What Is Child-Only Health Insurance and How Do I Get It?
Child-Only Health Insurance
Child-only policies are health insurance policies that insure just children.
There are many options for child-only insurance in both the private and public sectors. The best option for you will often be determined by the financial situation of your household.
Buying insurance on Healthcare.gov is the best way to get child-only insurance for most people because you can choose your coverage and cut costs based on your income. Those with a low income can sign their child up for Medicaid or CHIP, which costs little or nothing for good coverage.
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Types of child-only insurance
When shopping for child-only health insurance, choose the type of plan, such as Medicaid or an ACA plan based on your coverage needs and financial situation.
Child-only insurance | Cost | Details |
|---|---|---|
| Medicaid | Cheapest (free or little cost) | Eligibility determined by income |
| CHIP | Cheaper (free or little cost) | Eligibility determined by income |
| ACA | Varies based on income and plan | Full-benefit plan; can only enroll during specific periods |
| Private | Expensive | Full-benefit plan; available to anyone |
| Short term | Can be cheap | May have high deductibles or coverage exclusions |
- Children’s Health Insurance Program (CHIP) and Medicaid are the cheapest options and are available to children whose households have a low income. It's usually easier to qualify for CHIP than Medicaid.
- Affordable Care Act (ACA) plans are good for most children. Anyone can sign up for comprehensive plans during open enrollment. Rates are discounted based on your income and can be as low as $0 to $10 per month.
- Private insurance plans bought directly from an insurance company or agent are a good way to insure children if you can't sign up for an ACA plan because it's not open enrollment or you don't qualify for mid-year enrollment.
- Short-term health insurance can be good when you need to cover children for a few months. Plans can be cheap, but the benefits aren't usually as good.
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About child-only health insurance
Most child-only policies exist as part of larger health systems or plans in the public and private sectors, providing a range of options for parents looking for child-only policies.
Most people in the U.S. — adults and children — access health insurance through employer-based plans. But in many instances, children — those under age 19 — lack any type of health insurance. (The federal government usually defines children as 0-17, though most state-run programs define children as 0-18 or 0-19.)
Children may reside in a household where no one is covered or where their parent or guardian cannot afford policies that cover their dependents. In other cases, an employee health plan may cover just the employee or the employee and the employee’s spouse, leaving the children uninsured.
As a result, parents are forced to look for child-only policies.
Medicaid
Medicaid provides full health benefits to those who have a low income, including adults and children.
It's easier for children to qualify for Medicaid than adults. That means a child can be insured with Medicaid, even if a parent or guardian isn't.
Eligibility varies by state and the age of your child. For example, children in a family of four could qualify for Medicaid if the household earns less than $39,000 to $90,000, depending where you live and how old your child is. That's a household income limit of 130% to 300% of the federal poverty level, depending on where you live.
- Pros: Medicaid generally does not charge copays or deductibles for covering children. This makes it a great deal and a highly desirable form of coverage. If you're eligible, you can enroll at any time during the year. Only four state Medicaid programs — California, Maryland, Michigan and Vermont — charge monthly premiums or enrollment fees for children.
- Cons: Medicaid's income restrictions can make it difficult to qualify for in some states. Some doctors may be reluctant to take Medicaid patients because it doesn't pay as much for medical services as standard health insurance. Medicaid coverage can take up to 45 days to take effect in some states after an application is approved.
Children’s Health Insurance Program (CHIP)
CHIP is a program that provides full coverage to children only, under the age of 19 in most states.
The income requirements for CHIP are not as low as Medicaid. As with Medicaid, eligibility requirements vary from state to state. In some states, such as Massachusetts, CHIP is part of the state Medicaid program, and Medicaid administers the CHIP benefits, functioning as a children’s Medicaid program.
- Pros: CHIP provides comprehensive children's coverage for very low costs. You can enroll anytime without having to wait for an open enrollment period. In addition, routine checkups and dental visits are free under CHIP.
- Cons: In some states, coverage can take up to 90 days to take effect. The income restrictions mean that many children are not eligible because their household incomes are too high. And in many states, there are some medical costs or monthly costs for coverage.
