Options for uninsured children
What if my child isn’t listed as a beneficiary under either parent’s health insurance?
Sometimes even if a parent has group health insurance through an employer, family members are not covered. If the problem is that the premiums cost too much, talk about this with your team social worker, who should know more about financial resources that may offer help.
One option is for the insured parent to talk with their employer (or their employee benefits person at work) about how to enroll their child. Look closely and compare plans if you’re trying to decide among several insurance or managed care options. Sometimes there’s a chance to look at and consider different types of coverage during open enrollment periods. (During open enrollment you are able to make changes in your health coverage. This usually happens once a year.)
Another option is the health insurance marketplace. You can buy insurance here if the marketplace is in an open enrolment period. Your child can’t be turned down because of a pre-existing condition, and you’ll find out if your child qualifies for Medicaid or CHIP when you apply.
Sometimes it’s possible to add yourself, your spouse, or a child to a work health insurance policy or buy insurance on the health insurance marketplace outside the open enrollment period if you’ve had a major change in situation; for instance, if you’ve married, divorced, adopted a child, or a parent left their job. Check with your health insurance administrator at work about your group health plan, and contact your state health care marketplace about enrolling your child in a private individual plan there.
Some workplace plans may be grandfathered, which can mean coverage is limited (with things like annual caps and pre-existing condition exclusions). Check before you sign up. (See “Grandfathered employer plans” in the section “Other things to know about health insurance.”)
If you get insurance through your job (or your spouse/partner’s job), you may want to keep the administrator’s phone number and email address handy. Group insurance is better for most people than individual insurance. But in some cases, you may find a better deal for your child in your state’s marketplace. (See “Where to get private individual coverage: the health insurance marketplace” in the section “Private health insurance options.”)
What if my child is a young adult?
The new health care law provides coverage for young adults up to the age of 26 under their parent’s health insurance, if the plan has dependent or family coverage. This means adult children ages 18 through 25 can join or stay on a parent’s plan whether or not they are:
- Living with a parent
- In school
- Financially dependent on a parent (the young adult does not have to be listed as a dependent on the parent’s tax return)
The only exception is if the young adult can get their own job-based coverage, then they cannot be covered by the parent’s plan.
The cost of the insurance for young adults can’t be any higher than for dependent children under the age of 18.
What can I do if my work doesn’t offer group health insurance?
Families that don’t have health insurance through an employer can explore a number of options:
- Under the new health care law, people looking for health coverage will be able to compare plans and select the best one for their family on health insurance marketplaces in each state. Your state’s marketplace will collect information from you to find out if you or your child qualifies for Medicaid. Low or middle-income families may qualify for financial help to pay for coverage. For a list of state marketplaces, visit www.healthcare.gov or call 1-800-318-2596. The next open enrollment period will start November 15, 2014.
- You can also buy individual insurance outside the marketplace to cover children or families. Most plans will meet the requirements for sufficient coverage so that you avoid the penalty at tax time, but some don’t. Be sure to ask whether it meets the minimum requirements of the new law.
- 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 or government agency that offers health insurance.
- 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 or current 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 your 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.”
- 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.
- If your family income is low, find out if your child is eligible for state or local benefits such as Medicaid or CHIP.
- If you have insurance at work and want to leave the job, ask 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.) Another option: if you leave your job and lose your insurance along with it, you qualify for a special enrollment period in the state marketplace. You’ll have 60 days to shop for and buy new insurance coverage there.
When looking into insurance options, find out about differences in coverage. The health care law requires plans to provide a Summary of Benefits and Coverage (SBC). The SBC is an easy-to-understand document with details on the benefits and the costs you’ll be responsible for. It includes specific disease examples to help compare plans and find the one that’s right for you. Look into 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)
- How much deductibles and co-pays will cost you
Be wary of ads or agents who call or visit to offer what they might call “government-issued insurance” or other low-cost health insurance. See “Fake health insurance and other deceptions” in the “Types of private health plans for children” section for more on this.
If you think 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.
- Covering the costs of cancer treatment
- Private health insurance options
- Types of private health plans for children
- How to manage your child’s health insurance
- Getting answers to insurance-related questions
- Keeping records of your child’s insurance and medical costs
- Handling a health insurance claim denial
- Keeping employer-sponsored health insurance coverage
- Government-funded health plans
- Who regulates insurance plans?
- Options for uninsured children
- What sources are available to help with treatment costs if my child doesn’t have insurance and there’s no public assistance available?
- Financial issues for families: Getting help with living expenses
- To learn more