Key takeaways

  • Healthcare is critical for a child’s long-term well-being. Children who have access to insurance coverage are more likely to receive preventive care and services such as routine physicals, vaccinations, and early treatment of health conditions, preventing more serious health consequences.
  • Public programs offer comprehensive, year-round, and typically affordable healthcare coverage for children. Medicaid and the Children’s Health Insurance Program (CHIP) help parents and caregivers find affordable insurance coverage to help ensure children have access to affordable healthcare.
  • The Health Insurance Marketplace (for the Affordable Care Act, also referred to as Obamacare) offers insurance options for families and child-only plans. These plans are often more expensive than Medicaid or CHIP, and open enrollment periods may apply.

Research suggests that children in the United States who do not have insurance are more likely to have unmet medical needs compared to children who have health insurance.

According to the Children’s Hospital Association, around 95% of all children in the United States have some form of insurance coverage — private, state-sponsored, or federal options.

The number of children who have insurance has risen over the decades as state and federal governments have prioritized providing affordable coverage for children. But over 4 million children still have no health insurance coverage.

If you are one of the more than 4 million families with no health insurance coverage for your children, or if you are facing the loss of your child’s current health insurance, this article is for you.

Read on for information about how to find health insurance for children, how to enroll them, and other important information you need to know.

Health insurance is designed to help cover the costs of healthcare — from routine checkups to long-term care.

Access to coverage is especially important for children since uninsured children in the United States are more likely to have unmet medical needs. These urgent healthcare needs include services like routine physicals and vaccinations, to treatment for illnesses that can worsen without treatment, like ear infections and respiratory tract infections.

One important way to improve the health of children is to help them access health insurance.

There are several ways to find health insurance for a child. Some options are designed specifically for low income families. Depending on the parents’ income, these options may be affordable or free.

Here are two main options for healthcare for children: public plans and private plans. The most common options for each type include:

These insurance options are provided by the United States government:

Medicaid

Medicaid is a program sponsored by the federal and state governments. It provides low cost insurance coverage for families with limited income. Children can be enrolled at any time — there is no open enrollment period limitation — and, in some circumstances, may be automatically enrolled if a parent is enrolled.

Eligibility for Medicaid is based on the family’s income and the child’s age. In 2025, a family’s income must be between 133% to 375% of the federal poverty level (FPL), based on the child’s age and the state in which they live. These income standards change slightly each year.

The current FPL is $15,650 for an individual and $21,150 for a household of two people. The amount goes up as the family size increases. The FPL amount also typically changes annually.

Medicaid covers newborns, preventive care, prescription drugs, specialist care, hospitalizations, and more.

You can find more information about how to enroll your child in Medicaid in your state at the HealthCare.gov website.

Children’s Health Insurance Program (CHIP)

CHIP offers low cost health coverage to children and some pregnant people who do not qualify for Medicaid. CHIP eligibility rules and costs vary from state to state, but they range from 170% to 400% of FPL, and you’ll never pay more than 5% of your total family income per year.

Like Medicare, children may enroll in CHIP at any time of the year through their state’s Medicaid office or by phone.

CHIP covers services, including:

  • routine checkups (well-child visits are free, but some services have a small fee)
  • immunizations
  • doctors’ and dental visits
  • vision care
  • hospital services
  • behavioral health (mental health) support
  • emergency care

You can find more information about how to enroll your child in CHIP in your state at the HealthCare.gov website.

Medicare

Medicare is government-sponsored insurance primarily for individuals ages 65 years and older; however, some people younger than age 65 years — including children — may also qualify.

Children who qualify for Medicare may enroll any time after they receive a qualifying diagnosis or if they qualify and have a loss of their private insurance coverage.

For Medicare, a “child” is defined as an unmarried person younger than 22 years old or a person between ages 22 and 26 years who meets other requirements.

One parent has earned credits toward Medicare by working and paying Social Security OR one parent is receiving or is eligible for Social Security or Railroad Retirement Board benefits, and:

  • They have end stage renal disease (ESRD), and all the following conditions apply:
    • Their kidneys no longer work.
    • They need regular dialysis or have had a kidney transplant.
    • They are a dependent child of a person who meets either of the requirements listed above.

OR

  • They are between ages 20 and 22 years and currently receive Social Security disability benefits.

In addition to meeting the conditions for ESRD and at the qualifying age to be eligible for Medicare, a child must be related to a person who currently qualifies for or is receiving Social Security or Railroad Retirement benefits as one of these:

  • a biological child
  • a legally adopted child
  • a stepchild (for over 1 year)
  • a grandchild or step-grandchild (in some cases)

If your child qualifies for Medicare, there may be fees such as premiums, deductibles, and coinsurance. These fees typically change each year. If you think your child may qualify for Medicare, contact your local Social Security office for more information and help enrolling them.

