Did you know that nationwide 95.5 percent of children now have health insurance, up from 92.9 percent in 2013?

Interestingly, the number of children covered under employer-sponsored health insurance has remained relatively static. That means child-only health insurance has led to many of these coverage gains.

Interested in learning more about insurance for kids? Or perhaps you’d like to know whether your child proves eligible for public or subsidized coverage?

We’ve got your answers, so read on for 11 tips you need to make an informed decision about kids health insurance.

1. Know What Child-Only Health Insurance Is

Child-only health insurance refers to policies for individuals age 18 or younger. These policies generally do not cover parents or guardians.

Depending on the state, however, some programs like Medicaid and the Children’s Health Insurance Program (CHIP) cover prenatal care and even coverage for parents and related guardians. When it comes to child-only health insurance, knowledge remains your best friend. Read on to learn more about your options.

2. Do Your Research

If you don’t have adequate coverage for your kids, or your employer’s plan doesn’t fully cover them, don’t give up hope! You have more options than you realize. Now’s the time to dive in and do your research.

Your options include:

• Public programs for low- to middle-income families
• Employer plans
• Subsidized health insurance plans through the healthcare marketplace
• Unsubsidized plans through the open market

As you’re working on applying for insurance coverage, get in touch with local organizations such as community health centers and rural health centers to address immediate needs.

Two public programs work in concert providing medical insurance to children whose parents fall within the low- to mid-range income brackets based on household earnings. These programs are Medicare and CHIP. If your household income falls below their maximum cap, start by applying for these programs.

3. Apply for Medicaid

Managed and funded by states with additional dollars from the federal government, Medicaid offers coverage to those whose household income falls into the low category. This coverage applies not only to children but also parents, pregnant women, those with disabilities, and senior citizens on fixed incomes.

When it comes to Medicaid, your kids may prove eligible even if you’re not. But they must be citizens or lawful immigrants. Do some online research to learn more about your Medicaid eligibility.

4. Explore Your Child’s CHIP Eligibility

Funded by the federal government, individual states administer CHIP. As a result, eligibility rules differ depending on where you live. In general, CHIP provides health insurance for those aged 19 or younger. CHIP fills an essential gap for those working families who make too much money to qualify for Medicaid but still have a tough time paying for their kids’ insurance needs.

CHIP generally only cover kids and pregnant women. But your state may be an exception. In fact, in some states, coverage extends to parents and even other family members who are functioning as caregivers (e.g., grandparents).

Learn more about CHIP coverage here. Or, call 1-800-318-2596 (TTY: 1-855-889-4325) for more information.

5. Research Employer-Based Plans

Less than 50 percent of families rely on employer-based plans to meet their children’s health insurance needs. But you should get familiar with all of your options. So, check out your employer-based plan just in case.

Just know that when it comes to employer-based plans, most of them do not have a child only option. That means, in order to get health care coverage for your child, the eligible adult must also pay for coverage.

This can add up quickly making employer-based plans unattainable for some families. Fortunately, you have other options.

6. Shop Subsidized Insurance Plans

But what if you don’t qualify for Medicaid or CHIPS? That doesn’t mean you’re out of luck. You just need to explore different options.

Because of the Affordable Care Act (ACA), now more private insurance companies offer child-only health coverage. And you can shop for providers online through the health insurance marketplace.

This digital marketplace makes it convenient and easy to find the right private health insurance plan for your family’s unique needs. You can shop prices and see exactly what you qualify for. What’s more, you can complete your eligibility application for Medicaid, CHIP, and the health marketplace simultaneously.

7. Check Out Unsubsidized Private Insurance

But what do you do if you don’t benefit from an employee plan and don’t qualify for a subsidized one? Then, it’s time to research the open market. This can get tricky and feel downright overwhelming.

But with the right guidance, and a comprehensive listing of health insurance quotes, you’ll be well on your way to finding the right plan for your kids. What’s more, insurance companies cannot deny your children due to pre-existing conditions. And you’ll find many of these plans cover common expenses associated with children’s health at no extra cost to you.

8. Make an Educated Decision About HMOs, PPOs, and POSs

As you search for an insurance plan, whether it’s on the healthcare marketplace website or through your employer, you need to understand some basic insurance terms and how they affect your coverage.

HMOs refer to insurance plans that maintain strict rules about staying in-network when it comes to medical care. In fact, they may not cover out-of-network costs at all.

PPOs, on the other hand, will cover your expenses up to a certain point when you go out of network. But expect to pay more. You’ll also need a referral from your primary physician to go out of network.

Finally, POSs let you go out of network. And you don’t need a referral. But if you choose to stay in-network, they reward you.

9. Know Your Child’s Vision Care Coverage

In decades past, getting a good vision plan for your family proved a serious hassle. Oftentimes, this insurance covered very little beyond an office visit for adults. And good luck trying to get coverage for your kids!

Fortunately, because of the ACA, all insurance plans doing business on the marketplace must offer vision insurance to children. As a result, children aged 19 and younger can get one eye exam each year.

If you’ve already found out that you’re covered under Medicaid or CHIP, congrats! You’ll also reap the benefits of vision plan coverage for your little ones. In fact, Medicaid and CHIP often cover the cost of vision correction, too. This coverage may include glasses or contacts.

10. Understand Your Child’s Dental Care Coverage

Like vision plans, insurance companies doing business on the marketplace must also offer dental insurance to children aged 19 or younger. Dental plans may come as part of your larger health insurance package, or they may get offered as a stand-alone service.

These dental plans generally cover biannual exams, cleanings, x-rays, and fluoride treatments. They may also cover a percentage of orthodontic costs. That said, you may need to stick with an in-network dentist and orthodontist for this coverage to apply.

So, do some research and make sure that you fully understand your child’s dental care coverage. As for Medicaid and CHIP, they also cover dental work maintenance, restoration, and complications involving pain and infections.

11. Get an Advocate

If you have a child with special healthcare needs, you’re not alone. Organizations such as Family Voices can help. Contact one of their Family-to-Family Information Centers to speak with a specialist.

They can answer your questions, guide you through the process of getting insurance for children, and provide you with additional resources. Each state has an office run by parents who understand because they, too, have kids with special health care requirements.

In the Meantime…

Do you have a federally-funded community health center or rural health center in your area? If so, it represents an excellent place to receive low-cost medical care for your kids and yourself, too.

Which kinds of treatments do community health centers and rural health centers handle? They can see your kids, teenagers, and you for help with:

• dental care
• prescription drugs
• checkups
• immunizations
• ailments
• injuries
• mental health care
• substance abuse care
• prenatal care

Many community health centers and rural health centers bill based on a sliding scale determined by your household income. In some cases, your medical care might even prove free.

Not sure if your community offers such a clinic? The Department of Health and Human Services (DHHS) website can help you locate the clinic nearest you. You can also find out more about hours, costs, services, and appointments there, too.

Turning to a local community health center or rural health center remains a cost-effective way to receive medical care when you’re in-between insurance plans or still attempting to establish Medicaid or CHIP eligibility for your little ones.

More Useful Tips

Interested in more information about child-only health insurance or coverage for adults? Or, maybe you’ve got other questions about the day-to-day challenges that you face? From what to wear to the gym to why you need a personal fireproof safe, we’ve got you covered.

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