The Affordable Care Act now extends a number of additional benefits to children.
WebMD readers have written in with questions about their rights and challenges they’ve faced when trying to insure their young adult children. Here are answers to the most common questions.
Q: The law states we can keep our adult children on our insurance until age 26; however, my insurance company says it doesn’t have to honor that because it’s self-funded. Is that true?
A: No, it's not true.
A plan that is self-funded is one in which the employer pays health care claims on its own, as opposed to buying coverage from an insurance company. These plans are regulated by the Employee Retirement Income Security Act (ERISA), and can be exempt from certain state insurance laws.
But the right to keep your adult child on your insurance plan until age 26 is a federal law that went into effect last year as a result of health reform. Though there will be aspects of the new law with which self-funded plans will not be required to comply, this provision is not one of them. By law, you should be allowed to keep your adult child on your health plan.
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?
A: Right now, there is no fine for going uninsured. The Affordable Care Act does require all U.S. citizens to get health insurance or face a penalty beginning in 2014. However, there will be exemptions for financial hardship.
Your daughter currently has a few options. She might look into a college health insurance plan, if she doesn’t already have one. The quality of these programs varies greatly, however, with many having been found to provide insufficient coverage. Still, it is an option for some coverage if she has none, and worth researching. Just be sure to carefully read the fine print before signing on.
If your daughter is under 26 years of age and you have insurance, you may be able to add her to your health plan. Check with your company’s human resources department, or call your insurance company directly to inquire about adding your daughter if you buy insurance on your own in the private market.
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.