Child-only health insurance refers to coverage designed to assist in covering the medical expenses and certain preventive care for children. Accessible options for children’s health insurance include enrollment through the Affordable Care Act (ACA) marketplace at HealthCare.gov, Medicaid, the Children’s Health Insurance Program (CHIP), and direct purchase from health insurance companies.
Determining the most suitable child-only health insurance for you is contingent upon your eligibility. If you qualify for premium tax credits, you might discover affordable coverage within the ACA marketplace. Alternatively, meeting eligibility requirements may open doors to excellent and cost-effective coverage through Medicaid or CHIP.
Types of Child-Only Health Insurance
You can buy health insurance for children through multiple sources. Each type of health insurance has its pros and cons.
Affordable Care Act Marketplace Plans
Pros
- Comprehensive coverage provided, including emergency services, hospitalizations, mental health, outpatient services, prescriptions, pregnancy and maternity and preventive care.
- ACA health insurance marketplace plans offer premium tax credits and subsidies based on your household income and size, which offset the cost of coverage, if you qualify.
- Multiple health insurance plan options depending on where you live.
- ACA plans must offer dental and vision insurance to children.
Cons
- Usually more expensive than employer-sponsored coverage unless you qualify for premium tax credits.
- Rural areas may not have many ACA plan options.
- ACA plans typically have more restricted networks than employer-sponsored health insurance, which means you may have to stay in the plan’s network. An example is health maintenance organization (HMO) plans, which are more common than preferred provider organization (PPO) plans in the marketplace.
Medicaid
Pros
- Low-cost or even free coverage depending on your household income and size.
- Comprehensive coverage provided.
- Dental and vision care for children covered by Medicaid.
Cons
- You may have more trouble finding providers who accept Medicaid than you would with private health insurance.
- Eligibility requirements limit who can get Medicaid.
Children’s Health Insurance Program
Pros
- Cost is based on household income and size.
- Comprehensive coverage similar to what’s found in Medicaid plans.
- CHIP plans cover vision and dental coverage for children.
Cons
- Public health plans like CHIP may not have wide provider networks that’s common in private insurance.
- Eligibility requirements limit who can get a CHIP plan.
Catastrophic Health Insurance
Pros
- Low premiums ($189 monthly on average for children under 15).
- Must cover essential health benefits, similar to ACA plans.
- You can buy a plan through the ACA marketplace.
- No coinsurance, so once you reach the plan’s deductible, the catastrophic plan covers costs for healthcare services.
Cons
- Only available for people under 30 and those facing severe financial problems.
- You have to pay all of the healthcare costs until you reach the plan’s deductible of $9,400 for individual coverage, which is also the out-of-pocket max.
- Doesn’t offer tax credits or subsidies to help pay for coverage like an ACA plan.
Short-Term Health Insurance
Pros
- Low-cost coverage ($171 per month on average for an individual).
- Short-term health insurance can fill gaps between standard health coverage, such as following a job loss.
- Typically much cheaper than COBRA insurance.
- Similar coinsurance levels as standard health insurance, such as 20% and 30%. Coinsurance is the percentage of healthcare service costs that you have to pay with the health plan picking up the rest. Coinsurance starts after you reach your deductible.
Cons
- Plans don’t have to follow ACA requirements.
- Only available for a year with the option of extending to three years in most states.
- Banned in some states; restricted in others.
- May have higher deductibles than are found in standard health insurance.
- Usually caps coverage and limits what’s covered.
Private Insurance Plans Sold Directly From Insurance Companies
Pros
- You may find a cheaper individual plan since these plans don’t have to comply with ACA regulations.
- Gives you more options than you would find from employers.
Cons
- Not eligible for premium tax credits and subsidies like ACA plans.
- Plans don’t have to follow ACA requirements.
- Most likely doesn’t qualify as minimum essential coverage, which dictates whether you’re considered properly insured or not by states that require health insurance.