Where CHIP has a monthly cost or enrollment fee
Where CHIP charges copays or deductibles
- Alabama
- Arizona
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Louisiana
- Maine
- Massachusetts
- Missouri
- Nevada
- New Jersey
- New York
- North Carolina
- Pennsylvania
- Texas
- Utah
- Washington
- West Virginia
- Wisconsin
Where CHIP has a monthly cost or enrollment fee
- Alabama
- Arizona
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Louisiana
- Maine
- Massachusetts
- Missouri
- Nevada
- New Jersey
- New York
- North Carolina
- Pennsylvania
- Texas
- Utah
- Washington
- West Virginia
- Wisconsin
Where CHIP charges copays or deductibles
- Alabama
- Arkansas
- Colorado
- Connecticut
- Florida
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Mississippi
- Montana
- New Jersey
- North Carolina
- Pennsylvania
- Tennessee
- Texas
- Utah
- Virginia
- West Virginia
- Wyoming
Affordable Care Act (ACA)
The ACA gives individuals and families access to health insurance through health insurance marketplaces.
Also called Obamacare, full benefit plans from private insurance companies are often available at discounted rates.
You can sign up during open enrollment, which usually occurs in the fall, or during a special enrollment period if you have a qualifying event. You can also enroll at any time if you have a low income.
Child-only health insurance costs an average of $322 per month if you pay full price.
How much you pay is based on the plan you choose and your income. Those who have low incomes can get coverage for $10 per month or less, after applying subsidies.
- Pros: Many people seeking ACA plans qualify for subsidies, which help make coverage affordable. Plans are required to cover preventative care, doctor visits, hospital costs and prescriptions. Having a preexisting condition won't affect your costs or prevent you from getting coverage.
- Cons: You have to sign up during open enrollment, which usually begins in the fall. Exemptions are made for people with qualifying life events. Even with subsidies, the costs of ACA plans for most people are higher than the costs of CHIP and Medicaid plans. Also, it can be confusing to choose the best plan for your situation.
Private plans
Private health insurance are full-benefit plans that you can buy directly from an insurance company, agency or broker, without using the ACA marketplaces.
Look for a plan that says it provides "minimum essential coverage" or is ACA compliant. That means coverage for your child will include the main medical expenses.
Not all companies will sell you private plans outside of open enrollment. Watch out for situations where you think you are buying a standard insurance plan, but the company is selling you a short-term plan instead.
- Pros: Private plans can be bought from an insurance company without having to go through the ACA marketplace. Unlike with ACA plans, you usually don’t have to wait for open enrollment periods to apply. Private plans also have to adhere to the same protections that apply to ACA plans.
- Cons: Private plans are more expensive than CHIP and Medicaid plans as well as ACA marketplace plans. Unlike with an ACA plan, you'll have to pay full price for a private plan, without subsidies.
Short-term plans
Short-term health insurance plans are typically bought directly from an insurance company to get coverage for a few months if you're between two health insurance plans.
- Pros: Short-term plans are good for bridging gaps in coverage while providing cost protection against catastrophic events such as a broken leg. These plans also tend to be cheaper than traditional health insurance, and coverage can start immediately.
- Cons: Short-term plans have benefits that can vary widely such as having very high deductibles or exclusions for prescriptions, mental health or preexisting conditions. You'll have to answer a medical questionnaire, so you could be denied coverage or have to pay more based on your health history.
Pivot Health is one of the best short-term health insurance companies that sells child-only policies.
Other top companies allow you to add a child to an adult's policy, but they may not insure the child on their own.
What is the best child-only health insurance coverage?
Medicaid and CHIP are the best child-only health insurance plans if you're eligible. For others, ACA plans are the best.
First choice: Medicaid
Medicaid is the largest source of child-only health insurance in the country, providing care to more than 35 million children. For any parent looking for a child-only health insurance policy, Medicaid should be the first option to consider.
In addition to providing full benefits, Medicaid is also the cheapest form of health insurance available.
The program, funded through a combination of state and federal funds, covers all types of medical care — regular medical services, preventive services, prescription drugs, dental and vision care as well as long-term care.
Medicaid programs do not charge deductibles, and most state Medicaid programs charge nothing for covering children. The challenge with Medicaid is not everyone qualifies for the program because you must meet the income requirements of your state.
Second choice: CHIP
CHIP is the next-best option for parents who want child-only health insurance policies.
Like Medicaid, CHIP is funded through a combination of state and federal funds and has its own eligibility requirements that vary from state to state. Unlike Medicaid, CHIP only covers children, usually those younger than 19. CHIP income limits are set above the income limits for state Medicaid programs.
Your child may qualify for CHIP even if your household earns too much to qualify for Medicaid.
For example, in Michigan, a child will qualify for CHIP if the household earns less than 217% of the poverty line and will qualify for Medicaid with a household income of less than 160% of the poverty line.
Although costs differ in every state — some state programs charge copays and deductibles, for example — any family contribution to the cost of coverage cannot exceed 5% of family income.
