Can I Get Health Insurance for My Child Only?

Health insurance is fundamental for a child’s well-being, ensuring access to medical and preventative services. Many parents wonder if it is possible to secure health coverage solely for their child, independent of their own insurance status. Child-only health insurance is an option, with various avenues available. Understanding these pathways ensures children receive the care they need. This guide explores how to obtain such coverage, outlining eligibility, available sources, and the enrollment process.

Eligibility for Child-Only Coverage

Eligibility for child health insurance is determined by several factors. Age is a factor; federal guidelines allow children to remain on a parent’s plan until age 26 (including Marketplace plans). For programs like Medicaid and the Children’s Health Insurance Program (CHIP), eligibility extends up to age 19.

Residency requirements mean the child must reside in the state where coverage is sought. Income guidelines are important for government programs and Marketplace financial assistance. These income thresholds are based on the Federal Poverty Level (FPL) for the household.

Child-only coverage is needed in various situations, including:

• When parents lack employer-sponsored health benefits for themselves or their family.
• Divorce scenarios where one parent is responsible for the child’s health insurance.
• A child losing coverage due to family circumstances or aging off a previous plan, where child-only options provide a safety net.

Sources of Child-Only Coverage

Several avenues exist for obtaining child-only health insurance. Government-sponsored programs like Medicaid and the Children’s Health Insurance Program (CHIP) are key sources, providing low-cost or free health coverage to children in families meeting specific income requirements.

Medicaid and CHIP are jointly funded by federal and state governments. States set income thresholds based on the Federal Poverty Level, with many covering children in families earning up to 200% or 300% of the FPL. These programs cover comprehensive services, including doctor visits, immunizations, dental care, vision, and prescription medications. State Medicaid or CHIP program information can be found on the state’s health department website.

The Health Insurance Marketplace also offers child-only plans, available through HealthCare.gov or state-run marketplaces. Enrollment in Marketplace plans occurs during the annual Open Enrollment Period, from November 1 to January 15.

Outside of Open Enrollment, a child may qualify for a Special Enrollment Period (SEP) due to qualifying life events, such as a loss of other health coverage or a change in household size. Families with incomes between 100% and 400% of the FPL may be eligible for premium tax credits, which reduce monthly premiums.

While family plans are more common, the Marketplace accommodates child-only enrollments when parents do not need or qualify for Marketplace coverage. Some private insurance companies also offer individual child-only plans directly, outside the Marketplace. However, these plans are less common and do not qualify for federal premium tax credits, making them a more expensive option.

Information Required for Enrollment

Before applying for child-only health insurance, gather required information and documentation. Having these details available streamlines enrollment, regardless of whether you apply through Medicaid, CHIP, or the Health Insurance Marketplace.

You will need:

• The child’s full legal name, date of birth, and Social Security Number (SSN) or Taxpayer Identification Number (TIN).
• The applying parent or guardian’s full legal name, date of birth, SSN or TIN, current mailing address, and phone number.
• Household income information, including recent pay stubs, W-2 forms, or previous year’s federal tax returns (e.g., Form 1040). Proof of other income sources, like self-employment or social security benefits, may also be needed.
• Your tax filing status (e.g., single, married filing jointly, head of household).
• Documentation confirming the child’s and applying parent’s or guardian’s citizenship or immigration status (e.g., birth certificates, passports, naturalization certificates, green cards).
• Details about any existing or previous health coverage for the child or other household members, which helps determine eligibility for specific programs or special enrollment periods.

The Enrollment Process

Once required information is gathered, the enrollment process for child-only health insurance starts. The most common method is online portals, offering a convenient and expedited way to submit an application. For Marketplace plans, use HealthCare.gov; Medicaid and CHIP applications are processed through state-specific websites.

Online platforms guide you through entering prepared information, including personal details, income data, and household composition. While online applications are encouraged, alternative methods are available. This includes applying by phone or visiting a local assistance office for in-person support.

After submitting the application, you receive a confirmation. Eligibility determination follows, ranging from immediate to several weeks depending on the program and verification processes. You may be contacted to provide additional documentation if further verification is needed. Upon eligibility approval, you receive enrollment instructions and details on how to select a plan, if applicable, followed by an insurance card.