Low-cost health insurance for children, toddlers, and teenagers is available from many reputable and top-rated companies. Compare cheap rates from state-subsidized Marketplaces, government programs, and many private insurers that offer inexpensive policies that cover pre-existing conditions, office visits, prescriptions, depression, mental illness, and major medical expenses. The enrollment process is quick and easy. You can also compare options and change to a different plan during Open Enrollment, and after the OE period ends. Dependent applicants under age 26 may be able to remain on a parent's plan.
In the past, young adults often payed high premiums for their healthcare coverage. Currently, children and adults may be eligible for a substantial federal subsidy that can drastically reduce your premiums if CHIP (see below) coverage is not offered. Since medical benefits are no longer legally required by the Affordable Care Act legislation, but a major expense is just an accident or illness away, we provide the best available options. Routine annual physicals and sports physicals are typically covered with no out-of-pocket expense. Baby well-check benefits are also typically covered with no out-of-pocket expenses. Our expertise and unbiased recommendations helps save money and find the most suitable coverage.
CHIP (The Children's Health Insurance Program) offers inexpensive medical coverage for children in households that do not qualify for Medicaid because of excess income. Together, Medicaid and CHIP provide an enrollment option any time throughout the year. Benefits include office visits (primary care physician and specialist), prescriptions (generic and non-generic), x-rays, lab tests, urgent care visits, ER visits and treatment, inpatient and outpatient hospitalization, and dental and vision coverage. The cost of benefits is often free, but never higher than 5% of the household income. It is possible to qualify for CHIP benefits without being Medicaid-eligible.
Upcoming changes (perhaps in 2024) may enhance benefits for young persons by providing additional policies with flexible benefits. Currently, about 3 out of 10 young adults are not covered. which is a substantially higher percentage than uncovered children. Often, as they transition into entry-level jobs, coverage may not be offered by the employer. And benefits are often badly needed, since about 15% are treated for chronic illnesses, including cancer, asthma, and diabetes. Pandemics (COVID) are also important to treat, although younger persons are impacted less than adults. Younger persons tens to utilize telemed options more than adults.
Individual states may be provided more control over plan availability. Many of the most important topics concerning children's health will continue to be addressed, including ADD, autism, chickenpox, child nutrition, leukemia, immunizations, deafness, juvenile diabetes, exercise, growth disorders, measles, mumps, nutrition, pregnancy, premature babies, reflux rubella, SIDS, smoking, tonsillitis, and whooping cough. Availability of free preventative medical treatment has also recently become a common discussion topic.
Because most children and teenagers are healthy, purchasing your own health insurance is one available option that will save money. An individual plan is offered by many major carriers, with numerous companies offering both short-term and long-term coverage. Several private plans can cost as little as $70 per month for young adults (short term coverage), and can provide significant savings over the costs of other policies. These types of policies are typically approved within 24 hours, and can also be canceled by the policyholder at any time.
Guaranteed coverage of 36 months is also offered by selected insurers in many states, although the maximum number of guaranteed covered months varies. If a major medical condition is present, once the guaranteed period ends, a policy is unlikely to be renewed. If during the ACA Open Enrollment period, an Exchange plan can be chosen, applicants with pre-existing conditions should choose this option. Although the effective date must be January 1 or February 1, immediate benefits will be offered for all conditions.
Temporary policies have several limitations including not covering pre-existing conditions and reducing the length of time you can own the coverage. 1-12 months (4 consecutive 3-month contracts or 360 days) of coverage can be purchased, although additional benefits can be obtained by applying before the expiration date (termination date) of coverage. And although short-term contracts are not considered "qualified," the tax penalty has been eliminated. This penalty is not expected to be reinstated during the current administration or future administrations.
An experienced agent or broker at our website, or in your area, can quickly determine if this type of policy is the best choice. NOTE: Unless you missed Open Enrollment (see below), a short-term plan should not be your primary choice. If qualified coverage was suddenly lost or terminated, and SEP exemption or COBRA will probably be offered. Although the rates will be higher than a short-term plan, benefits will be much more comprehensive, with no waiting period, or reduction in benefits. Also, unlimited annual benefits will be offered, instead of caps of $1 million or $2 million. Generally, $100,000 is the minimum liability coverage provided.
