Health Insurance for Children Only

What is a Child-Only plan?

A child-only plan is a health insurance product in which there are no insured parents on the policy. It can be purchased by a parent or guardian in the private market to provide coverage for one or more related children. Under the Affordable Care Act, insurance companies are not allowed to deny healthcare coverage to children under age 19. 

 

Kid’s only health insurance is offered at the same metal tiers as grown-up insurance policies, and must cover essential health benefits. These plans follow the same enrollment guidelines as their adult counterparts, and can only be purchased outside of enrollment periods when there is a qualifying event.

There are reasons for selecting a Child-only plan: 

The reasons why parents may seek health insurance quotes for children are varied. The most likely scenario is the parent may work for an employer who does not provide dependent coverage. The parent also could be self-employed. A child may be residing with grandparents who are covered through Medicare. Children may have special needs that are not covered by a parent’s insurance policy. 

Or, parents may simply be considering child-only health insurance because they want to ensure coverage in the event they lose or change jobs. In the event of job loss, or a change in careers, you qualify for a Special Enrollment Period (SEP).

 Most group policies have one rate regardless of the number of children being insured. A parent of just one child pays the same as
 a parent who has five children. This means there could be some potential savings with a kid’s-only health insurance policy. Finally,
 a family may only be able to afford to insure their children. While parents of healthy children might be tempted to skip coverage, all
 children need regular check-ups to assess development and growth. Not to mention, children are at risk for things like chickenpox,
 pinkeye, pinworms, scabies, ear infections, colds and coughs, and diaper rash.

There are several child-only health insurance options in California, including: 
  • Short-term health insurance for a child: affordable, temporary coverage
  • Major medical plans: ACA-compliant coverage sold through government and private exchange
  • Children's Health Insurance Program (CHIP) & Medi-Cal: state-based program providing low-cost coverage 

Insurance plans being offered by most carriers include:
  •  HMO: In this plan, your child has to use the network to access covered services. Exceptions are made only for emergencies.

  • EPO: In this plan, your child has to use the network to access covered services, but you don’t need a referral from your primary doctor to see a specialist. Exceptions are made only for emergencies.

  • PPO: In this plan, services are cheaper when your child goes to a network doctor, but you have the freedom to get services from an out-of-network physician.

HMO plans may also require that you select a primary care physician for your child, and that physician has to refer you in the event you need to see a specialist. With an PPO and EPO, you are free to see doctors and specialists without a referral. However, you’ll find that your child may receive more benefits with an HMO if you live in an area with wider network coverage. 

When selecting health care coverage for your child, you’ll also want to consider the following: 
  • Your Coverage: If you are covered by your employer, it may be more cost effective to purchase a child-only health insurance plan for your child instead of insuring them through your employer’s plan.

  • Your Income: Review the household income limits to see if you qualify for a tax credit. If you do qualify, and are not offered insurance through an employer, it is much more affordable to apply for a family insurance plan rather than a child-only plan.

  • Consider Medi-Cal: Check your household income to see if you qualify for Medi-Cal. Most employed people find that their kids can qualify for Medi-Cal, which covers medical services for their children at very affordable rates.

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Updated July 13, 2019

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