaid, Medi-Cal, and CHIP
First, let’s learn a bit about the Affordable Care Act of 2010 (ACA) and the Health Insurance Portability and Accountability Act of 1996, (HIPAA). These have huge effects on child health insurance policies in the US.
Child Only Health Insurance, ACA and HIPAA Explained
President Obama signed the Patient Protection and Affordable Care Act (ACA) in 2010. It completely overhauled the US health insurance market.
The ACA and Child Only Health Insurance
ACA covers a lot of ground, too much to explore in a single article. But for parents – or guardians of minors – these are the four most significant points:
- Health insurers cannot deny coverage to anyone based on pre-existing conditions. That includes rare childhood diseases or common ones, genetic diseases or congenital disorders (birth defects).
- Children can remain a dependent on their parents’ policies until they are age 26. Prior to 2010, children had to find health insurance coverage when they turned 18 or 21, depending on the state and the insurer.
- All health insurance policies are now standardized through a metal tier system. In other words, a bronze plan at Company A will be nearly identical to the bronze plans at Company B as far as coverage. Still, the price of those identical plans can vary a lot from one insurer to the next.
- Every state and Washington DC now has a statewide health insurance marketplace. In some states, it’s managed by the state government. In others, it’s managed by the federal government. You can buy child only health insurance policies there, or from a private insurer.
If you would like to learn more about ACA, you can read the complete document online.
The other federal rule that pertains to healthcare and child only health insurance is HIPAA.
About HIPAA and Health Insurance for Children
The Health Insurance Portability and Accountability Act (HIPAA) was designed to help working adults keep some health insurance coverage when the moved from one job to the next.
However, HIPAA has gone through some changes, and in 2003 those changes began to focus on patient privacy and permissions for services. This is a key concern for parents and guardians.
HIPAA and Child Healthcare Concerns for 2022 and Beyond
In a nutshell, under HIPAA regulations, only a parent or guardian can view a minor child’s medical history. A parent or guardian must also consent to medical procedures, at the time of writing. So, for example, a 14-year-old patient cannot legally consent to having their tonsils removed without a parent / guardian signature.
But there are exceptions. As of 2021, for example, San Francisco area minors aged 12 and up can consent to COVID-19 vaccines without parental knowledge.
So, if you’re shopping for child only health insurance, be sure to ask the insurer about any key issues in your state or region that might be important to your family values or your child’s health.
Now that we’ve covered all the pertinent legislation, let’s talk about shopping for child only health insurance.
Where to Look for Child Only Health Insurance
Most parents / guardians will begin their search for child only health insurance on their favorite search engine. From there, you’ll have countless options for both private insurance providers, and your state’s insurance exchange.
Remember that health insurance plans are all standardized in the US. The coverages will be nearly identical, whether you get them through a state marketplace or a private insurer in your state.
The coverages in a state are nearly identical, but insurers set their prices based on several factors, including local cost of living. In other words, a child only health insurance policy might cost much less in Kansas City, KS than in Los Angeles, CA.
How to Compare Health Insurance Coverage for Child Only
Whether your child health insurance comes from a state exchange or a private insurer, all health insurance plans are divided into four metal tiers: Bronze, Silver, Gold and Platinum plans.
|Plan||Plan Cost||Coverage||Ideal Customer|
|Bronze||$||60% of most medical care||Young, healthy people on a strict budget|
|Silver||$$||70% of most medical care||Families who might need occasional care|
|Gold||$$$||80% of most medical care||Seniors, individuals with significant health concerns|
|Platinum||$$$$||90% of most medical care||Seniors or anyone with major known medical concerns|
As you see, a Bronze plan is the most affordable but covers the least amount of medical care. Many parents select a Bronze or Silver plan for their children.
Gold and Platinum plans are more expensive, but they might be worth the monthly premium if your child has medical problems.
Next, let’s think about which coverages are included on all health insurance plans for kids.
What Coverages are Included on All Child Health Insurance Policies?
Since the Affordable Care Act standardized health insurance, all the most common healthcare needs will be covered by your child health insurance policy.
Typical covered treatments and procedures include:
- Emergency treatment at a hospital or operating room (OR)
- X-rays and most diagnostic tests, like MRI or bloodwork
- Prescription medications, like antibiotics
- Standard childhood vaccinations, like TDAP and MMR
- Influenza vaccines, and in the future, it seems likely that COVID-19 vaccines will be covered
- Annual “well child” visits, annual checkups and school physicals
- Additional physicals, like those required for sports or employment for older kids
- And some specialized services – like a dermatology or physical therapy – if it’s prescribed by a primary physician
But no child health insurance policy is perfect. You might need to pay a little more for special services, hearing care and vision care / glasses. If you’re shopping for a private child health insurance plan, be sure to mention your child’s unique needs when getting quotes. Vision care and hearing care can be costly if they are not covered by your child’s insurance policy.
