Due to the potentially high costs that often go along with health care for children under 19, some insurance companies have opted out of being a carrier for private health insurance for children. Carriers that are still in the market to provide child health insurance, do so with the ability to apply premium surcharges. Despite the potential for higher rates for individual child health plans, it is still one of the viable options available so that no child need be uninsured.
Private Insurance Plans for Children
Until just recently, children had to wait until an open enrollment period to apply for private health insurance. Now, several carriers, like Kaiser Permanente in California, are accepting child health insurance applications year-round. In some cases, the rates could be increased if there is no prior health coverage or if there is a pre-existing medical condition.
Surcharging due to a pre-existing health issue will be handled on a case-by-case basis and be affected by variables, such as the severity of the medical condition, the age and medical history of the child, plus the treatments needed. Even with surcharged premiums, private health insurance for a child is sometimes still better than other alternatives, especially over not having any insurance, which could potentially mean a greater cost.
Business Group Insurance is Becoming a More Affordable Choice
Another option for insuring your child would be through an employer-sponsored group plan, if you and your child are eligible. Many companies are shying away from offering health benefits, but if you are the business owner, this might be the best direction for you or your family.
With the exception of a few states, group plans are generally not subject to rate increases for pre-existing conditions. In some instances, group policies that are not subject to surcharge for medical issues tend to be the most cost-effective option for families with children. The bigger the family, the larger the savings on a group plan.
If you are not the business owner, your employer might still be open to offering group insurance. For you, the only potential disadvantage is that you’ll need to stay with your employer to keep the health care benefits, and the company will need to keep the group insurance active.
If you do own your own business and are interested in covering your children through your company, you could qualify if there are at least two people working for the company. The two-people rule could be satisfied by you and your spouse, providing both of your names are listed on the business license or similar business document. Call 1-800-514-0958 for more information. If you work for someone else, ask your employer about eligibility and pricing information.
When COBRA Could be the Most Cost-Effective Option
Some children may be eligible for health insurance through COBRA benefits. If the parent lost medical benefits due to a job loss, the child could qualify for private health insurance under the qualifying events rule, but in some cases, COBRA could still be the most cost-effective choice.
COBRA is a way to continue with the coverage benefits you had before the job loss. Coverage through COBRA is for a limited period. It’s a band-aid of sorts, but for some, buying time until they start working again may be all they need, especially, if there are ongoing medical treatments and the coverage needs to be seamless.
Usually, COBRA premiums are extremely high. However, there are times when the COBRA premium is better than the cost for a child health insurance through a private or group plan. This could be the case if you worked for a larger company of 50 or more employees. For answers to COBRA questions, contact your former employer or the insurance carrier.
If the Child is Already Insured, Does it Work to Keep the Plan?
For some parents whose children already have insurance, keeping up with the monthly premiums is sometimes the challenge. Due to financial hardship, parents are looking for ways to make the child health insurance more affordable. In these cases, you might consider finding a plan with a higher deductible, just make sure your out-of-pocket for the services that the child needs most will not cost you more in the long run. Also, you might consider some of the health care options through the state or federal agencies.
State and Federal Health Plans for Children
Some children may qualify for medical coverage under the state-regulated, “Children’s Health Insurance Program” (CHIP), also known as “Healthy Families” in CA. Eligibility is based on income and is for children’ who do not qualify for Medicaid or Medi-Cal. The CHIP rules and benefits vary by state. For more information about Healthy Families in CA, visit: http://www.mrmib.ca.gov/mrmib/HFP.shtml. .
Another option is Medicaid or Medi-Cal. This is a public health insurance program. It is funded by the state and federal government, but is operated by the states. In CA, “Medicaid” is known as “Medi-Cal”. You must meet the income threshold to qualify. For details about Medi-Cal, go to: http://www.dhcs.ca.gov/individuals/Pages/default.aspx .
What if None of These Options Meet Your Needs?
To learn about other child health insurance options in your particular state, you can find a helpful tool on http://finder.healthcare.gov/.