Good news for parents around the US who have been fretting over their children’s insurance coverage, or rather the lack of it: You don’t have to live in a low income household to be eligible for government subsidized children’s health insurance. Middle-class families struggling through the recession can also benefit from the measures that resulted in recently passed healthcare reform laws. Medicaid and Children’s Health Insurance Program (CHIP) together serve families who are not able to afford health insurance coverage in the private market or do not have coverage available to them. Upper middle class families also can make use of these plans, paying affordable rates. This is good news all around, but, especially for those living in states where the insurers are dropping children’s plans rather than cover kids under the expanded new laws.
These insurance plans cover a full range of services including doctor visits, vision and dental care, prescription medicines and immunizations, as well as services like hospitalizations and care for children with special health care needs. While there may be premiums or other cost sharing associated with certain categories, in general, the programs are designed to be affordable.
According to the InsureKidsNow.gov website sponsored by the U.S. Department of Health and Human Services, every state’s program is unique and has individual income eligibility rules and benefits covered. But, in general, children in families with incomes up to $44,100 per year (for a family of four) are likely to be eligible for coverage.
Parents and kids around the US are already benefiting from the reforms. According to the New York Times, Medicaid and CHIP, which blend state and federal assistance, have expanded their reach over the last several years, covering a wider swath of the population.
As to the degree of coverage, here’s a statistic to give you an idea: Out of seven million children who are at present uninsured—that is almost 10 percent of American children—around 4.7 million are eligible government coverage.
But many of those kids are not yet covered even though they are eligible because a lot of parents don’t know about these insurance plans. And those who do know feel that it is a cumbersome process to register for them.
You can find out more about the different state programs at InsureKidsNow.gov. First find out whether you qualify for Medicaid or CHIP by visiting InsureKidsNow.gov coverage map and clicking on your state. You can also call 877-543-7669 for this information. This coverage map also gives you information about health and oral care providers in your state.
Signing up is easy too. In most states applicants have to fill out just one short application to find out if they qualify for Medicaid or CHIP. Many states allow online applications. Some states let you apply over the phone and send you a filled-out application for you to sign.
Cindy Mann of the federal Centers for Medicare & Medicaid Services was quoted in the New York Times saying that you should have an answer within 45 days of submitting your application, or often much sooner. Some states—eleven including New York—also allow qualified providers to grant immediate, temporary coverage for children in both Medicaid and CHIP if they appear to be eligible.
In related and encouraging news, McClatchy reports that the Department of Health and Human Services Secretary Kathleen Sebelius is pushing back against the insurance companies who proposed different enrolment rules for healthy and sick children. The proposal was to allow healthy kids sign up any time, but leave a narrow window for sick kids to be signed up. Sebelius says that enrollment rules must be the same for healthy and sick kids because what insurers wanted is legally questionable and inconsistent with the language and intent of the health care law.
Here’s the summary of what is available for people in different income categories, as reported by the New York Times:
LOW-INCOME FAMILIES: Medicaid provides free, or very low cost, health coverage for people under 21 who live in families with poverty-level incomes, currently $22,050 for a family of four. The program also covers children under age 6 who live in families with incomes at or below $29,326 (133 percent of the poverty level).
Children who are covered by Medicaid receive a full range of services, including immunizations, vision and dental care. Eligibility rules vary by state.
MIDDLE-INCOME FAMILIES: Created in 1997 and expanded by President Obama in 2009, CHIP provides low-cost health insurance for children in middle-class families who make too much to qualify for Medicaid. Each state designs its own plan and determines its own income requirements. In some states, coverage may be free; typically, it is subsidized.
Every state plan must provide free preventive care and immunizations to children in the program, as well as free or reduced-fee checkups, prescription medications, and dental and hospital care.
UPPER-MIDDLE INCOME FAMILIES: If your income is too high for a government plan, you should first find out whether your state’s CHIP program allows families to buy in — that is, pay the full cost without receiving a subsidy. About a dozen states have this option.
If not, a child-only policy from a private insurer might be affordable. Under the new health care law, insurers that offer child-only policies must accept every child who applies, and they cannot change rates based on a child’s health.
To look for a child-only policy, you can go to the government’s new health insurance web site, healthcare.gov, and enter your child’s information. The site will give you a list of possible policy choices.