Understanding Child Only Health Insurance

Posted on January 13, 2018

Understanding Child Only Health Insurance

Children's health is a parent's primary concern and this means having insurance coverage. Here you'll learn about child only health insurance as an option.

Thanks to a social movement and expansions in child coverage, around 95% of US children are now covered by health insurance.

43% are covered by government-sponsored programs. But the majority have private insurance.

This is largely thanks to child only health insurance policies. If, for whatever reason, you choose not to cover yourself, you can still get affordable and comprehensive coverage for your child.

Let's explore why child only health coverage is so important and how it works.

The Benefits of Child Only Health Insurance

The benefits of health insurance to a child begin before that child is even born. The prenatal care that the mother receives helps that child start out life on the right foot.

Studies show that a child whose mother was covered will be healthier and have a lower BMI.

If health insurance can do this much before the child is even born, what can it do after the child is born? Let's take a look.

Children up to age 5 had a lower chance of high blood pressure and heart disease later in life.

In addition, having insurance reduced family medical debt, therefore lessening financial stress. This can take its toll on a child even if parents try to hide it.

Better health has a ripple effect on a child's life.

It also found better reading scores and academic performance among children with health insurance. In addition, they found a reduced "drop-out rate" among insured children.

Furthermore, studies have been able to show a link between child only health insurance and financial success later in life.

What Child Only Health Insurance Covers

Coverage may vary by insurer. But under US law, child only insurance must cover certain necessary services like:

  • Immunizations
  • Routine check-ups
  • Prescriptions
  • Doctor visits
  • Inpatient & outpatient hospital care
  • Dental & vision care
  • Laboratory & X-ray services
  • Emergency services

You may have noticed that unlike adult coverage that doesn't cover routine dental and vision, child only policies typically do.

Child vision and dental issues have been strongly linked to a child's success in social settings, school, and life. Children with untreated tooth decay or poor eyesight struggle in every aspect of life.

So this is good news for all.

A child with health insurance gets screenings that they might not otherwise receive like those for:

  • Autism
  • Cancer
  • Developmental delays
  • Hearing
  • Depression
  • Anemia
  • Lead-poisoning
  • Sexually transmitted diseases (yes, children can contract them)

When doctors catch these kinds of conditions early, the treatments are often less costly and impactful.

These conditions untreated can cause life-long set-backs and struggles. Even if you choose not to get coverage for yourself, having coverage for your child will give them the support they need to learn and grow.

How To Get Child Only Health Insurance

There are several ways to get insurance policies.

Employer-Based Plans

Fewer than 1/2 of family ensure their children through employer insurance. This is largely believed to be due to the fact that it's not affordable.

While children need preventative healthcare, it's relatively inexpensive so many don't see paying these high premiums as worth it.

On top of this, most of these plans require that the adults be insured in order to cover the children. They are, therefore, most often, not child-only plans.


For children who qualify, the CHIP program is available. This program is intended to help families who make too much to qualify for Medicaid but make too little to afford health insurance for their children.

It offers families a discount on private insurance purchased through the marketplace.

Each state eligibility is a little different so you'll need to check requirements for your state.

Well visits and dental are "free" to the family. Other services will have a copay. Healthcare costs are capped at 5% of your family income.

Un-subsidized Private Insurance

If you do not fall under an employee plan or a subsidized plan, you'll be researching your options on the open market.

The great news is that these plans can't deny your child coverage because of a pre-existing condition. And they cover a lot of necessary services without extra cost to you.

But you need to do your homework when choosing a plan that fits your needs.

Evaluating a Private Insurance Plan

There are many things to consider when comparing plans. A broker will help you evaluate your needs and select the best plan. Here are some of the factors they'll consider.

Catastrophic Insurance

This kind of insurance pays very little unless you have a very large expense.

People who have some savings on hand to cover the high deductible may choose these plans because they're often less expensive.

When getting a catastrophic plan you should know that you are assuming a greater risk.

Bronze Plans

Bronze plans are a step up from catastrophic. They are less expensive but you take on more of the risk.

They're usually only advisable if your child is very healthy and you have some savings on hand to meet high deductibles. But your case may vary so you should speak with an expert.

Silver & Gold Plans

These are your middle of the road option. They help balance risk with lower deductibles. But you will pay more for this.

A broker can help you get the best price.

Platinum Plans

These are the highest level of coverage. You may have heard them called the "bells & whistles" plans. You'll pay less out of pocket when your child needs care. But for this luxury, they'll typically cost more.

These plans often make sense for families who can afford higher premiums and have a child in need of a lot of medical care.


Finally, you need to understand the differences among these 3 types of plans.

An HMO has a strict network of medical providers. If you go outside the network, the bill may not be paid.

A POS has a network. But it allows you to go out of the network if you're willing to pay more for the service. You need a referral from your primary doctor to go out of network.

PPO rewards you for staying in the network. But you can go out of network if you'd like without a referral.

Get Your Child Covered Now

Getting your child health insurance can improve their overall health and success in life. But there are many options to choose from and much to consider.

We help you consider your option to make the right choice for your child and family. To learn more about how we can help you get the best coverage for the most affordable rates with trusted insurers, get a quote now.

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