Health insurance for your family
Health insurance (also called health coverage or a health plan) helps you pay for medical care. Health insurance is really important for you, especially if you’ve had a baby and started a family.
What health care services are covered for babies and children?
The Affordable Care Act (also called ACA) says that insurance plans have to cover certain health services for children. These include:
- Well-baby and well-child checkups. These are checkups your child gets when he’s not sick. There’s no co-pay for these checkups. This means you don’t have to pay your child’s health care provider each time you take him for a check-up. Visit healthcare.gov for a list of services for your child that don’t have a co-pay.
- Vaccinations. These are shots your child gets that help protect him from certain diseases. There’s no co-pay for vaccinations.
- Sick-baby and sick-child visits. This is when you take your child to her provider when she’s sick. Depending on your insurance plan, you may have a co-pay for these visits.
- Hospital care
- Emergency services. This care is covered even if you take your child to a hospital that’s not part of your health plan.
Similar services also are covered for you and your partner:
- Regular health checkups
- Checkups when you’re sick
- Hospital care
- Emergency services
How do you make sure your child is covered by your health insurance?
If you get insurance through your employer, you most likely can get family coverage. This means your plan takes care of you, your partner and your children. But it’s not always so simple. Sometimes children can get coverage that their parents can’t. Some states have health plans that only cover children (called a child-only plan). And sometimes children in the same family get different kinds of coverage depending on how old they are.
Your child’s health can affect which insurance plan you choose. If your child has a medical condition, you may want to choose a plan that includes your child’s health care provider or covers prescription medicine. And if your child has a condition that requires special vision or dental care, you may want to choose a plan that covers those services.
When you’re choosing your health plan, look at the plan summary. Each plan has a summary that includes what’s covered for children. Every plan uses the same summary form, so it’s easy to compare costs and services.
You can find plan summaries and get information about health plans for your children in your state’s Marketplace. This is an online resource that helps you find and compare health plans in your state. Be sure to include information about your children on the Marketplace application so you get the right information.
Under the ACA, if your plan covers your children, they can stay on it until age 26, even if they don’t live with you or if they’re married. If your child isn’t covered by your insurance now, you may be able to add him to your plan. But you may be able to do this at only certain times of the year or in a certain amount of time. Check with your plan if you need to add older children to your coverage.
Are special medical needs covered for your child?
The ACA helps make sure that children with special medical needs have the health insurance they need to pay for services and treatment throughout their lives. For example:
- Insurance plans can’t deny coverage or charge you more money for a child with a pre-existing condition. This is a health condition that your child has before you sign up for a health plan. The ACA says that a health plan has to cover any condition your child already has. For example, if your baby was born with a health condition and you add her to your insurance plan after her birth, medical expenses for your baby’s condition have to be covered.
- Insurance plans can’t set a lifetime cap (limit) on health insurance. This means an insurance plan can’t stop covering your medical expenses once they reach a certain amount of money. For example, if you have a baby who needs special care after birth, your insurance company can’t stop paying for care once the cost reaches a certain amount. This goes for you and your partner, too. The ACA also says that a plan can’t drop you, your partner or your child if you get sick.
- Insurance plans have to set a cap (limit) on annual out-of-pocket expenses. Out-of pocket means the amount of money you pay for health care services. Health plans have to set an annual limit on the amount you spend for care each year. Once you reach this limit, your health plan fully pays for health care services through the rest of the year. So if your baby is born with a health condition and your plan’s out-of-pocket limit is $10,000, you’re responsible only for $10,000. If your expenses are more than $10,000, your plan has to pay the rest.
- Medicaid may help some children with special health care needs who are covered by private insurance plans. This is called a wrap-around service. For example, Medicaid may cover services not covered by a private plan. Or it may pay for more provider visits than a private plan allows. Medicaid is a government program that provides free or low-cost health insurance to people with low income.
Last reviewed: August, 2014