Now that we’ve outlined where to look for child only health insurance policies, and covered some pricing and coverage basics, let’s talk about who might need a child only health insurance policy.
Who Could Benefit from Child Only Health Insurance Policies?
In a perfect world, no one would ever get sick and parents could afford the best health insurance for their entire family, all the time.
But sometimes life throws a curveball at us. You might be in the market for child only health insurance policy because you’ve recently become unemployed and need to provide insurance for your child or ward while finding new employment.
Other times, court-appointed guardians or next-of-kin might seek a child only health insurance policy for a child who is in their care temporarily.
Grandparents can Buy Child Only Health Insurance for Children in Their Care
Let’s imagine, for example, a grandmother aged 68. Her name is Betty, and she has Medicare coverage for health insurance.
Life throws some curveballs at Betty’s family. Her adult daughter is sentenced to two years in prison, and she’s pregnant. Rather than allowing her newborn grandchild to enter the foster care system, Betty gets custody of the baby.
- The health insurance hiccup happens when Medicare – a federal senior health insurance program that Betty has earned through a lifetime of work – doesn’t accept children.
- So Betty finds herself seeking a child only health insurance policy.
Her first step is to search for child only health insurance plans on the internet. From there, she learns about a few private insurers and some other child only health policies available through her state exchange.
Betty selects a Bronze plan, because it seems like the infant is healthy so far, and Betty is on a careful budget. She compares the prices of Bronze plans among several insurers, and in this case, they are all priced about the same. Ultimately, she chooses an insurance company that she’s used in the past, because she is familiar with the network and local providers.
Now, there are some programs that might suit Betty and the baby if she qualifies as low-income. We’ll talk about those in a moment.
“Blended” Families can buy Health Insurance for an Individual Child, too.
Sometimes a judge will place the responsibility for a child’s health insurance on one parent during divorce and custody hearings. If you’re a single mom responsible for insuring your children, but end up re-marrying and joining your spouse’s health insurance plan through work, that insurer might not insure your child from a previous marriage. In that case, you could find yourself looking for a child only health insurance policy.
Now that we’ve discussed some family situations that might benefit from child only health insurance coverage, let’s talk about a few programs for low-income or middle-income families.
Medicaid, Medi-Cal and CHIP, Health Insurance Programs for Families & Kids
Medicaid is a government funded program that provides health insurance for low-income families, older low-income adults, pregnant women and some children – like foster kids. It is jointly funded by the federal government and individual states. California has its own version, called Medi-Cal.
CHIP – the Children’s Health Insurance Program – is a health insurance program like Medicaid, but for families that do not quite qualify as low income.
So, your next question is “How much money do I need to make to be eligible for Medicaid or CHIP?”
Eligibility for Child Health Insurance Programs
There are two ways to qualify for child health insurance programs like Medicaid and CHIP. The first is based on income, but it is not the only way.
Income Eligibility Varies by State
The income eligibility requirements for government-funded programs like Medicaid and CHIP can change from one year to the next and vary from state to state.
For instance, as of December 2021, an individual in Alabama must earn less than $13,128 annually to qualify for the program. While in California, the yearly income for a single individual must be less than $16,395 per year.
The best way to find out what child health insurance programs you may be eligible for is to apply through your state marketplace. From there, you will immediately learn if you qualify for Medicaid or CHIP, or if you need to find your child health insurance through an insurance company.
Other Ways a Child Might Qualify for Medicaid / CHIP
Some children can qualify for child health insurance programs based on:
- Refugee status
- Placement in foster care
- Parental disability, or Social Security Disability Income (SSDI) payments
Again, start with your state insurance exchange online and enter all your child’s information.
While programs like Medicaid and CHIP are essential for more than 72 million Americans, about twice as many Americans will continue to rely on private insurance plans for themselves and their children.
Now that you’re an expert, let’s wrap it up with a few final reminders.
Child Only Health Insurance Plans: The Key Takeaways
Remember these points as you shop for child only health insurance policies:
- No insurance company can deny coverage to your child based on pre-existing conditions.
- Parents and legal guardians have access to most of their child’s medical records, usually.
- Most families prefer Bronze or Silver tiered plans, unless someone needs special medical care.
- Health insurance plans are standardized: two Bronze plans at two companies will be nearly identical, except for price.
- Child only health insurance covers standard care, like “shots” and emergency room visits.
Finally, be sure to shop around for the best price. Get quotes through your state marketplace and private providers to get the best price for child only health insurance.