For families who do not qualify for Medicaid or CHIP, private insurance options are available, such as:

Employer-sponsored coverage

These insurance policies are subsidized by employers, and a child is typically covered through plans that cover the entire family or the employee and a child or children. Typically, the employer pays a portion of the cost, and the employee (parent) will pay the remaining premium.

Private plans typically cover the same services as public plans — routine care, hospital services, emergency care, and others. Exact services and costs will vary by insurance company.

Depending on the type of plan, there may be out-of-pocket costs for medical appointments and services, and routine pediatric care may be covered completely.

Child-only health plans and other ACA Marketplace Plans

Child-only plans can be purchased through the federal Affordable Care Act (ACA) Health Insurance Marketplace or directly from insurers. Many large insurers — Aetna, Anthem Blue Cross, Cigna, UnitedHealthcare, Blue Shield of California, and Kaiser Permanente — offer plans that meet the health needs of children.

These plans may be purchased by parents or guardians on behalf of a minor if they’re not covered under a family or group policy.

Marketplace plans must include essential health benefits like preventive care, emergency coverage, hospitalization, prescription drugs, and pediatric dental and vision services. Tax credits and cost-sharing reductions are available based on household income, making coverage more affordable for moderate income families.

Direct purchase and short-term plans

Families may purchase child-only plans directly from various insurance providers. Short-term health insurance is available for urgent coverage needs, such as playing sports or traveling. However, these plans usually do not cover preexisting conditions, and they may not cover routine pediatric care.

These plans may not be a good option for children who need ongoing healthcare. They are typically only a short-term solution and are usually not recommended for ongoing child health coverage.

Follow these steps to apply for health insurance for your child:

  • Find out which programs your child may qualify for: Use your state health department, healthcare.gov, or Medicaid.gov to complete a preliminary eligibility check.
  • Be sure you have the documents you need to apply, such as your child’s:
    • Social Security card
    • birth certificate
    • proof of citizenship or immigration status
    • proof of your income (pay stubs or tax returns)
  • Review and select a plan: For Marketplace or private insurance, be sure to plan for premiums, out-of-pocket costs, and included medical services.
  • Complete the application for the plan you choose: You can submit applications for coverage online through healthcare.gov, your state’s marketplace, or directly through your state’s Medicaid or CHIP office (by phone, mail, or online).
  • Complete enrollment and ensure continued coverage: To maintain your child’s coverage, you’ll need to respond to any requests for additional information and keep your address and income data up to date as required — typically each year.

There are special situations that may affect your child’s eligibility for some types of health insurance, such as:

  • A child is in a mixed-status family: Even if parents do not qualify for Medicaid or CHIP, children who are citizens or lawfully present immigrants may qualify.
  • Coverage for transition periods between insurance policies and eligibility: Medicaid and CHIP provide continuous coverage for infants up to 1 year; eligibility is reviewed yearly or after major life events.
  • Children with special health needs: Medicaid and CHIP are good options for children with health conditions because they both offer access to specialists and care for children with special needs.

Here are a few things to consider and keep up with once your child has health insurance:

  • Use the services of a local “assister” when choosing and enrolling in a plan: Healthcare.gov offers free “assisters” in each state to help you choose and enroll in a health insurance plan.
  • Review each plan’s provider network: Check to see whether any plan you’re considering covers the healthcare professionals your child needs or whether healthcare professionals you already see take the insurance you are researching.
  • If you have private insurance, know when open enrollment begins and ends: You can only enroll or reenroll your child in private insurance during open enrollment periods. Medicaid and CHIP accept applications year-round.
  • Check your eligibility often: Income thresholds and program rules change annually.
  • File an appeal right away if your child is denied coverage: Follow up immediately if your child’s application for insurance is denied or if their eligibility is in question. You may only have a short period of time to challenge the decision.

Finding health insurance for children involves understanding eligibility rules, knowing which programs are available, and comparing plan benefits and costs.

Your choices will depend on your family’s income, where you live, and your child’s individual health needs. You have options from free public-funded insurance coverage to private insurance through your employer or through the healthcare exchanges.

Most states offer free assisters to help individuals navigate the ACA Health Insurance Marketplace, and most companies have human resources staff who can help if you are choosing employer-sponsored health insurance.

High quality health insurance is available for most children in the United States, but knowing your options is key.