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Obamacare and Health Insurance for Children

As a parent, your first instinct is to always protect your children, and part of that is making sure they have adequate health insurance coverage. Immunizations and regular check-ups, in addition to the occasional visit to the doctor’s office or emergency room, are routine needs for most children. Parents enrolled in Obamacare health insurance may wonder how health insurance works for their children and how it may change as their family grows and changes.

Let’s answer a few questions that you may have about Obamacare (the law also known as the Affordable Care Act) and how it affects the health insurance coverage of your children.

Can I get Obamacare health insurance for my kids?

The short answer is “yes.” Under Obamacare, health insurance coverage is available to anyone who qualifies and this extends to individuals of any age as well as families with children. If you as a parent are shopping for Obamacare coverage, including coverage for your children, you will be able to do so during the open enrollment period that runs each year from November 1st through the following January 31st. If you experience a qualifying life event, you may also be able to enroll during a special enrollment period outside of those dates. Children may be added to your coverage when you initially enroll, or during open enrollment or following a qualifying life event if they are not already on your existing plan.

Qualifying life events that may trigger a special enrollment period for your family include:

  • The birth or adoption of a child
  • The addition of a dependent for any other reason
  • Marriage or divorce
  • Loss of employer-based coverage
  • Moving to a new coverage area

In any of these events, you will typically have 60 days to enroll in a plan after your qualifying life event.

I’m pregnant, how can I find health insurance for my child?

Obamacare will allow you to add a child to your health coverage or to enroll in Obamacare coverage for both of you, but only once the child is born. Pregnancy itself it not considered a qualifying life event under the law and will not make you eligible for a special enrollment period outside of Obamacare’s nationwide open enrollment period. Once your child is born, you will typically have 60 days to enroll your child (and your whole family, if you prefer) in health insurance coverage, and apply for any government premium subsidies you may qualify for.

I just had a child, how can I get him or her signed up for Obamacare?

If the birth happens to fall during the open enrollment period you can add your child to your existing coverage or enroll the baby or the whole family in a new Obamacare plan. If the birth occurs outside of the open enrollment period, you will still typically qualify for a special enrollment period. You will have 60 days from the date of your child’s birth to enroll your baby (and yourself if needed) into a health plan, and also apply for any subsidies that you may qualify for. If you miss the enrollment window you may be out of luck until open enrollment. If you already have Obamacare coverage, you should speak to your existing insurance company prior to the child’s birth about how best to add your baby to your existing health insurance plan.

How can I find health insurance for my young adult children?

Adult children – those between 18 and 25 years old – have several health insurance options under Obamacare. First, if they can afford to do so, they can apply for Obamacare coverage on their own. And if they are not claimed on your (or anyone else’s) tax return, they can even apply for subsidies to help pay for their coverage. Second, if they are already on your existing Obamacare coverage, they can remain there until they reach age 26, if you allow them to do so (you’re not required to). If your adult children are not presently insured, they can join your family health insurance plan during an enrollment opportunity and stay enrolled until they turn 26.

Prior to their 26th birthday you can keep adult children insured under your family health insurance plan even if they:

  • Get married
  • Have a baby or adopt a child
  • Start school or college, or leave school or college
  • Live at home or on their own
  • Turn down coverage from an employer
  • Are not claimed as a dependent on your taxes

Just note that if your adult children live outside of the coverage area for your family health insurance plan, their benefits and access to network doctors and hospitals may be limited.

What about covering a grandchild on my Obamacare Health Insurance Plan?

Unfortunately, you cannot cover a grandchild under your Obamacare health insurance plan. This is even the case if your son or daughter (the grandchild’s parent) is covered under your family’s Obamacare plan. If the grandchild is a newborn, his or her birth is a qualifying life event under the law and will provide both your child and grandchild a 60-day special enrollment period to enroll in coverage and apply for subsidies (if qualified).

There is one exception, however: if you have legally adopted your grandchild you can then add them to your existing Obamacare family health insurance plan.

Did Obamacare improve health insurance coverage for children?

By standardizing benefits, among other things, Obamacare did strengthen the coverage options available to children and young adults:

  • Free preventive services:Services such as immunizations; screening tests for conditions like autism, obesity, depression, and hearing problems; iron and other vitamin supplements for kids with deficiencies; drug counseling and more are often available at no out-of-pocket cost under Obamacare health insurance plans.
  • Obamacare’s “essential health benefits:” Benefits covered by all Obamacare plans include ambulatory and ER care, hospital stays, maternity and newborn care, mental health and substance abuse services, prescription drug plans, rehabilitative care, x-rays, and lab tests.
  • Medical, dental, and vision coverage for a child under age 19: Health insurance coverage is available even if your child has a disability or pre-existing medical conditionlike diabetes or asthma that might have made it hard to qualify for coverage prior to Obamacare.
  • Adult children under age 26 can stay on their parents’ plan even if they don’t live at home, are not claimed on your taxes, and even if they’re married.
  • Obamacare and CHIP: The federal CHIP program can help kids get coverage all year long and, in many cases, even if their parents don’t qualify for Medicaid.

How does having a child affect my eligibility for Obamacare subsidies?

Your eligibility for Obamacare subsidies (also known as premium tax credits) is based on your income and also on the total number of people in your household. Having a child can definitely have an impact on your eligibility for a subsidy. People earning up to 400% of the federal poverty level may qualify for subsidies, but the upper limit for eligibility moves higher for each person added to your household. So individuals (single earner) earning up to about $47,000 (in 2016) may qualify for subsidies, but families of four can earn up to about $97,000 (in 2016) and still qualify for subsidies. Having a baby may mean that you qualify for Obamacare subsidies now, though you didn’t previously.

In closing: Obamacare and insurance for your kids

Having a child is a big change for any family, and can have a tremendous impact on your finances and health insurance needs. Obamacare offers many options for those who are looking to cover any child in the family, whether a newborn or a graduating college senior. Knowing your options under Obamacare can help ensure your children gets the coverage they need.