As a new parent, you’ll want to make certain that your entire family is financially secure by virtue of reliable health insurance, especially if you’ve just had your first child.
Fortunately, the coming or addition of a child to a family, either by birth or adoption, can count as a QLE or Qualifying Life Event, under the Affordable Care Act. This makes it possible for all the members of the family to sign up for Marketplace coverage (also known as the Affordable Care Act plans or Obamacare plans).
A qualifying life event triggers SEP or the “Special Enrollment Period”. As a result, you will be able to use the Marketplace without having to go through the Open Enrollment Period, which is held annually.
You’ll be surprised to learn how easy it is to secure insurance on health after having a kid or adopting one. Here are the things you need to know.
How Is a Child’s Adoption or Birth a Qualifying Life Event?
If the dynamics of your household change, it may entail a QLE or Qualifying Life Event for Special Enrollment Periods (SEP).An addition to your family in the form of the birth of a new born baby or adopting a child is an example of such a change.
It is possible if you already have a plan to add your child to it. If you do not have an insurance plan, you can still shop for one based on your QLE. If you qualify for a SEP through this QLE, you might be eligible to purchase an Obamacare plan by virtue of the Marketplace. The Marketplace will provide you with 60 days in which to apply and obtain coverage after a SEP has been issued.
What Takes Place During a Special Enrollment Period?
While typically, it can be hard to sign up for health insurance during special enrollment periods; this isn’t the case when having a baby! Your child’s birth certificate or letter of adoption is required if you have given birth or adopted a child so that you can begin coverage.
Once your QLE has been validated, you will have the same access to the Marketplace as you had during the Open Enrollment Period. Plan and premium options can be compared as well as any possible tax credits(premium).
Your SEP must be completed within 60 days of your QLE. When your Special Enrollment Period (SEP) ends, you’ll have to wait until the next OEP or Open Enrollment Period so you can sign up for Marketplace insurance.
Other Than the Health Insurance I Have Bow, What Other Options Do You Have?
You can go to the official Health Scout website to find out more about your other options. Or you can give us a ring at 816-888-8888 to acquire Affordable Care Act (otherwise known also as Obamacare) Marketplace insurance. In addition, there are a few other choices listed below.
Medical Health Insurance
Health insurance in the form of Medicaid may be an option for you if your income is low enough. Medicaid is a federal-state health insurance program that covers low-income people in the United States. The amount of Medicaid you are eligible for will depend highly on your monthly income. Anyone can benefit from Medicaid, including pregnant women, adults, senior citizens or the elderly, children, and disabled individuals or people with infirmity.
Medicaid is administered and maintained autonomously by states, and respective Medicaid programs define the benefits they offer. However, these programs are subject to the federal government’s standards.
Medicaid programs are required to cover a range of mandatory benefits. They include physician care, hospital treatment, whether inpatient or outpatient, home health care, and nursing home care, x-ray and medical laboratory services.
Along with nurse midwives, family planning, family nurse practitioners, qualified pediatric and freestanding birth centers (were licensed and state recognized). In addition, pregnant women are also required to undergo mandatory smoking cessation counselling.
Eligibility for Medicaid
Numerous states have opted to enlarge the scope of their programs for Medicaid in order to comply with the requirements of the Affordable Care Act to include low-income people (ACA).
To receive benefits from Medicaid, states must either expand Medicaid or meet additional criteria (including being pregnant, parenting a minor, or having a disability).
Currently, more than 30 states have expanded theirMedicaid coverage to otherwise ineligible individuals. In the meantime, 2 states have not done so yet: Idaho and Nebraska.
Anyone earning below Federal Poverty Level (that is under 138%) is entitled to Medicaid in the majority of these states. This translates to $17,608 for individuals and around $36,156 for families with a minimum of four members.
Most of the time, adults are deemed not qualified for Medicaid benefits in any of the 14 states that refused to extend their Medicaid programs except if they meet certain criteria first.
At the time of this writing, 49 states allow Medicaid expansion to children whose families’ income is at least 200% of the Federal Poverty Level. To put it in perspective, it is going to be a family of 3 that earns around $43,440 a year. Pregnant women with earnings equal to or more than 200 per cent of the Federal Poverty Level are insured in 34 states as well (FPL).
The Medicaid expansion under the Affordable Care Act now includes anyone with earnings up to 138 % of the poverty line in 32 states, owing to the result of implementing the law. Increasing number of states have shown interest in participating in Medicaid expansion, although they have not taken any solid action yet.
Applying for Medicaid
Even if you do not qualify for Medicaid during the yearly Open Enrollment Period, you can still register for it at any time.
You can find out if you can actually enjoy the benefits of Medicaid depending on your income, your place of residence, and whether or not your state has entered into Medicaid extension through Health Scout’s Medicaid.
The Medicaid application process can be started online through Health Scout, assuming you pass the qualifying conditions for the coverage. Your application is forwarded to the Medicaid office in your area for further processing once it has been completed.
Within a few weeks of receiving your application, the authorized staff will evaluate your information, then after which send you an official report of determination reflecting their decision. However, in the event that you fail to receive a response from them within a fair amount of time, we encourage you to give them a ring to follow up on the matter.
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program, also known as “CHIP”, provides substantial support to states in funding health care systems that benefit children. Each of the states has their own program that focuses on helping low-income individuals and families. Many of these households are beyond Medicaid eligibility limits or have job insurance that excludes their kids. CHIP entitlement varies by state. However, an awful lot of them cover children whose families earn below 200% FPL or Federal Poverty Level.
Who Can Enjoy the Benefits of CHIP?
CHIP is funded through the resources of the government (federal), but every individual state comes with their own set of rules. However, each state’s program can only provide barebones healthcare to uninsured youngsters belonging to the age bracket of 19 and under, living in households with a family income that is way too high for them to be entitled to enjoy the benefits of Medicaid. Rules differ from state to state, so the best course of action to take to know if your kids qualify is to reach out to your state and verify it yourself.
What Does CHIP Cover?
All states’ CHIP programs provide the fundamental coverage, even though eligibility is determined differently in each state. These include the following:
- Routine examinations
- Routine examinations
- Inpatient and outpatient hospital care
- Ambulance and ER services
It’s necessary to keep in mind that this scheme covers the cost of biannual dental visits and primary care needs for a child.