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Although individual health insurance plans specifically for children can be difficult to find, they are available for children as young as 6 months old. Experts say these plans are an especially attractive option if your children spend significant time in places where your health plan might not have a network of doctors—for instance, if you’re divorced or if your children spend lengthy summer vacations with relatives halfway across the country.
Before you rush into buying your children their own health plans, there are several factors to consider so you don’t end up with a policy that omits needed coverage.
Children of divorce
Securing health insurance coverage for your child is perhaps most useful if you’re divorced and living in a different state than your ex-spouse. The courts will often mandate that either you or your ex-spouse provide health coverage for the children.
If you and your children are on a group health plan through your spouse’s employer and you get divorced, you and your children may be eligible for COBRA coverage, allowing you to keep the same health benefits for as long as 36 months. (See know your COBRA rights.) You may decide to take COBRA and keep the children on your ex-spouse’s plan. That’s fine — as long as you and the children stay in the health plan’s service area and you can afford the premiums.
If you move to another state, you may be moving out of the service area covered by your HMO or PPO. In this case, you could add your children to another group health plan if you have access to one through your employer.
What happens if your child spends a few months on vacation with your ex-spouse in another state? If your child is enrolled in an HMO and it doesn’t have national networks, your child might not be covered.
An individual indemnity policy for the child might be the best solution. With a fee-for-service or indemnity policy, the child can see almost any provider, no matter with whom the child is staying at the time. (If your individual plan is an HMO, you can see only network doctors.)
A few HMOs will cover your children when they travel. For example, BlueCross BlueShield has an HMO plan called “Away From Home Care” that offers coverage nationwide. If your child is enrolled in that HMO, the child can receive care from an affiliated BlueCross BlueShield HMO plan in the area where he or she is staying. However, the “Away From Home Care” plan is not sold in every state, and to be eligible, the insured child must travel out of your service area for at least 90 consecutive days.
The cost of having children
You may consider adding your child to your plan at work and realize you can’t afford the increased cost. Don’t be tempted to let the child go uninsured. A serious illness or accident could wipe you out financially.
If you can’t afford adding your child to your group health insurance at work, shop for an individual health plan for the child, especially if the child is over age 1. (Individual policies for babies are generally double because babies require so many doctor visits, checkups and immunizations.) You might find a high-deductible individual health insurance plan for a healthy child that will save you money over COBRA premiums.
Before you go with such a plan, make sure you know what benefits the policy provides and compare them to the benefits the child would receive under a group health plan, if one is available to you. The cheapest plan will not always provide the child with the best value for your health insurance dollars.
Another major consideration when examining any health plan is the covered benefits. Individual health insurane plans sometimes don’t cover wellness or preventive care. Deductibles, co-payments, lifetime dollar limits and out-of-pocket contributions also must be weighed.
If you meet income qualifications, your child also might be eligible for health insurance through the State Children’s Health Insurance Program or other state assistance programs.
