Who Offers Insurance for Kids With Pre-Existing Health Conditions?


Quick Answer

All insurance plans a consumer obtains through Health Insurance Marketplace, including Medicaid and the Children's Health Insurance Program, cover pre-existing conditions, states the U.S. Centers for Medicare and Medicaid Services. The only plans exempted from covering pre-existing conditions are some grandfathered private plans that consumers buy directly.

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Full Answer

The Affordable Care Act's health coverage rights and protections forbid an insurance company from refusing coverage or treatment or charging more because of pre-existing health conditions such as asthma, diabetes or cancer, reports MMS. Eligibility for Medicaid and CHIP depend on income, household size, family status and other factors. The specific rules differ among states. In states with expanded Medicaid coverage, eligibility may depend only on income and family size, says MMS.

CHIP provides low-cost health coverage for children in families that don't qualify for Medicaid based on income. In all states, the coverage includes routine checkups, immunizations, doctor visits and prescriptions. It also includes dental and vision care, inpatient and outpatient hospital care, laboratory and X-ray services and emergency services. There may be co-payments for some services and a premium in some states, but the annual cost doesn't exceed 5 percent of the family income, notes MMS.

A consumer can apply for Medicaid and CHIP through the Marketplace at Healthcare.gov any time of the year, even outside of the October through December open enrollment period, notes MMS.

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