During Open Enrollment periods, a Marketplace plan will provide richer benefits and not exclude past, present, or future medical conditions. And the federal government may help you pay the premium! Since you can also cancel a Marketplace plan at any time, you are not obligated to commit to a long-term coverage arrangement. If a plan is suddenly discontinued, you may choose an alternative plan without answering medical questions (during the OE period). A different carrier will likely utilize a different provider network, and out-of-area may not be as robust.
If your projected household income substantially increases or decreases (change in employer, work hours, or job description), the federal subsidy can be adjusted. If you become ineligible for Medicaid or CHIP coverage, you may have to change to a conventional plan. Federal assistance may be available, depending upon your household income. The Employee Benefits Security Administration details how the Affordable Care Act helps young adults. Both married and unmarried individuals can be covered.
If you missed Open Enrollment and you do not qualify for a special enrollment exception, we recommend quickly applying for short-term policies, so you can cover major medical and hospital claims, while waiting for your eligibility for a more permanent plan. Often, immediate benefits are offered, which is almost always sufficient until the next policy is applied for, and approved. The maximum length of coverage is now 12-36 months, which provides benefits until the beginning of the next Open Enrollment period. Many states have a 360-day cap, so applying for coverage with a January 1 effective date may result in a lapse of coverage late in the year.
The Impact Of The ACA Legislation (Obamacare)
Currently, under Obamacare (ACA), the lower your income, the cheaper the cost of a plan. For instance, consider the example of a 22-year old in Dallas (Texas) who earns $34,000 per year, and is not listed as a dependent on anyone's federal tax return, and needs to purchase their own policy.
There are many plans that are very budget-friendly. We listed several popular plans below. Nine options are offered that cost less than $30 per month. All policies include office visits (pcp and specialist), prescriptions, ER, hospitalization (inpatient and outpatient), and all other required essential benefits. NOTE: These options are also available for family policies. Also, both married and unmarried children may remain on their parent's Marketplace plan until age 26.
$12 -- Cigna Simple Choice 9100
$13 -- Cigna Connect 8900
$22 -- Cigna Simple Choice 7500
$24 -- Cigna Connect 5500
$24 -- Cigna Connect 6800 Enhanced Diabetes Care
$24 -- Cigna Connect HSA 7050
$25 -- BCBS Of Texas MyBlue Health Bronze 402
$28 -- Cigna Connect 8200
$29 -- UHC Bronze Standard $9,100 Deductible
Comprehensive Preventive Benefits
Since most young persons are typically healthy, and are not regularly treated for chronic illnesses, free preventive benefits are often utilized more than major medical benefits. Whether it's a routine annual physical, immunizations, depression, vision, or hearing screenings, iron supplements, or obesity counseling, there is no cost to the patient (or parent), and availability of network providers is widespread in the vast majority of counties across the US. Additional carriers have increased the number of 2023 available plans. For example, Cigna has entered the Pennsylvania market, and Ascension has entered the Indiana market.
Waiting periods, deductibles, and copays do not apply. The only out-of-pocket expenses would result from conditions and subsequent treatment needed as a result of the original preventive office visit or procedure. Regardless if the child is a toddler or young adult, all of these provisions apply. As your child gets older, adult preventative benefits will begin to become available. Mental health and drug counseling coverage is not excluded, and no waiting periods apply. Typically, mental health office visit copays match primary care physician (pcp) copays.
Each year, the list of covered items is updated. For instance, one of the more recent additions was the new nasal spray flu vaccine that has an impressive history of safety. The Centers For Disease, Control and Prevention (CDC) recommends this treatment for children between ages two and eight. Previously, anyone with symptoms of asthma, certain allergies, immune system issues (and several additional symptoms) was asked to consider the injectable option. During the COVID-19 crisis, medically-necessary testing and treatment was covered. Testing was free and treatment was subject to applicable copays and deductibles.
