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Medical Insurance for Toddlers

To sum it up...
  • Your children are eligible to stay on your health insurance plan until they reach the age of 26
  • If you recently adopted a toddler, you are eligible for a special enrollment period to sign up for a marketplace plan that covers your child
  • If you are worried about affording health insurance for your toddler on your income, your family might be eligible for the Children’s Health Insurance Program
  • Under the Affordable Care Act regulations, certain pediatric services are required to be covered by all insurance plans

Your children can be covered by your medical insurance plan until they reach the age of 26. If you have employer-based coverage, you should be able to add your toddler to the plan during the open enrollment period. If you just started a new job, you are typically entitled to special enrollment for you and your children after your waiting period is over.

You can add your toddler to a marketplace plan when you apply for your own coverage. If you do not have health insurance for you and your child, you may be responsible for paying the individual mandate penalty fine. The fee will either be 2.5 percent of your household income or $695 for each adult living in the house and $347.50 for each child.

Am I eligible for a special enrollment period when I add my toddler to my plan?

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You may be eligible for a special enrollment period when you are adding your toddler to your health insurance plan. For example, if you recently adopted a toddler, you are entitled to a 60-day special enrollment period after the adoption to enroll in a new marketplace plan.

Several other life circumstances might entitle you to a special enrollment period. These include losing your previous health coverage, getting married, having a baby, moving, or being denied Medicaid coverage.

What is the Children’s Health Insurance Program?

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If you are concerned about affording health insurance for your toddlers because you are living on a limited income, you should consider applying for the Children’s Health Insurance Program. This program helps cover the cost of health insurance for families with an income that is too high for Medicaid.

The Children’s Health Insurance Program is required to cover immunizations, prescription drugs, dental and vision, emergency care, x-rays, laboratory tests, hospital care, and visits to the doctor. Additional services may be covered by your CHIP insurance plan depending on the state.

The cost of your CHIP plan can vary depending on the state you live in, as well. Annual check ups and dental exams are generally free of charge, but other services may require you to pay out of pocket expenses.

Some states charge a monthly fee to enroll in the Children’s Health Insurance Program, but it will never be more than 5 percent of your annual household income.

If your toddler qualifies for a CHIP insurance plan, you will not be able to use tax credits to enroll them in a health care marketplace plan. However, you will be able to apply for a marketplace plan with savings for yourself if you do not qualify for Medicaid.

There are two different ways to apply for CHIP coverage. You can either call the CHIP call center or you can fill out an application on the marketplace. If your income qualifies for CHIP or Medicaid, a marketplace representative will forward your information to your local CHIP office.

Are certain pediatric services considered required benefits?

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There are some essential health benefits that must be covered by all Marketplace plans, including pediatrics services such as an annual eye and dental exam. Additional essential health benefits include pregnancy and newborn care, emergency services, hospital care, prescription drug coverage, and several preventive services.

Several pediatric preventive care services must be covered by marketplace plans without charging any out-of-pocket expenses. This includes autism screening, depression screening, developmental screening for toddlers under the age of three, annual hearing screening, lead screening for those who might have been exposed, immunizations, and alcohol and drug assessment for teenagers.

Medical Insurance for Toddlers

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There are certain pediatric benefits that all medical insurance plans must cover. Whether you have an employer sponsored health insurance plan or you are looking to purchase a health insurance plan on the Marketplace, you should be able to add your toddler to the plan.

If you recently adopted a toddler or started a new job, you will get a special enrollment period to find a new plan.

Depending on your income, your child might be eligible for the Children’s Health Insurance Program and you will not have to purchase an insurance plan for them.

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