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Common Questions about Obamacare Health Insurance Coverage for Children

As parents, we worry about our kids’ health, and it’s no wonder. You want your children to be healthy and happy and you want them to have access to good doctors and hospitals when they get sick.

A lot of parents have questions about Obamacare and what it means for their children’s health care and health insurance needs. In this article, we’ll answer some of the more common questions that consumers ask about Obamacare and kids.

Does Obamacare cover medical care for kids?

Yes, it does. Not only did Obamacare expand family access to Medicaid (in most states) and expand access to the Children’s Health Insurance Program (known as CHIP), it also required all individual and family major medical health insurance plans to cover a broad range of pediatric services.

Pediatric care is one of the 10 essential health benefits that the Obamacare law requires all health insurance plans to provide. This includes a number of preventive pediatric services like well-child visits and immunizations that are covered for free – that is, with no out-of-pocket costs to you, even if you haven’t fulfilled your deductible for the year.

Obamacare health insurance plans – no matter which insurance company offers them – provide great health insurance benefits for kids.

My child has a pre-existing medical condition. Will health insurance under Obamacare cover her?

Under Obamacare, health insurance companies can no longer decline health insurance coverage to anyone based on his or her personal medical history of the presence of pre-existing medical conditions. This applies to both adults and to kids.

The only catch is that you need to enroll during Obamacare’s nationwide open enrollment period (which usually runs from November 1 through January 31) or when you experience a qualifying life event.

A qualifying life event (such as a marriage or divorce in the family, loss of employer-based coverage, moving to a new coverage area, or the birth of adoption of a new child) provides you with a sixty-day window to enroll in an Obamacare health insurance plan, even outside of the nationwide open enrollment period.

Will our pediatrician accept my new Obamacare health insurance plan?

Obamacare is a federal law, but health insurance companies in different states are allowed some freedom when it comes to offering Obamacare-compliant plans. Most health insurance plans today utilize networks of doctors, hospitals, and other medical care providers. Outside of the network, many plans offer only emergency coverage.

Whenever you’re considering a new Obamacare health insurance plan for yourself or your family, you should make sure it covers your preferred doctors. Some private health insurance marketplaces online will allow you to search for health plans accepted by specific doctors. You can also confirm a doctor’s network status through the insurance company or through the doctor’s office.

How do I add a child to my Obamacare health insurance plan?

If you’re about to have a baby call your insurance company and ask them how and when to add your child to your policy. Generally speaking, you have a month or two to do so after the birth of your child. If you miss your chance, your child may still qualify for CHIP coverage in your state.

Otherwise, you will need to wait until the next Obamacare open enrollment period, or until you experience another qualifying life event providing you with another special enrollment window.

Can I buy my child an Obamacare health insurance plan of his or her own?

Yes, health insurance companies offer coverage to individual children on their own without a parent on the policy.

I just had a child. Can the whole family change health insurance plans now?

With the birth of a child, many families decide that rather than adding the baby to the family’s existing health plan, they need a new health insurance plan altogether. At least in their first years, children tend to see the doctor and get medical care more often than adults. Now that you have a baby, you may decide that you need a new Obamacare health insurance plan with a lower annual deductible, for example.

Under Obamacare, the birth or the adoption of a child is a qualifying life event for the whole family. So, even if it’s not open enrollment season, you will typically have a sixty-day window to make any changes you like to your family’s health insurance coverage.

Please keep in mind that you may need to provide proof that you have experienced a qualifying life event. Hospital records or a birth certificate should be sufficient in this case.

I just had a child, does this mean I qualify for Obamacare subsidies?

The Obamacare health insurance law makes government-funded subsidies available to people earning no more than 400% of the federal poverty level (that is, about $47,000 for a single person or about $96,000 for a family of four in 2016).

When you add a new person to the family, the amount of money you can earn and still qualify for Obamacare subsidies increases. So, even if you didn’t qualify for Obamacare subsidies in the past, you may qualify for subsidies now that you’ve added a new member to the family.

Work with a licensed health insurance agent, an online broker, or with the government-run Obamacare health insurance market in your state to see if you qualify for subsidies.

Just remember that subsidies are based on your estimated income for the current year. If you end up earning more than anticipated, it’s possible that at tax time you may need to pay back some or all of the subsidies you received.

I’m pregnant and uninsured. Can Obamacare help me?

This is a hard one. The truth is that pregnancy is not considered a qualifying life event under Obamacare. Just becoming pregnant does not make you automatically eligible to sign up for health insurance coverage outside of the nationwide Obamacare open enrollment period. The birth of your baby will be a qualifying event, but not pregnancy itself.

If you’re uninsured and pregnant, and you’re not able to enroll in an Obamacare plan or an employer-based health insurance plan, you should contact your state’s department of insurance to see if there are state programs to help pregnant women get the medical care they need at an affordable price.

I’m currently covered on my parents’ health plan. Can my baby be enrolled in their plan too?

No, Obamacare will not allow your baby to be covered under your parents’ plan, though you yourself can be covered on their plan up to age 26.

If your baby is born during the Obamacare nationwide open enrollment period, you’ll be able to sign up the baby – or the baby and yourself – under a new plan when he or she is born.

Assuming it’s not open enrollment season, the birth of your baby will be a qualifying life event under Obamacare, both for your baby and yourself. You’ll have a sixty-day window to enroll the both of you in a plan of your own. You can even apply for subsidies based on your income. Or you can enroll the baby in a plan of his or her own during that time.

How long can I keep an adult child on my Obamacare plan?

Obamacare allows parents of adult children to keep their kids enrolled in the family health insurance plan until their 26th birthday. To be clear, it does not oblige you to cover your kids until age 26, but it allows you to do so if you wish.

Starting at age 26 they’ll need to get coverage on their own, either through an employer-based plan, through a spouse, or by enrolling in an Obamacare health insurance plan on their own.