Q: I’ve heard a lot of conflicting information about child-only 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. 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, but it is accompanied by an individual mandate that requires nearly everyone to have health insurance (the penalty was enforced via a penalty, from 2014 through 2018; the penalty no longer applies after 2018), along with premium subsidies to keep coverage affordable. Neither of those were 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.
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.