How to get health insurance for a child without a parent or guardian
Getting health insurance for a child by them self (without a parent/guardian) is a challenge with health care reform. I am an insurance broker located in Austin, Texas and I help people protect their family with health, dental and life insurance. Being an insurance broker you tend to run into many different situations that you try to help people find the best coverage for their particular situation. Before the health care reform, the hardest part was placing people who could not be insured by a carrier due to preexisting conditions. In Texas we have been lucky to have the Texas Health Insurance Pool for people who had cancer, heart attack, diabetes and other ineligible medical history. This is a hard task to have to inform people that because of their condition, they have to go to the Texas Health Insurance Pool to obtain coverage, though major medical coverage at a higher cost.
Since September of 2010, we had a new law go into effect to help Americans get coverage. These changes included no riders/preexisting conditions for children, so they have all conditions covered with no waiting period, preventative/wellness/physicals available to everyone who had insurance. Adults are expected to have the same no riders rule starting in 2014. The government did add a plan to help those states who did not have a Health Insurance Pool, and some states who had a Pool as well have the Government Insurance, they call this plan Pre-Existing Condition Insurance Plan. This plan was similar goal as the Texas Health Insurance Pool. The Government Plan has a few items I cannot understand, they have a waiting period, and people need to be uninsured for 6-months to be eligible. You do have the advantage of no waiting period for preexisting conditions to be covered if you have been uninsured, other than the 6-months you need to be uninsured to be eligible.
The intent of the changes all sound good on paper, but this week I ran into a situation that really opened my eyes to a condition we created for healthy children. I would have never guessed that this was a side effect of the changes. When the changes when into effect for children to be issued without any riders or they cannot be denied coverage, the major medical carriers decided that they would not offer coverage to any child under 18 without a parent on the policy. This means no children can get a policy by themselves, even if they are healthy without any conditions. You would think the Health Insurance Pool or the government plan would be obtainable for child who cannot obtain coverage from a major medical carrier, but this is not the case for healthy children.
Health insurance rates have gone up more this year as result of some of the changes mandated by the law, making it harder for Americans and Texans to afford comprehensive coverage for themselves and their family. This higher costs cause parents to make tradeoffs of paying necessary bills verses obtaining health coverage for their family. They make tradeoffs for themselves, but try to cover their children with health insurance.
The issue that opened my eyes was a young girl who legal guardian is the grandmother (on Medicare) who was looking to obtain coverage for her granddaughter and needs to look at individual policies for her. I originally thought the Texas Health Insurance Pool was the best option for her. She had not been uninsured for 6-months, so the government plan was not an option. We decided to submit an application to the Texas Health Insurance Pool, and get her coverage, so I thought. After a few weeks, we had gotten a letter back from the pool rejecting the reason for obtaining coverage as being a child under 18-years old. I thought that this would be a valid reason to be accepted into the health insurance pool. I ended up calling to ask the question as to why they would not accept this young girl. I ended up talking to the Director of the Pool for Texas, and he told me that they pool would not be able to accept this healthy young girl. He mentioned a hole in the health insurance pool rules and a flaw in the major medical companies allowed offer insurance in Texas and not offering coverage to children. The government plan you would think may be the next option, but they would accept her if you can prove that her premium is more than their rates. I have not found a solution for this young healthy girl that really has nowhere to obtain major medical coverage.
One suggestion that could help improve this in the future is to impose that companies that offer health insurance in the state of Texas need to offer policies to children alone and they do not have the option to reject or not insure children without a parent. This may take a while to get addressed so, children may need to go to limited benefit plans if they are healthy. This is not the best approach for protecting their health and families financial exposure. I think we need to make people aware of this big gap that hurts healthy children from obtaining coverage. It is sad to see the changes help the sick and families who can afford health insurance, but hurt the healthy and less fortunate. I just want to help people who need coverage find the best solution, but in this case, we do not have one. I will do my part to raise the awareness of the issue.
Holly Horton says
My mother is 81 years old and we are taking care of my deceased sister’s 16 year old daughter, although her legal guardians are not a part of our household. We were told to go through the Texas Health Insurance Pool to find insurance for this child. Is there no answer for us in regard to our need for health insurance for her?
It is a sad situation but the same thing is happening all over the country. I live in NC and the same thing is happening here. You can try medicaid/NCHC but if you make too much income for that and then can not purchase a policy for a child under 18 what are you to do. The health care reform was supposed to help people not hurt them. I believe everyone should be educated about this lapse in the program.