Health Insurance for Kids

There are various ways to get health insurance for children. Plans may be available through a parent’s workplace, or kids may be added to a parent’s individual or family plan. Government-sponsored programs and marketplace tax credits can help those concerned about affordability.

Health insurance helps you cover medical expenses and avoid possible financial hardship due to high out-of-pocket costs when you seek medical care. The best plan for your family depends on your needs and circumstances.

Note that the health plans for children cover those aged 0­–18 or 19. However, data used in this guide references children aged 0­–14.

• How to Get Health Insurance for Kids
• How Much It Costs
• Frequently Asked Questions About Health Insurance for Children

There are generally four ways to get medical insurance for kids. Depending on your circumstances and eligibility, you may get insurance for a child through the insurance marketplace, directly through a private health insurance provider, Medicaid or CHIP.

When choosing a plan, compare the pros and cons of the options available to ensure you’re getting the right coverage at a fair price.

Health insurance for kids is available through the federal or state health insurance marketplaces. These marketplaces, established by the Affordable Care Act, allow families and individuals to compare and select insurance coverage based on their specific needs and budget.

All plans available through these exchanges must comply with federal standards and provide a comprehensive set of 10 essential health benefits, which include:

• Outpatient care
• Emergency room trips
• Hospital treatment for inpatient care
• Care before and after a baby is born
• Treatment, counseling and other services for mental health and substance use disorders
• Prescription drugs
• Services and devices for injury recovery, disability or chronic conditions
• Laboratory tests
• Preventive services for managing chronic illnesses
• Pediatric services, including vision and dental care for kids

Children can be covered under family plans purchased via the marketplace, and families may be eligible for tax credits or subsidies depending on their income — families that make between 100% and 400% of the Federal Poverty Level may be eligible. The marketplace is especially beneficial for families that do not qualify for Medicaid or CHIP but still require cost-effective options for children's health insurance. You must enroll during the annual open enrollment period unless you qualify for a special enrollment period due to qualifying life events.

You can also get a health insurance plan for kids directly through an insurance company. You can check insurance providers’ websites or contact an agent to learn more about their options. This only really makes sense if you're sure you don't qualify for any tax credits or subsidies, so be sure to double-check before going this route.

Another option is to search through private companies providing child-only health plans in your location. For instance, BlueCross BlueShield allows individuals and families to shop for insurance based on state or ZIP code.

Most health insurance plans available for purchase from reputable insurance companies are ACA-compliant, meaning they follow the same guidelines as marketplace plans and are only available during open enrollment. However, subsidies do not apply if purchased outside the marketplace.

The more affordable health insurance option may be to purchase a short-term plan for your child, but short-term plans usually have limited coverage, such as not covering pre-existing conditions, and may have unexpected out-of-pocket costs as a result. Approach these kinds of plans carefully.

For children from low-income families, Medicaid is a great option to get necessary health coverage. This program follows federal requirements but is administered by states. That means that aside from mandatory benefits, individual states may include optional benefits for your kids.

Medicaid coverage for children includes a wide array of medical services such as routine check-ups, immunizations, doctor visits, hospital stays, dental care, vision services and emergency medical services.

It is designed to ensure that children have access to essential health care services without financial strain on their families. However, not all children or families qualify for Medicaid.

Medicaid eligibility for children hinges on the state of residence and family income. In states with Medicaid expansion, families with incomes up to 138% of the Federal Poverty Level (FPL) may qualify for coverage.

In states that have not expanded Medicaid, eligibility criteria can vary widely and may include considerations beyond income, such as household size, family status (e.g., pregnancy, caring for young children), disability, age and other specific factors.

Due to the variability of these rules from state to state, the only definitive way to determine eligibility is to apply through your state's Medicaid program.

Families looking for affordable health insurance for kids who don’t meet the Medicaid income requirements may consider applying for CHIP. This program caters to families who earn above the Medicaid income threshold.

Generally, CHIP covers children up to 19 years old in most states, those who are uninsured, ineligible for Medicaid and without access to affordable group health insurance.

To qualify, a child must be a U.S. citizen or meet specific immigration requirements, reside in the state offering CHIP and fall within the state's CHIP income eligibility range, which varies but extends from 170% to 400% of the Federal Poverty Level (FPL), depending on the state.

CHIP coverage also differs by state but universally includes a comprehensive package of health services: regular health evaluations, vaccinations, physician appointments, medication coverage, oral and eyesight treatment, hospitalization for both admitted and in-house procedures, diagnostic lab tests, imaging services and urgent medical attention. Some states may offer additional benefits beyond this core list.

Financially, CHIP aims to be accessible, with routine "well child" doctor and dental visits typically free of charge. While some services may require copayments, and a few states impose a monthly premium, costs are designed to remain below 5% of a family’s annual income.

States may have different rules for CHIP, so you may need to meet other eligibility requirements to qualify.

For children aged 1–14, Bronze health insurance plans cost an average of $266 per month with high out-of-pocket maximums (MOOP) up to $9,356. Catastrophic plans are cheaper at $204 monthly on average, but their eligibility is more limited. On the higher end, Platinum plans cost about $542 per month but have an average MOOP of only $2,441.

Various factors affect the cost of medical insurance for kids. The family’s income and insurance provider can affect premium costs.

Getting health insurance for kids can help protect your family from huge health-related expenses. However, many children remain uninsured. Cost may be among the major reasons for this. According to the Kaiser Family Foundation, children who live below 100% of the federal poverty level comprise over 25% of uninsured kids.

Medicaid, subsidized marketplace coverage and CHIP make cheap health insurance for kids more accessible to families in need.

The table below shows the average insurance costs, including the average monthly premium, yearly deductible and maximum-out-of-pocket (MOOP) from the health insurance marketplace for different market tiers.

These costs are averages. The lower average deductible for platinum plans is because some plans have a $0 deductible. The actual costs of premiums may vary depending on various individual factors.

Children-only health insurance plans can be cheaper than adding a child to a parent’s plan. However, higher metal-tier plans tend to be more expensive.

For children 0-14 years old, the least expensive states, on average, for Silver plans are:

• New Hampshire, Anthem (BCBS): $194
• Arizona, Blue Cross Blue Shield: $208
• Michigan, Blue Cross Blue Shield: $216

Premiums vary by state and are influenced by age, family size and health history. When choosing a plan for your child, consider the trade-off between monthly premiums and out-of-pocket costs. Available plans will also vary by state.

The table below shows the states with the lowest monthly insurance premiums for Silver health plans for children. Note that this is just a snapshot of the marketplace coverage. These plans may be subsidized or replaced by government programs.

Aside from the cost, there are various factors to consider when looking for the best health insurance for a child. MoneyGeek answers some frequently asked questions to help you find the right plan for your child.