The CDC had originally terminated the intranasal formulation because of poor results from seven years ago. Effectiveness of the injectable option was substantially higher, and it is was the only offered method. But AstraZeneca, the manufacturer, reformulated the vaccine, and it is once again quite effective. Shortages rarely occur. Generally, all persons over age six months old, and Seniors, are highly recommended to receive the vaccine each year. However, the flu vaccine is not recommended for children that have had Guillain-Barre Syndrome, or have experienced a life-threatening allergic reaction to a flu vaccine or any ingredients in the vaccine.
The Magic Of Silver Tier Plans
"Silver" Exchange policies offer a special "cost-sharing" feature that is unique to these types of contracts. These subsidies increase the insurance company's share of paying for benefits, which subsequently lowers needed spending for many expenses. Maximum caps are reduced, resulting in some of the best available Marketplace offers. In many situations, the subsidy exceeds the entire cost of the policy (more often on Bronze plans), creating "free" health insurance. However, major changes in household income could impact cost-sharing.
You are eligible for a cost-sharing reduction if your household income is between 100% and 250% of the Federal Poverty Level. For example, for a family of four persons, this would be approximately $24,000-$59,000. And depending on your income level, a typical $3,000 deductible could be reduced to $250 or $600. Also, office visit copays to primary-care physicians and specialists could reduce from $25-$50 to no charge. When shopping and comparing, the "Silver" tier policies should always be at the top of the list to review (assuming you qualify for a subsidy).
In many situations, the less-expensive Silver-tier option will provide better benefits than a Gold-tier option. The savings in out-of-pocket expenses can be substantial, and all Marketplace carriers offer Silver-tier options. Platinum-tier plans, although sometimes offered, are rarely purchased, and are also often unavailable.
Since the federal government pays these reductions directly to the insurance company, you are not required to pay the higher amount and wait for reimbursement. You also are not taxed on the cost-savings since this feature is built into the Affordable Care Act legislation. While the Silver plan is not always the best option for your teenager or child, it should always be one of the plans you consider. "Catastrophic" and high-deductible options can be ideal, if your healthy child has no major medical issues throughout the year.
Higher-income households that have dependents with severe and/or chronic medical conditions, should consider Gold or Platinum plans, depending on maximum out-of-pocket expenses. Although many high-tier policies feature low deductibles, the maximum out-of-pocket expenses could be as much as $8,700 ($17,400 per family). Note: Medicare-eligible persons can not include their children on their Marketplace plans. However, CHIP is likely available, and coverage is very comprehensive with low copays.
Of course, if your young one is still a toddler, cheap newborn health insurance can be easily purchased. Even if it is not an Open Enrollment period, the birth of a child is considered a "qualifying event" and you would be able to obtain benefits easily through an SEP (Special Enrollment Period). Any pre-existing conditions would be covered and federal financial assistance would be provided, if you meet eligibility requirements. There would be no waiting periods, surcharges, or extra copays or deductibles to meet. Your carrier may not utilize a nationwide network, so local providers may have to be used.
Some of the benefits typically provided on a "toddler" policy include routine check-ups, immunizations, diagnostic testing, prescriptions and emergency services. Screening is also provided for autism, vitamin deficiencies, sickle cell anemia, congenital hypothyroidism, and hearing issues. Many additional screenings are also covered with no out-of-pocket expense. If there are recurring problems, often testing and treatment is needed, and it is important that the proper plan be selected to minimize your out-of-pocket costs. For example, if an expensive Tier 4 drug is required to be regularly taken, a Gold-tier plan may be the most cost-effective if cost-sharing is not available. Most importantly, qualified plans do not place a cap on annual benefits paid.
