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Health Care Reform:

Health Insurance & Affordable Care Act

Health Care Reform and Children: FAQ

Answers to WebMD readers' questions about health care reform and children.

Q: My daughter is a college student and she can’t afford the high cost of insurance. Should she just opt out, pay the annual fine, and go uninsured? continued...

In 2014, when health insurance exchanges go into effect, there will be subsidies available to help families with annual incomes below $88,000 pay for health plans. You can learn how much of a subsidy you’ll be eligible for in 2014, by inputting your financial information into the Kaiser Family Foundation’s health reform subsidy calculator.

And if your daughter’s income doesn’t exceed the federal poverty level ($14,404 for individuals and $29,326 for a family of four), she may qualify for Medicaid benefits.

Q: What will health reform do for autistic children?

A: Health reform will help kids with disabilities, such as autism, in a number of ways.

The law eliminates lifetime spending limits, and ultimately, annual caps on care. Insurers cannot deny coverage to kids with pre-existing health conditions, and adult children must be allowed to remain on their parents’ health plan until age 26. In addition, mental health services and behavioral health treatments and therapies will be required covered services by 2014. The details of exactly which services will be covered, however, have yet to be determined.

Q: Does the new law change prenatal care costs?

A: As of Sept. 23, 2010, all new health plans are required to offer preventive services, including prenatal care,with no cost-sharing.

Q: Our son-in-law, who has a pre-existing condition, tried to get insurance for his two small sons, ages 2 and 3. He was told that since he had been declined for pre-existing conditions, they were legally able to decline his sons as well.

A: Under the new health reform law, all insurance companies offering child-only plans are required to extend coverage to children younger than 19, regardless of their medical condition or that of their parents.

If your son-in-law applied for family coverage with his sons, however, it’s possible that the entire application was denied because of his pre-existing condition. If that’s the case, he should reapply for child-only plans for just the boys. Legally, the children cannot be denied.

Unfortunately, in many states, insurance companies chose to drop out of the child-only market entirely, rather than take on the cost of these potentially expensive policies. If you live in one of these states, a family plan may be your only option in the private market.

Another option to explore is your State Children’s Health Insurance Program (SCHIP). SCHIP provides coverage to low-income children 18 years of age or younger. If your son-in-law meets the income requirements, he may be able to insure his children that way. Check InsureKidsNow.gov to find out.

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