Learn more about how the law will affect single or expectant parents.
Explore different options for your children
There are lots of ways that you can provide health insurance to your children at little to no cost. ACA has made some changes that make it easier for children to gain access to quality health insurance.- Tax Subsidies. You might qualify for a tax subsidy, which is kind of like a discount on a new health insurance plan. Your subsidy can used to lower how much you pay each month for insurance or reduce how much you pay when you use your plan. The subsidy will be paid by the government directly to your brand-name insurance company.
- Medicaid Expansion. Under the new law, Medicaid has been expanded to include more people. The income cut-off used to be 100% FPL, but it has been raised to 138% FPL starting in 2014.
- Children's Health Insurance Program (CHIP). Since 1997, each state has offered a program to help cover children whose families make too much money for Medicaid but still require some financial assistance toward health insurance. See if your children qualify for CHIP in your state.
If your household income is below 400% Federal Poverty Level (FPL) - that's about $94,000/ year for a family of four - you'll probably qualify for a subsidy. The less you make, the bigger your subsidy. A bronze plan can be sold for as little as $1 per month by using tax subsidies. Go to www.Healthcare.gov for more information. Or, contact us! We are authorized to help you qualify for subsidies and enroll in your plan.
Medicaid can vary state-by-state, and not all states choose to go forward with the expansion. Qualifying for Medicaid also varies by state, so your children might qualify for Medicaid even if you don't. www.Medicaid.gov
Benefit changes that are helping children
- No child can be turned down for health insurance because of pre-existing conditions or health history. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or use your health plan often. And no insurance company can drop you just because you get sick.
- You can't be charged extra premium for pre-existing conditions. All pre-existing conditions are covered. Insurance companies can longer penalize your child for having pre-existing conditions.
- All plans cover Essential Health Benefits with no yearly or lifetime limits. All plans must include coverage for certain benefits with no limits so you can never run out of insurance for core care. Essential Health Benefits includes doctor office visits, hospitalization, prescriptions, and more.
- Dental and vision care for children under age 19. Is your child overdue for a dental cleaning? Is he squinting to see the board at school? Dental and vision care for children is included in all new health plans.
- Children up to age 26 can be covered on a parent's health insurance. It does not married if your child is married, a student or not, or if you claim him/her as a dependent. Up to age 26, they can be covered with you - no questions asked.
- Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include free preventive care for your kids for things like checkups and immunizations.
Changes in maternity coverage
- Pregnancy is longer a pre-existing condition. Remember how insurance companies used to ask, "Are you pregnant?" on an application for private health insurance, and then they would usually decline you? Or not cover the pregnancy? Not anymore. Now insurance companies cannot turn you away just because you are pregnant. But you must enroll during Open Enrollment: October 1, 2013 - March 31, 2014.
- Maternity care is always covered. On all new health plans, all your maternity visits and delivery are covered. And when you're baby arrives, you can add him or her to your plan.
- Your new baby might actually lower your health insurance costs. Remember that tax subsidies are based on household income and family size, and your family size is growing. A tax subsidy is the amount the government pays directly to your insurance company to keep your health insurance affordable.
- What if the baby is born after Open Enrollment ends? No problem. Birth is a qualifying event, which allows you to enroll in a new health plan at an odd time of the year. It's good to plan ahead, so you can make your plan choice right after the baby is born.
The power of choice
- Choose your insurance company. Whether you qualify for a tax subsidy or not, you can still choose your insurance company from the ones offered in your area. A tax subsidy is the amount paid by the government directly to your private insurance company to help make your health insurance more affordable.
- You'll have four plan choices: Platinum, Gold, Bronze, and Silver. See the guide at the bottom to help you compare the plan choices. If you're under 30 years old (or all other plans are still unaffordable for you), you'll have a fifth "catastrophic plan" choice, which has a lower monthly premium but you'll pay much more when you use your plan.
Something to think about
Before choosing your plan, consider the network of healthcare providers that you can use.- Provider network. Most health insurance plans have a list of doctors, hospitals, and other providers that are in the network. When you use doctors on that list, you'll pay less. When you use doctors who are not on the list, you'll pay more. And sometimes there's no coverage at all for providers who aren't on the list. Doctor and hospital choice is especially important to parents and expectant parents.
- You'll probably notice fewer doctor choices under ACA. And some plans might not cover your care at all if you don't use a provider on the list. So if there's a doctor you love, ask them if they take the insurance plan you're considering before you enroll. Or, you can always go online to the insurance company's website and look at their provider directory.
- Questions to ask yourself: "Will my child's pediatrician take this insurance plan?" And if you're pregnant, "Is my OB-GYN on the list? What about my delivering hospital?" It's a good idea to figure that out before you make a final decision about your insurance.
- If you're pregnant, you might want to consider a better benefit plan. You already know that you're going to have a lot of doctor visits and probably a hospital stay, so it might be a good idea to consider a lower out-of-pocket plan - like Platinum or Gold - as long as the premium is affordable for you. Use the guide below to help you decide.
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