If you are under the age of 26, staying on your parents plan is another option. It is no longer a requirement that an individual must be a full-time student to remain or even be added to their parent’s health care policy, which is an advantage for you. And, if health insurance is offered through your employer, you can use that coverage instead. Often, it will include maternity benefits, which many private plans did not cover four years ago. Now, it is part of a required "Essential Health Benefits" package, although many expenses are subject to a deductible. Cheaper high-deductible (HSA) options are also frequently available through large employer group plans. Common deductibles are $3,000, $5,000, and $6,000. Common coinsurance options are 0%, 20%, and 30%.
Many group plans offer very comprehensive benefits with low deductible options to their employees. Of course, some others do not, instead, providing options that contain high deductibles and high out-of-pocket costs. It's important to study the differences between both types of options since often, purchasing personal coverage is the best choice. You can choose the deductible and decide if paying extra to lower coinsurance and maximum potential expenses is worth considering.
Coverage for spouses and dependents is often much more expensive if the employer does not help pay the cost. In many situations, purchasing private plans provides an affordable alternative. However, generally, a federal subsidy can not be utilized, and deductibles are often higher ($9,100 maximum allowable). The typical deductible for an employer-provided plan is between $3,000 and $6,000. Maximum out-of-pocket expenses for the entire household are higher. $1,000 deductible plans are offered, but the rate is high.
However, if you're fortunate to work for an employer that pays more than 50% of your premiums, and your income is above 400% of the Federal Poverty Level, purchasing Marketplace coverage (if you were eligible) would likely result in higher policy costs. The latest trend of many businesses is to create a medical savings account (MSA) and contribute from $1,000 to $3,000 to be used for qualified expenses. For young adults with no medical issues, selecting this option can be very cost-effective. For households with chronic illness, it is not a popular option because of the recurring major expenses.
Any unused funds for the calendar year will not be lost, so there is a great incentive to stay healthy and utilize the 100% free preventive benefits. Since children (whether at home or at college) rarely incur large medical expenses, if your contribution from the company is based on the number of household members, you have an increased chance of accumulating substantial savings if everyone stays reasonably healthy. Depending on the type of account (HSA), dental, hearing, and vision expenses may also be allowed to be paid from the account. Over-the-counter drugs also qualify for a tax deduction.
Monthly Rate For Infants/Children Ages 0-14 In Selected Cities
$88 -- CareFirst BlueChoice Young Adult $9,100 (HMO) -- First three pcp office visits $0 copay.
$152 -- ConnectiCare Choice Catastrophic (POS) -- First three pcp office visits $30 copay.
$114 -- Highmark Together Blue Major Events EPO Catastrophic 9100 (EPO) -- First three pcp office visits $0 copay.
$180 -- Kaiser GA Signature Catastrophic 9100 (HMO) -- First three pcp office visits $0 copay.
$164 -- Oscar Secure (EPO) -- 3 $0 PCP Visits (EPO) First three pcp office visits $0 copay.
$198 -- Oscar Secure (EPO) -- First three pcp office visits $0 copay.
$187 -- BCBS MyBlue Health Bronze 402 (HMO) -- Select physician pcp office visits $0 copay.
$109 -- UCare M Health Fairview Core -- First three pcp office visits $30 copay.
$128 -- PacificSource Navigator Catastrophic (PPO) -- First three pcp office visits $0 copay.
$128 -- Medical Mutual Market HMO Young Essentials (HMO) -- First three pcp office visits $40 copay.
$137 -- Common Ground Healthcare CGHC Catastrophic (EPO) -- $0 copay for pcp office visits.
$232 -- Ambetter Essential Care 1 (HMO) -- $0 copay virtual care visits.
How Much Does Health Insurance Cost For A Teenager?
Shown below are rates for teenagers (ages 15-19) in selected areas. The federal subsidy has not been applied. If applicable, the subsidy can substantially reduce the cost of coverage. Prices are monthly.
