Options for uninsured children

What if my child is not listed as a beneficiary under either parent’s health insurance?

Sometimes even if a parent has group insurance coverage through an employer, family members are not covered because the premiums would cost too much. You will want to talk about this with the team social worker, who should know more about financial resources that may offer help.

If possible, the insured parent should talk with their employer (or their employee benefits person at work) about how to enroll their child. Some plans have annual or semi-annual “open enrollment” provisions that allow you to sign up for family coverage despite current medical problems.

Cancer treatment can go on for long time and cost a lot. Insurance issues can be very complex and many families need help not only in finding answers, but even knowing the right questions to ask.

What can we do when work does not offer us group health insurance?

Families that do not have medical insurance through an employer can explore several options:

• As of 2010, your state should offer some type of high risk pool or Pre-Existing Condition Insurance Plan (PCIP) to cover people who have not had insurance for 6 months or more and have cancer or another pre-existing condition. Also, some states have health insurance options for low-income residents, in which the state pays for part of the coverage.
• Decide if one parent should look for a job with a large company that offers health insurance.
• Look into buying individual health insurance to cover your child. Although this is costly, rates have become more competitive with private insurance companies who see this as a business opportunity.
• Find out if there are health maintenance organizations (HMOs) or health care service plans in your community. You can sometimes get very good coverage through these plans. Many offer a period of open enrollment each year during which applicants are accepted regardless of past health problems.
• If a parent and child have recently been covered under an employer-sponsored plan for at least one day, and the employer still offers insurance coverage, the parent should be able to keep their medical insurance (or just the child’s, if the parent went part time, lost or left the job, died, got divorced, or became eligible for Medicare) through COBRA. The employer should tell you, in writing, about this COBRA option. For more information, please see “COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)” in the section called “Keeping employer-sponsored health insurance coverage when you leave your job.”
• Look into your child’s eligibility for Medicare, which covers people who are permanently disabled and have been getting Social Security (SSI) for 2 years.
• See if your child is eligible for state or local benefits, such as Medicaid if you are in a low-income bracket or are unemployed.
• If you are employed, don’t leave your job until you have found out if you can convert your group insurance to an individual plan for your family. Some group plans have a clause that allows people to convert, but premiums may be much higher. You usually must apply for individual plans within 30 days of leaving a job. (This is different from COBRA, which allows you to stay with the group insurance but only for a limited time.)

When looking into insurance options, find out about differences in coverage. Ask about these things:

• Choice of doctors
• Protection against cancellations
• Increases in premiums
• What the plan really covers, especially in the event of catastrophic illness (a serious illness, like cancer, that can add up bills quickly)
• What are the deductibles and co-payments? (Sometimes higher deductibles go along with better or more complete coverage.)

Be wary of ads or agents offering what they might call “government-issued insurance” or other low-cost health insurance. See “Fake health insurance” in the “Private health plan coverage for children” section for more on this.

If you feel an insurance company has treated you unfairly, contact your state insurance commission for more information. See the “To learn more” section to find your state insurance department.