Q. 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 through 2025, thanks to the American Rescue Plan and Inflation Reduction Act). But regardless of where you get her policy, any health insurer offering coverage to adults must offer the same coverage to children.
For a while in 2010/2011, it was common for health insurers to not offer child-only policies, but that is no longer the case. One of the earliest provisions of the Affordable Care Act (ACA) 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, albeit with limited enrollment opportunities. And the ACA also created premium subsidies that became available starting in 2014. But there were no subsidies available in 2010, and enrollment was available year-round in the individual market. So 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 life 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.
Medicaid and CHIP are available year-round for eligible children, just as they are for eligible adults. 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.