Jefferson County, AL
$156 -- BCBS Of Alabama Blue Protect
Santa Clara County, CA
$158 -- Valley Health Minimum Coverage HMO
Gwinnett County, GA
$182 -- Anthem Catastrophic Pathway X Guided Access HMO 8550
Genesee County, MI
$148 -- Blue Cross Select HMO Value
Lancaster County, NE
$175 -- Medica With CHI Health Catastrophic
Multnomah County, OR
$118 -- PacificSource Navigator Catastrophic
Allegheny County, PA
$127 -- Highmark Together Blue Major Events EPO 8550
Arlington County, VA
$144 -- BCBS BlueEssentials Catastrophic 1
Union County, SC
$144 -- CareFirst BlueChoice HMO Young Adult $8,550
Expiration Of Obamacare Tax Penalty
Purchasing healthcare in the US was a legal requirement (until three years ago), and was another reason to secure coverage to avoid the IRS tax. Previously, the penalty was $695 per adult, and $347.50 per child, or 2.5% of the household income, whichever was higher. The maximum penalty was $2,085 per family. Thus, if you made $60,000 per year and did not buy coverage, potentially, you were forced to pay a tax of $1,500. Ouch! Thus, alternative plans became available, providing 12-month short-term options along with inexpensive major medical contracts. 36-month short-terms are also offered in several states. 24-month and 12-month ST plans are also offered.
Previously, the legality of instant tax credits appeared to be in jeopardy. However, the Supreme Court ruled eight years ago that all citizens were eligible, regardless if they lived in states where state or federal governments managed the Exchange Marketplaces (King Vs. Burwell). Also, it has been determined that only Congress can change or eliminate tax credits for the ACA legislation. A full repeal will require coordination of the President, Senate, and House Of Representatives. This is extremely unlikely, although changes to the legislation continue to occur, especially when the same party controls the Senate AND House Of Representatives.
Although we all know that making comparisons is something that should be done before purchasing a policy, many times young people simply do not understand the significance of this step. Comparisons involve reviewing and closely examining several companies and their prices, determining which carrier offers the best value, and ensuring there is no lapse in coverage if a change is made. Potential maximum out-of-pocket expenses must always be considered, along with the available provider network. Currently, $9,100 is the maximum allowed out-of-pocket expense for Marketplace plans, although the amount increases each year. In 2024, the maximum allowed deductible will probably increase again.
The enrollment process generally takes less than 25 minutes. If you qualify for a federal subsidy, additional information may be required regarding your projected household income for the upcoming calendar year. A retired spouse's income must also be considered, even if they are covered through Medicare. Generally, investment income and pension or social security income must also be included when calculating the amount of subsidy. Job or career changes throughout the year could impact the eligibility (or amount) of federal subsidies. Medicare or Medicaid qualification will result in no federal subsidies. Seniors that qualify for both Medicare and Medicaid may be eligible for "dual" Medigap plans.
University Student Medical Plans
Are you in college or preparing to further your education? Not only does this mean you are taking big steps toward a great future, it also means that you can greatly reduce the costs you will pay for healthcare. Rates for applicants under age 25 are the cheapest of all age groups, and a wide variety of private and group plans are offered. Although catastrophic plans are inexpensive, copays for pcp and specialist office visits are often frequently utilized. Therefore, paying a slightly higher premium for comprehensive plans can be a very viable financial strategy. Silver-tier plans with cost-sharing will also provide lower deductibles and copays.
Many Bronze-tier plans provide copays on pcp office visits without any limitations. The copays will greatly vary with specialist copays often significantly higher than primary-care physician office visit copays. Many plans offer a $0 copay for the first three pcp office visits. Urgent Care visits are generally between $30 and $100, although a deductible may also apply, depending upon the carrier. Urgent Care visits are always covered, but often are subject to a deductible.
Most public and private universities offer coverage to students, even those attending part-time, who are not a part of their parent’s plan. Choosing to use the services offered through your school could result in hundreds (or thousands) of dollars in savings. However, several school plans are very expensive and may not offer or include specific coverage you need. Instead of primary coverage, the plans may be best utilized as supplemental coverage, to help pay out-of-pocket expenses, or simply provide basic services at the campus medical center. Although these facilities are not typically open 24 hours, their Urgent Care facilities often offer extended hours.