Like Medicaid, CHIP provides comprehensive health coverage. All state programs cover the following:
- Routine checkups
- Immunizations
- Physician visits
- Prescriptions
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
To learn about applying for CHIP, visit HealthCare.gov's CHIP resource center or call your state CHIP office.
Third option: The Affordable Care Act
Health plans provided by the ACA are the best option for parents whose children do not qualify for Medicaid or CHIP. Parents can buy child-only policies through the ACA marketplaces during open enrollment, which usually takes place during the fall, or during a special enrollment period.
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In many cases, the cost of coverage can be reduced based on your income. These subsidies, also called premium tax credits, can help keep coverage affordable.
Individual and family plans under the ACA are required to cover 10 essential benefits, which are:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Pediatric services
- Preventive and wellness services
- Mental health and substance abuse care
- Prescription drugs
- Rehabilitative services
- Laboratory services
How much does health insurance cost in your state?
Plans are divided into coverage levels named after metals, which can help you understand how much medical care might cost. The higher tiers have higher monthly payments but lower deductibles and copays.
For example, with a cheaper Bronze plan, you could have to pay 40% of the cost of an X-ray. But with a Gold plan, you could only have to pay 10% of the cost.
- Bronze plans have the cheapest monthly premiums but high out-of-pocket expenses such as copays and especially deductibles. If your family has trouble paying these high upfront costs, your child may not be able to access medical care.
- Silver plans balance the cost of a plan with the cost of medical care. A Silver plan will usually cost more than a Bronze plan, but it will have a lower deductible to meet before the plan's full benefits begin. If you have a lower income, you can also qualify for cost-sharing reductions, which improve the plan's benefits.
- Gold plans are usually the most expensive on the state marketplaces. But the deductibles and copays are much lower than those of Bronze or Silver plans. It's usually worth it to pay for a Gold plan if your child needs ongoing or expensive medical care.
Some states have Platinum health insurance plans, which give you the best coverage for your child's medical expenses at a high monthly rate.
Use HealthCare.gov to see what plans are offered in your ZIP code and compare options based on the doctors, hospitals and medications that are covered.
Private plans and short-term options
Private insurance and short-term plans bought outside of the ACA exchanges should be the last resort for any parent or parents looking for child-only policies.
- Long-term private insurance is more expensive than Medicaid and CHIP, and unlike ACA plans, private plans do not include subsidies to help lower costs. Private plans that sell full-benefit coverage outside of the state exchanges still have to comply with the protections laid out in the ACA, providing safeguards for customers.
- Short-term health insurance is another option for child-only policies. However, plans don’t have to adhere to protections normally associated with qualified health care plans under the ACA.
Short term plans can refuse to cover a child's preexisting condition such as asthma or diabetes.
Short-term plans are typically used for protection against catastrophic events until longer-term insurance takes effect or can be found.
If a child falls and breaks a leg, for instance, the short-term policy should cover the cost of fixing the broken leg. Parents should always remember that short-term plans are a temporary solution, often bought while trying to find a more permanent type of coverage or waiting for Medicaid, CHIP or an ACA plan to kick in.
Aside from filling gaps, short-term plans have other benefits. They usually provide immediate coverage. You don’t have to wait for open enrollment or special enrollment periods, for example. The cost of child-only insurance in the short-term market also tends to be lower than the cost of other plans on the private market because the coverage is shorter in duration.
Frequently asked questions
What's the best health insurance for kids?
If you have a low income, Medicaid and CHIP have the best child-only health insurance. Otherwise, you can enroll in an ACA health insurance plan, which can discount your child's insurance costs based on your income and let you choose the company and level of coverage you prefer.
How do you get health insurance for a child?
Most adults add a child to their health insurance plan. This can happen any time if you have a qualifying event such as birth, adoption, marriage, divorce, moving or losing other insurance coverage. You can also sign up for child-only health insurance through Medicaid, CHIP or the ACA marketplace.
How much does child-only health insurance cost?
A child-only health insurance plan costs about $322 per month if you pay full price. Many people who shop on Healthcare.gov or a state marketplace will get discounted rates based on their income. You can also get free or cheap insurance for children through Medicaid and CHIP if you qualify for the programs because of your income.
Methodology
The cost of health insurance for children is based on rates for kids age 0 to 14 for a Silver plan. Rates are based on aggregated data from the Centers for Medicare & Medicaid Services (CMS) about private health insurance plans sold on HealthCare.gov. Data excludes states that use their own health insurance marketplace instead of HealthCare.gov.
The best child-only health insurance policies are based on three criteria: cost, extent of coverage and eligibility criteria.
Other sources include Healthcare.gov, Medicaid.gov and the Kaiser Family Foundation (KFF).
Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.