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Are child-only policies available through the exchanges?

You can purchase a child-only policy – either in the exchange or off-exchange. | Image: digitalskillet1 / stock.adobe.com

You can purchase a child-only policy – either in the exchange or off-exchange. | Image: digitalskillet1 / stock.adobe.com

Are child-only policies available through the exchanges?

Q. I’ve heard conflicting information about child-only health insurance policies. I’m on Medicare, but I need coverage for my 16-year-old daughter. Are these plans available in the exchange? What about outside the exchange?

A. Yes, you can purchase a child-only policy for your daughter, either in the exchange or off-exchange. If you qualify for a subsidy to help pay for her coverage or to lower the out-of-pocket amount, they are only available in the exchange (note that subsidies are larger and more widely available for 2021 and 2022, thanks to the American Rescue Plan). But regardless of where you get her policy, any health insurer offering coverage to adults must offer the same coverage to children.

There have been a lot of changes in the child-only market since the ACA was signed into law, and for a time, many insurers stopped offering child-only policies – hence the confusion.

One of the earliest provisions of the law was to make coverage for children under age 19 guaranteed issue in the individual market starting on September 23, 2010. From that point on, children could not be denied coverage based on medical history.

This same provision has been in effect for all policies in the individual market since 2014, accompanied by an individual mandate that required nearly everyone to have health insurance. The individual mandate was enforced via a penalty from 2014 through 2018, and the ACA also created premium subsidies that became available as of 2014 to keep coverage affordable. Neither of those was applicable to children in 2010 – there was no requirement that parents maintain health insurance for their children, nor were there any subsidies to help pay for coverage.

The risk of adverse selection was significant; carriers worried that parents would wait until their children were sick to purchase child-only coverage.

As a result, many carriers simply stopped offering child-only policies in 2010. But over the next year, numerous states issued regulations or passed laws to bring back child-only coverage. (Open enrollment windows were a common solution.) By 2012, child-only policies were once again being sold across much of the country.

Since 2014, coverage has been guaranteed-issue for all applicants during open enrollment (or a special enrollment period triggered by a qualifying event). Child-only policies are available in every state, from all carriers that offer policies for adults. The same rules apply for children and adults in terms of coverage only being available during open enrollment or a special enrollment period, although Medicaid and CHIP are available year-round (and household income caps for Medicaid eligibility are higher for children than for adults, meaning that it’s common for a family to qualify for premium subsidies in the marketplace to cover the adults, but Medicaid or CHIP for the children).


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Carol
Carol
3 months ago

Can i buy insurance for a teenage child that is not my legal child…but lives with me. The only living biological parent acknowledges the child, but does not have the resources to raise the child which has fallen to me.

Louise Norris
Editor
3 months ago
Reply to  Carol

Carol,
This could end up being a bit complicated, depending on what coverage/assistance the child is eligible to receive, and I’d recommend that you reach out to an attorney who can advise you on how to best handle this.

But just as background info, have you checked to see if they’re eligible for Medicaid? Medicaid eligibility for children extends to higher income levels than for adults, so it’s possible that they might be eligible for free coverage under Medicaid or CHIP. Here are the income limits for each state, as a percentage of the federal poverty level: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels/index.html

If they aren’t eligible for Medicaid, and you enroll them in a plan through the marketplace, the problem is going to be qualifying for premium tax credits and handling the reconciliation process after the year is over (assuming they qualify for premium tax credits based on the total household income of whoever claims the child as a tax dependent). Premium tax credits have to be reconciled on a tax return using Form 8962. Assuming the child’s biological parent claims them as a tax dependent, they would have to complete that process on their tax return. But this would depend on whether you’ve officially been appointed as the child’s legal guardian. If you’re paying full price for a plan, however, and not claiming any premium tax credits, it should be a fairly straightforward process to enroll them in coverage.

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