You do your best to keep your children healthy, but sickness and accidents are a part of life. Getting health insurance for your children gives you peace of mind knowing they have health coverage when they need it. But for many hardworking families, affordable insurance can be hard to find. The ACA expands your options for health insurance for your children and makes those options more affordable.[i]
At a Glance
At a Glance
There are several provisions within the Affordable Care Act that give you more control over your children’s healthcare.
Click on the following for more information:
- Coverage for Children with Pre-existing Conditions
- Full Coverage for Preventive Care and Immunizations
- Coverage for Adult Children (Ages 19-26)
- Additional Funding for California’s Healthy Families Program
- The Health Benefit Exchange
- Additional Resources
Children with Pre-existing Conditions
Effective September 23, 2010, most insurance plans are required to provide insurance coverage to children under the age of 19 who have pre-existing conditions. In summary:
- Pre-existing conditions CANNOT be excluded from insurance coverage.
- Treatment of pre-existing conditions CANNOT be limited (for example, the insurer cannot refuse to pay for chemotherapy for a pre-existing cancer diagnosis.)
- This rule applies whether or not your child’s health problem or disability was discovered or treated before you applied for coverage.
- This rule applies to most job-related, group insurance plans and for many individual insurance plans issued or significantly changed after March 23, 2010.
The ACA allows one exception to this rule. Individual plans that are “grandfathered” do not have to comply with this provision. For more information and exceptions go to the section on this website entitled “Pre-existing Conditions.”
Prevention and Immunizations Services
Under the ACA, your children may be eligible to receive important preventive services at no extra cost to you. If your health insurance plan is subject to the new requirements effective September 23, 2011, you will not have to pay a copayment, co-insurance, or deductible to receive the recommended screenings, vaccinations, and counseling listed in the table below:[ii]
This ACA provision regarding preventive care applies to the entire family and yet there are certain plans that do not have to comply. For more information about coverage for preventive care see the section on this website entitled, “Preventive Care and Screenings.”
Coverage for Adult Children
One of the goals of the ACA was to increase the number of young adults who have access to health insurance. Effective September 23, 2010, children can remain on their parents’ health insurance plans until age 26 as long as they do not have an offer of health insurance coverage from their own employer and regardless of whether they have moved out, graduated from college, or gotten married.
Children under the age of 26 can be insured by their parent’s health insurance coverage under the following circumstances:
- The child is currently covered under the parents’ health insurance plan.
- The parent’s group or job-related Plan or Policy Year began on or after September 23, 2010.
- The parent purchased their health insurance directly on the Individual market (not through an employer or group).
For more information about this ACA provision, go to the section on this website entitled “Adult Children’s Coverage.”
Healthy Families Program
Healthy Families is low cost insurance that provides health, dental and vision coverage to nearly 900,000 California children.[iii] If your child is uninsured and does not qualify for no-cost Medi-Cal, they may be eligible for coverage under Healthy Families. President Obama signed a bill in February 2009 that extends funding through 2015. For more information about Healthy Families and other Public Programs, go to the section on this website entitled “Public Program Coverage Options.”
Health Benefit Exchange
As of January 1, 2014, you and your children may be eligible to purchase health insurance through the California Health Benefits Exchange (Exchange) which is being designed and implemented by the State of California. Individuals and families will be able to purchase insurance through the Exchange and premium assistance will be available to those with incomes between 133 and 400 percent of the federal poverty level (In 2010, this was approximately $29,000 to $88,000 for a family of four). Click here for more information about California’s Health Benefits Exchange.
[i] HealthCare.gov, U.S. Department of Health and Human Services, (2010). Families with children Retrieved from http://www.healthcare.gov/foryou/family/index.html
[ii] HealthCare.gov, U.S. Department of Health and Human Services, (2010). Understanding the affordable care act - about the law Retrieved from http://www.healthcare.gov/law/about/provisions/services/lists.html
[iii] California Healthy Families Program, (2009). State children’s health insurance program (schip)- reauthorization update february 9, 2009 Retrieved from http://www.healthyfamilies.ca.gov/EEs_CAAs/Program_Updates/SCHIP_Reauthorization_Update.aspx
[iv] HealthCare.gov. U.S. Department of Health and Human Services, (2010). Timeline - what's changing when Retrieved from http://www.healthcare.gov/law/timeline/index.html