Learn About Affordable Health Insurance Options for Families

Getting affordable health insurance can be a major challenge for many families. The cost of insurance coverage has risen disproportionately compared to incomes over the past several decades, making cheap health insurance more elusive than ever. In fact, the premiums for an average employer-covered family plan totaled $20,000 in 2018, according to a report from the National Conference of State Legislatures (NCSL). On average, these families contributed 29 percent of the cost for the premiums, with their employers paying the difference. This means that families without employer-based coverage face even higher prices.

Luckily, there are some affordable health care options designed to lessen the burden of getting covered. For example, low-income parents who do not qualify for Medicaid can get free or cheap health insurance for their children through the Children’s Health Insurance Program (CHIP). Additionally, lower-income families can qualify for Medicaid coverage outright. Finally, many families may qualify for subsidies under the Affordable Care Act (ACA) that make private health insurance more affordable.

What is the Children’s Health Insurance Program (CHIP)?

The Children’s Health Insurance Program (CHIP) is designed to provide affordable health insurance for kids. Children qualify if their parents make too much to qualify for Medicaid but cannot afford to purchase private health insurance for their kids. The exact eligibility requirements for CHIP health insurance for kids vary from state to state. However, children can generally be covered with CHIP through 19 years of age.

CHIP healthcare covers the following services in all states:

  • Routine wellness exams
  • Regular immunizations
  • Standard doctor visits
  • Medication prescriptions
  • Dental and vision care
  • Inpatient hospital services
  • Outpatient hospital services
  • Laboratory services
  • X-ray services
  • Emergency services
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TIP BOX

Some plans have state-specific income requirements, so make sure you meet these conditions when moving between states. Additionally, certain plans may have location-specific treatment options
Some plans have state-specific income requirements, so make sure you meet these conditions when moving between states. Additionally, certain plans may have location-specific treatment options

In addition to the health insurance for kids listed above, many states provide additional coverage. For instance, New York’s program also includes speech and hearing services, medical equipment, emergency ambulance transportation and hospice care. Some parents must pay a monthly premium for NY CHIP healthcare that ranges from $9 to $60, depending on the family’s income level.

Under the program rules, a family of four making under $40,152 per year would pay no premiums. A family of four making $100,404 a year would be charged a $60 premium per child, with a maximum premium of $180 per family per month.

You can apply for CHIP healthcare by calling the Healthcare.gov customer support line at 1-800-318-2596. Alternatively, you can complete an application through the Health Insurance Marketplace. Although general enrollment for private health insurance is limited to certain times of year, you can apply for Medicaid or CHIP benefits at any time.

What is Medicaid?

The Medicaid program provides low-income Americans with affordable health care coverage. It is operated jointly by the federal and state governments. It is the largest source of health coverage in the country, making it a vital program. However, Medicaid eligibility varies significantly from state to state. Additionally, many states are adding work requirements to the program.

Low-income Americans who need affordable coverage must research the eligibility requirements in their state to determine if they should apply for Medicaid in their states.

Generally, program recipients should have a household income that falls between 100 to 200 percent of the Federal Poverty Level (FPL) to receive affordable coverage. Some states may also require that applicants be parents, disabled, elderly or pregnant to qualify for coverage.

Although Medicaid differs state by state, the federal government requires states to include some services in its coverage. The following benefits must be covered by Medicaid according to federal law:

  • Certified pediatric services
  • Early and periodic screening, diagnostic and treatment services (EPSDT)
  • Family planning services
  • Federally qualified health center services
  • Home health services
  • Inpatient hospital services
  • Laboratory services
  • Nursing facility services
  • Outpatient hospital services
  • Physician services
  • Rural health clinic services
  • Transportation services for medical care
  • X-ray services

Along with the Medicaid benefits listed above, many states offer additional coverage in the program. For instance, many states include optometry, podiatry, dental or chiropractic services in their programs. Physical therapy, prosthetics and other more expensive treatments may also be covered.

Learn About Affordable Care Act (ACA) Subsidies

Individuals purchasing private insurance may still be able to get relatively low-cost health insurance thanks to marketplace subsidies. Although there have been many changes to the Affordable Care Act (ACA) since its initial passage, the premium subsidies remain in place. These subsidies offset some of the costs of seeking coverage in the marketplace, making insurance premiums more affordable for families who make too much for Medicaid or whose states did not approve a Medicaid expansion.

There are two subsidies available to families that seek affordable healthcare through the marketplace: the premium tax credit and the cost-sharing subsidy. Almost 90 percent of people who received coverage through the marketplace qualified for the premium tax credit in 2018. Just over 50 percent of those who received coverage in the marketplace received the cost-sharing subsidy.

Families between 100 and 400 percent of the FPL who do not have access to affordable health care through work, CHIP or Medicaid can qualify. Note that the definition of affordable employer-based coverage is based on the employer contribution for one employee and does not include dependents. Subsidies cover part of the portion of monthly premiums so families can shoulder a more affordable health insurance cost.

The cost-sharing subsidy provides affordable health insurance for families that have incomes under 250 percent of the FPL. However, families with incomes below 200 percent of the FPL will receive the most benefit from the service. The subsidy allow these families access to the benchmark Silver plan.

The subsidy lowers of the out-of-pocket expenses for a Silver plan. It lowers the maximum out-of-pocket for the Silver plan from $7,900 per individual to $2,600 per individual for those with an income between 100 and 200 percent of the FPL. It lowers the expense to $6,300 for an individual with an income between 200 and 250 percent of the FPL.

In addition, enrollees can receive a higher actuarial value, meaning they have access to more affordable health insurance treatments. Cost-sharing can therefore increase the actuarial value of the Silver plan from 70 percent to as much as 94 percent, which is better than a Platinum plan.

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