Children's health insurance: The options and benefits
Insurance options for children include Medicaid, the Children’s Health Insurance Program (CHIP), or private health insurance programs.
Income levels can affect which insurance options a person’s children are eligible for. Medicaid offers insurance coverage for children in lower-income families. CHIP and private health insurance are options for those who do not qualify for Medicaid coverage.
Children’s health insurance may help lower preventable hospitalizations, manage chronic conditions, and offer peace of mind to parents and caregivers.
Medicaid is a state insurance program that offers coverage for children from low income families. Although Medicaid programs must follow certain federal guidelines, certain features may differ from state to state, including:
To learn more about eligibility for Medicaid in a specific state, people can contact their state Medicaid agency.
Although Medicaid’s benefits may vary from state to state, all programs must offer certain mandatory benefits, including:
CHIP offers coverage for children from families not eligible for Medicaid but who may not be able to afford private health insurance. Like Medicaid, people can apply for CHIP at any time in the year.
CHIP programs vary by state and work closely with the state’s Medicaid program. Despite differences in coverage, all CHIP plans offer the following:
CHIP costs may differ from state to state, but will never exceed 5% of a family’s income. Some people may need to pay a monthly premium or a copayment for certain services.
People may be able to get Marketplace health coverage if they are ineligible for or lose Medicaid or CHIP coverage. If someone loses Medicaid or CHIP coverage, their state may contact them with information about Marketplace plans.
People can also contact a Marketplace assister, who offers impartial, free information about their options. They can answer a person’s questions and help them apply for a Marketplace plan.
There are various Marketplace health insurance plans that may suit someone’s needs.
If people do not qualify for Medicaid or CHIP, they may be able to get insurance coverage for children through private health insurance plans.
An individual may be able to get private health insurance through their employer. Coverage, benefits, and costs will vary depending on the plan.
Inadequate coverage for children can involve unreasonable out-of-pocket costs or benefits that do not meet their needs.
Although adults are more likely to be uninsured than children, the latter can still experience coverage gaps. In 2023, 4 million children in the United States did not have insurance.
People may need to make special considerations about health insurance coverage for children in the following situations.
Although Medicaid and CHIP coverage are usually comprehensive, benefits may not always meet the needs of children with special healthcare requirements.
In these cases, people may be able to seek additional support from resources such as advocacy groups or state-led supplemental resources.
Individuals can speak with healthcare professionals and their insurance provider to better understand their options.
Qualified non-citizen children who meet their state’s eligibility requirements for CHIP or Medicaid coverage may be able to get health insurance after a 5-year waiting period. Certain immigration statuses may reduce this waiting time.
People may also qualify for emergency care coverage even if they do not meet the immigration eligibility requirements.
To make the most of a child’s healthcare insurance plan, parents and caregivers can find out exactly what the plan covers and ensure their child gets any suitable preventive services. This may include:
Since plan benefits may vary state by state, people can check their insurance plan for more information.
Although CHIP coverage can end at age 19, coverage may vary depending on the state, with potential extensions available. After coverage ends, children may qualify for Medicaid or Marketplace insurance plans.
The Affordable Care Act ensures that private insurance plans or issuers must offer coverage to a child on their parents’ plan until they are 26 years old. After this, they can move onto their own private, employer-provided, or Marketplace insurance plan.
Although CHIP coverage can end at age 19, coverage may vary depending on the state, with potential extensions available. After coverage ends, children may qualify for Medicaid or Marketplace insurance plans.
The Affordable Care Act ensures that private insurance plans or issuers must offer coverage to a child on their parents’ plan until they are 26 years old. After this, they can move onto their own private, employer-provided, or Marketplace insurance plan.
States must provide certain dental benefits to children on Medicaid or CHIP health insurance. The minimum benefits must include pain relief and infection relief, dental health maintenance, and tooth restoration.
These plans should also cover vision screening as part of a routine checkup.
The specific benefits of plans will vary from state to state and depending on the type of plan.
States must provide certain dental benefits to children on Medicaid or CHIP health insurance. The minimum benefits must include pain relief and infection relief, dental health maintenance, and tooth restoration.
These plans should also cover vision screening as part of a routine checkup.
The specific benefits of plans will vary from state to state and depending on the type of plan.
Medicaid and CHIP aim to offer insurance benefits to children in families with low incomes who cannot afford private health insurance. Children may not qualify for Medicaid or CHIP if their family can afford private health insurance.
Medicaid and CHIP aim to offer insurance benefits to children in families with low incomes who cannot afford private health insurance. Children may not qualify for Medicaid or CHIP if their family can afford private health insurance.
To appeal insurance claim decisions, people can file for an internal review, in which the insurance company reviews its decision, or an external review, in which an independent third party reviews the appeal.
To appeal insurance claim decisions, people can file for an internal review, in which the insurance company reviews its decision, or an external review, in which an independent third party reviews the appeal.
Children’s health insurance is important to cover emergency care, preventive services, and other health benefits. The available options may depend on a family’s income level and other factors.
Children may get health insurance coverage through Medicaid, Children’s Health Insurance Program (CHIP), Marketplace plans, or private health insurance plans.
The specific benefits and eligibility criteria may depend on the state a person is in and the type of plan they choose.