How to Choose Health Insurance for Your Child

The main options for kids' health coverage

Most children get health insurance through one of three routes: a parent's job-based plan, Medicaid (the state program for lower-income families), or the Children's Health Insurance Program, known as CHIP. Some families buy private plans directly from an insurance company. Each route has different costs, different doctors you can see, and different rules about who qualifies. The right choice depends on your income, whether you have access to an employer plan, and what your state offers.

Job-based plans are the most common. If your employer offers coverage, you can usually add your children for a monthly premium that comes out of your paycheck. You'll pay a copay (a fixed amount like $20) when you visit the doctor, and the insurance covers the rest. Medicaid and CHIP are free or very low-cost programs run by your state, but they have income limits — your family has to earn below a certain amount to may have access to.

Key Takeaways

• Job-based plans, Medicaid, and CHIP are the three main routes, and which one works best depends on your income and whether your employer offers coverage.
• Medicaid and CHIP are free or nearly free but have income limits that vary by state; you can check your state's limit by calling 211 or visiting your state health department website.
• Job-based plans cost more upfront but usually cover more services and let you see any doctor in the plan's network without waiting for approval.
• Private plans you buy directly are an option if you don't may have access to for Medicaid or CHIP and don't have access to an employer plan, but they cost significantly more.
• You can switch plans during open enrollment (usually November through December) or if you have a life change like a new job or birth.

Job-based health insurance through an employer

If you work for a company with 50 or more employees, your employer is required to offer health insurance. You can add your children to your plan, usually for a monthly cost that's deducted from your paycheck. The amount varies widely — some employers pay most of the cost, others pay very little. When you enroll, you'll choose a plan type: HMO, PPO, or POS. These names describe how much flexibility you have in choosing doctors.

With an HMO (Health Maintenance Organization), you pick a primary care doctor who coordinates all your child's care, and you pay less if you stay within the plan's network of doctors and hospitals. A PPO (Preferred Provider Organization) lets you see any doctor without picking one first, but you pay less if you use doctors in the plan's network. A POS (Point of Service) plan is a hybrid — it works like an HMO for routine care but like a PPO if you need a specialist.

Job-based plans typically cover preventive care (checkups, vaccines, screenings) at no cost to you. You'll pay a copay for office visits, urgent care, or the emergency room — usually $20 to $50 depending on the plan. If your child needs surgery or a hospital stay, you'll pay a deductible (a set amount you pay before insurance kicks in) that ranges from $500 to $3,000 or more. Ask your employer's benefits office for a summary of what each plan covers and what it costs.

Medicaid and CHIP for lower-income families

Medicaid and CHIP are state-run programs that cover children whose families earn below a certain income threshold. Medicaid is for the lowest-income families; CHIP covers families who earn too much for Medicaid but still can't afford private insurance. Both are free or cost very little — some states charge a small monthly premium or copay, but many charge nothing at all.

Income limits vary significantly by state. In some states, a family of three earning $30,000 a year qualifies; in others, the limit is $50,000 or higher. Your state's Medicaid office or CHIP program can tell you the exact limit. You can also call 211 (a free helpline) and say you're looking for health coverage for your child — they'll tell you which programs your family might may have access to for and how to apply. Many states let you apply online, by mail, or in person at a local office.

Medicaid and CHIP cover the same basic services: doctor visits, vaccines, hospital care, emergency room visits, prescriptions, dental care, and vision care. You usually don't need to pick a primary care doctor in advance, though some states' programs work like HMOs. Coverage is continuous as long as your income stays below the limit and you renew your enrollment each year (usually annually, though some states have longer renewal periods).

Private insurance plans you buy directly

If you don't have access to an employer plan and your income is too high for Medicaid or CHIP, you can buy a private plan directly from an insurance company. These plans are sold through the Healthcare.gov marketplace (the federal site) or through your state's marketplace if your state runs its own. Open enrollment — the time when you can buy or change plans — runs from November 1 through December 15 each year. Outside that window, you can only enroll if you have a may have access to life change, like losing other coverage or having a new baby.

Private marketplace plans are divided into four metal levels: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premium but the highest out-of-pocket costs when you use care. Platinum plans have the highest premium but the lowest costs when you visit the doctor. Silver plans are in the middle. If your income is below 400% of the federal poverty line (roughly $55,000 for a family of three in 2024, though this changes yearly), you may may have access to for a tax credit that lowers your monthly premium.

Private plans cost significantly more than Medicaid or CHIP — premiums can range from $150 to $400 or more per month for a child, depending on the plan level and your age. You'll also pay copays and deductibles. These plans are worth considering only if you don't may have access to for Medicaid or CHIP and don't have access to an employer plan.

