Health Insurance Options for Children

Healthcare Rights for Children

Health insurance companies are prohibited from denying coverage to children under age 19 or excluding coverage for a pre-existing medical condition.

Go to Healthcare.gov or HealthSherpa.com to shop for and compare private health insurance plans available in your state.

Children’s Health Insurance Program

Your child or teen may be eligible for free or low-cost health insurance through your state’s Children’s Health Insurance Program (CHIP) or Medicaid, depending on your income. Go to Insurekidsnow.gov or call (877) Kids-Now (877-543-7669) to find out if your child is eligible.

Options for Young Adults  

If you’re under age 26 and aren’t offered health coverage through your job, you can stay on or rejoin your parent’s health insurance plan, even if you’re married, don’t live with your parents or are no longer a dependent of your parents. Contact your parent’s insurance company to take advantage of this option.

Health Insurance Marketplace and Open Enrollment:

Open enrollment for the Health Insurance Marketplace is Nov. 1-Dec. 15 in most states. Find out more about your state’s open enrollment period at www.healthcare.gov, call toll free 1-800-318-2596 or visit HealthSherpa.com. The Health Insurance Marketplace and HealthSherpa provide one-stop shopping for health insurance for individuals and families. Financial assistance is available for those who qualify.

Eligibility:

Individuals who legally reside in the United States and are not incarcerated are eligible to purchase coverage through their state’s Health Insurance Marketplace. Employers with fewer than 50 full-time employees can also purchase coverage through the Marketplace. Insurance companies can’t deny coverage or charge higher premiums to people with pre-existing medical conditions.

Financial Assistance Available:

Most uninsured people can qualify for financial assistance called a Health Insurance Premium Tax Credit to help make their insurance premiums more affordable. The amount of financial assistance depends on your income and family size. People with low income may qualify for free or low premiums. To find out how much financial assistance you may qualify for, check out the Kaiser Family Foundation’s subsidy calculator.

Types of Coverage:

All health plans sold through the Marketplace and HealthSherpa are offered by private insurance companies. The plans are required to cover a comprehensive set of benefits that includes hospital care, doctors’ visits, emergency care, prescription drugs, lab services, preventive care and rehabilitative services, among others. Before choosing a plan, individuals see whether their healthcare practitioner participates in the plan’s network (if choosing a network plan). They then choose the plan that best meets their needs and budget.

How to Enroll:

Individuals who need coverage can fill out a single application to find out what financial assistance they are eligible for and to apply for coverage. Those needing assistance with filling out the application can get help from trained, certified counselors. To find in-person assistance near you, contact your state’s Marketplace or visit www.healthcare.gov or healthsherpa.com.

The next open enrollment period is Nov. 1-Dec. 15 in most states.  However, in certain circumstances, you may be able to buy coverage outside of the regular open enrollment period, such as if you:

  • Have or adopt a baby.
  • Get married.
  • Move to a new state.
  • Lose your other health insurance coverage.

Those who qualify can also apply for the Children’s Health Insurance Program (CHIP) or Medicaid at any point during the year. There is no open enrollment period for these programs. Also, if you own or operate a small business, you can begin offering coverage to your employees at any time.

Community Health Centers:

Some hospitals, health centers and clinics provide medical care, prescription drugs, dental care and other services regardless of your ability to pay. Anyone may use a community health center, whether you have health insurance or not. How much you pay depends on your income. Find a community health center near you.