Some University plans may have a smaller network of facilities that may limit treatment out of the area in the event of a serious illness or accident. Comparing your private policy options with your school's student plan will help ensure you are properly covered. Sometimes a combination of a private subsidized policy with a supplemental contract from a school (Ohio State University is one of many schools that has affordable and cost-effective supplemental coverage) covers most situations.
Supplemental plans are ideal if your primary coverage does not provide benefits on-campus, or the out-of-pocket expenses are too high on the University policy. Pre-paid care is often utilized, and prescription drug benefits are often provided. A campus facility will often offer extended evening and weekend hours to accommodate all students. Although prescriptions are available, many outpatient procedures are not offered. These facilities also should not be used for emergency and life-threatening situations.
If you are unable to afford the costs of coverage, government programs may be able to help you secure coverage. Medicaid is one option for low income individuals, offering reduced cost coverage. In addition there are also plenty of community centers offering healthcare at discounted rates. Many states are expanding their eligibility guidelines, so lower incomes are able to now qualify. Urban areas are more likely to have additional facilities in the area. CVS walk-in clinics (MinuteClinic) may also be available for persons with or without coverage. Treatment at these facilities is considered "in-network" by Aetna.
Medicaid uses a sliding fee scale to evaluate the total amount that is owed for the services rendered. Either of these options will help ensure that you are covered, should illness or sickness need to be treated. And they offer very good preventive benefits, especially for children. Often, immunizations and well-check visits are available at no charge. Pcp office visits and specialist visits are also covered, along with generic and non-generic prescription drugs. Chronic illnesses can also be treated, although Exchange plans offer a wider selection of treating facilities.
"CHIP" plans are available in all states and utilize a large provider network of doctors and other medical facilities. Copays are very low and deductibles rarely are applicable. CHIP benefits and rates will vary, depending upon which state you reside. However, all states must adhere to federal guidelines, which includes all medically necessary services and treatment. This includes standard office visit and prescription benefits, along with mental health and dental coverage. It is possible for separate members of a household to be covered under Marketplace and CHIP benefits.
More than nine million persons are covered by CHIP, with states administering their own programs. Preventative dental benefits are typically provided along with additional basic services. The benchmark dental coverage must be equal to the most popular federal employee option for dependents, most popular state employee program, or private individual coverage. Orthodontia treatment will have limitations.
Three types of treatment can be approved for children. They are "Secretary-Approved," "Benchmark," and "Benchmark-Equivalent." The first type is the most common, since it is based on standard BCBS, HMO, or state plans. The third option can be customized by individual states, but must be approved by HHS (Department Of Health And Human Services).
States with the highest number of applications submitted to Medicaid are Florida, Arizona, California, Pennsylvania, Indiana, Texas, Illinois, Washington, Ohio, and Michigan. States with the lowest number of submitted applications are District of Columbia, Wyoming, South Dakota, North Dakota, Vermont, Arkansas, Montana, Rhode Island, Minnesota, and Hawaii. The states that spend the most money on Medicaid are New Jersey, Michigan, Massachusetts, Illinois, Ohio, Florida, Pennsylvania, Texas, New York, and California.
Because of age, paying less for young adult and children's healthcare coverage is often possible by purchasing a private plan. There are many options available that will help you save money while still qualifying for the policy that you need. As earlier mentioned, Obamacare provides financial aid to pay your premium, and pays for all qualified preventative expenses. And of course, whether you're health is perfect, or you take multiple drugs that cost more than $500 per month, you can not be turned down for medical reasons.
Which plan is best for you? Often, by comparing different options, there may be several policies that provide the benefits that are most important to you at a very reasonable cost. We help you understand the differences between policies and how to easily and quickly enroll in the best plan. Low cost medical plans for teenagers (and younger persons) are available. You can change policies each year to match your expected out-of-pocket expenses, and customize prescription drug and office visits to meet current needs.