Comparing costs across the three main routes

The real cost of each option includes the monthly premium you pay, the copays when you visit the doctor, and the deductible you pay before insurance covers care. Job-based plans usually have the highest monthly premium (though your employer pays part of it), moderate copays, and a deductible that can be $500 to $3,000 or more. Medicaid and CHIP have no or very low premiums and usually no copays or deductibles. Private marketplace plans fall in between — lower premiums than job-based plans if you get a tax credit, but higher out-of-pocket costs than Medicaid or CHIP.

The trade-off is usually between monthly cost and flexibility. Job-based plans and private plans let you see any doctor in the network without waiting for approval (depending on the plan type). Medicaid and CHIP sometimes require you to pick a primary care doctor or get approval before seeing a specialist, which can mean a longer wait. But because Medicaid and CHIP are free or nearly free, they're the most affordable option if your family qualifies.

To compare plans side by side, write down the monthly premium, the copay for a routine doctor visit, the copay for an urgent care visit, the deductible, and what preventive services are covered at no cost. Then calculate what a typical year might cost: if your child sees the doctor four times a year for checkups and gets sick twice, what would you pay out of pocket? This rough calculation helps you see which plan actually costs less for your family's situation.

How to enroll and when you can make changes

For a job-based plan, contact your employer's benefits office or HR department. They'll give you enrollment forms and a deadline — usually you have 30 days after you're hired to enroll. If you miss that window, you can only enroll during the company's annual open enrollment period, which is usually in the fall.

For Medicaid or CHIP, contact your state's Medicaid office or CHIP program directly. You can find the phone number by calling 211 or searching "[your state] Medicaid" online. Most states let you apply year-round, and coverage usually starts within 30 days of approval. You'll need to renew your enrollment each year, usually by filling out a form or confirming your income online.

For a private marketplace plan, go to Healthcare.gov (or your state's marketplace website if your state runs its own) during open enrollment, November 1 through December 15. You can enroll outside this window only if you have a may have access to life change: birth of a child, loss of other coverage, change in income, or change in immigration status. Life changes usually give you 60 days to enroll.

What happens if you lose coverage or need to switch

If you lose job-based coverage — because you change jobs, your employer stops offering it, or your hours are cut — you have 60 days to enroll in a new plan without waiting for open enrollment. This is called a may have access to life change. You can enroll in Medicaid, CHIP, or a private marketplace plan during this window. Contact your state's Medicaid office or go to Healthcare.gov right away, because the 60-day clock starts the day you lose coverage.

If your income changes — you earn more or less than before — you may become ineligible for Medicaid or CHIP, or you may become newly may be able to access. Report the change to your state's Medicaid office or CHIP program as soon as it happens. If you're on a private marketplace plan and your income drops, you may now may have access to for a larger tax credit, which would lower your monthly premium. Go to Healthcare.gov to update your income and see if your credit changes.

If you're unhappy with your current plan, you can switch during open enrollment (November 1 through December 15) without a may have access to life change. You can also switch Medicaid or CHIP plans at any time if your state allows it — call your state program to ask. Job-based plans usually allow you to switch during the company's annual open enrollment, but not outside that window unless you have a may have access to life change.

Frequently Asked Questions

Can my child be on Medicaid if I have a job-based plan?

Yes. Medicaid and job-based coverage are separate programs, and your child can be on either one or both. Some families use Medicaid as a backup to cover copays and deductibles on a job-based plan. Check with your state's Medicaid office about your income limit — it's usually higher than you'd expect.

What if my employer's plan is too expensive?

If your employer's plan costs more than 8% of your household income, you may may have access to for a tax credit to buy a private marketplace plan instead. Calculate what your employer plan costs, then go to Healthcare.gov to see if you may have access to for a credit. You can also check whether your child qualifies for Medicaid or CHIP separately from your own coverage.

Do I have to use the same doctor with every plan type?

No. HMO plans require you to pick a primary care doctor and get referrals to see specialists. PPO and POS plans let you see any doctor in the network without a referral. Medicaid and CHIP plans vary by state — some work like HMOs, others like PPOs. Ask your plan what the rules are before you enroll.

What if I'm self-employed or a freelancer?

You can buy a private marketplace plan through Healthcare.gov during open enrollment, or year-round if you have a may have access to life change. You may also may have access to for a tax credit if your income is below 400% of the federal poverty line. Check whether your child qualifies for Medicaid or CHIP — income limits are often higher for children than for adults.

Can I change plans if my child gets sick?

No, a diagnosis is not a may have access to life change. You can only switch plans during open enrollment (November 1 through December 15) or if you have a may have access to life change like a job loss or move. If your current plan doesn't cover a treatment your child needs, contact the plan to ask about an exception or appeal.