Minneapolis, MN – With the beginning of the school year just around the corner, it’s time for kids to get their annual checkups. Today, healthinsurance.org explains how parents can make use of covered benefits for their children’s back-to-school health needs if they have an Affordable Care Act-compliant health plan.
“This is a great time of the year for your children to be seen by their doctor to stay ahead of fall school deadlines for immunizations and sports physicals,” said Louise Norris, a health policy analyst for healthinsurance.org. “In many cases, immunizations and physicals – where you can request clearance for sports participation – can be done at no cost to you under your child’s health plan.”
There are around 50 million students enrolled in U.S. public schools for kindergarten through 12th grade. In addition, there were more than 3 million students under the age of 24 enrolled in colleges and universities in 2024. Although many students may graduate by 24, it’s important to remember a dependent child can remain covered by their parents’ health insurance until the age of 26 under the Affordable Care Act (ACA).
In addition to physicals, which may be required for participation in school-related sports, there are a variety of other medical expenses ACA-compliant health insurance plans are required to cover for children and young adults:
Vaccines. Many vaccines are covered at no cost to the policyholder. This includes vaccines often required to attend school, including the diphtheria, tetanus and acellular pertussis (DTaP) vaccine, the measles mumps and rubella (MMR) vaccine, the poliovirus (polio) vaccine, the varicella (chickenpox) vaccine, and the meningococcal (meningitis) vaccine.
Mental health screening. Preventive care coverage mandated by the ACA includes screening adolescents for depression and suicide risk, as well as behavioral assessments. According to the Centers for Disease Control and Prevention (CDC), there are approximately 2.7 million children in the U.S. who have depression, and 5.5 million children with behavior problems.
“You can get this school year off to a good start by planning ahead and taking care of needed services and screenings before the end of summer vacation,” Norris said. “You don’t want to miss out on covered benefits and services that could set your child up for success this coming school year.”
Vision screenings. Pediatric eye exams, vision screening, and glasses to correct vision problems are also required coverage under the ACA for individual and small-group plans. Vision screenings for children are considered preventive care, so they are covered at no cost until a child turns 19. However, other vision services may require a co-pay or be counted toward the plan’s deductible. Coverage varies from one plan to another, and not all stand-alone vision plans offer the same level of pediatric coverage as ACA-compliant health plans.
Dental care. The ACA also considers pediatric dental care an essential health benefit. Coverage may be available as part of an ACA-compliant individual or small-group health plan, or under a separate stand-alone dental plan that the family obtains through the Marketplace in their state. Marketplace coverage of this benefit varies from one state to another.
“Any appointments you can squeeze in before the start of the school year will keep kids from missing class or after-school activities,” Norris said. “In addition to being more prepared for their school year, you can avoid racking up tardies and absences by taking care of appointments before kids are back in school.”
Children covered by Medicaid or the Children’s Health Insurance Program (CHIP) also have comprehensive health insurance that includes coverage of pediatric vision and dental care.
Healthinsurance.org provides online resources for consumers about individual and family health insurance. Healthinsurance.org, owned by HealthInsurance.org, LLC, has been providing consumer information about health insurance and health reform for over 25 years.
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