CBS News ran a story this week about the departure of several individual health insurance carriers from the child-only individual market. The story highlights the situation of a family with a daughter who has been unable to get underwritten health insurance because of some early childhood brain procedures. They were hoping that the arrival of guaranteed issue health insurance for children today would mean that they could get a policy for their daughter, but apparently they wanted to get a child-only policy for her, and most of the major carriers in Colorado have pulled out of the child-only market.
The CBS story doesn’t go into much detail, but it implies that the family will not be able to get health insurance for their daughter because of the lack of availability of child-only policies.
I don’t know anything more about the family than what was included in the CBS video. I don’t know their income or family size, but I do know that there are still, and have always been, options in Colorado for children who need health insurance – even those with pre-existing conditions.
The story seems to be saying that the family hasn’t had any options in the past:
“The family was filled with hope by this unqualified promise: (cut to clip of President Obama) No more discriminating against children with pre-existing conditions, those days are over.
(Cut to Toby Serrano – the father) When Health Reform passed, I saw a light at the end of the tunnel.”
Our healthcare system is very complicated, and the options for the Serrano’s may not be obvious to them. But in the past year, Mr. Serrano has explained his situation on major news outlets like the Denver Post, the Huffington Post, 9news, etc. He does actually have options for Maria:
Option #1 – Family Coverage
The most obvious answer is to have a parent apply for a policy along with the child. No carriers have left the family coverage market, and all carriers are required to accept children starting today, as long as they are applying for a policy that is currently being marketed. This means that while children can’t apply for child-only policies with carriers that are no longer selling them, they can apply as part of a family policy – which all carriers are still offering – and coverage is guaranteed issue (assuming at least one parent is approved for coverage). The vast majority of children who apply for individual health insurance do so as dependents on a parent’s policy. In the past, those children had to go through medical underwriting just like the parents, but that is no longer the case. This is a huge step forward, but it seems to have been lost in the noise about carriers leaving the child-only market.
Option #2 – Cover Colorado
I don’t know why the family CBS highlighted was specifically interested in a child-only policy for their daughter. But even if that’s what they prefer, Cover Colorado is – and has been for years – a good option for both children and adults who need guaranteed issue health insurance. For a child in the Denver area, a $1000 deductible policy with Cover Colorado is $200/month (with discounts based on family income that go as low as $143/month for families earning less than $40,000/year). For a $2000 deductible, the premium is $154/month (discounted premium as low as $110/month). If the major individual carriers were still offering child-only policies (now on a guaranteed issue basis) I cannot imagine a scenario in which private, for-profit carriers would be offering policies that were any less expensive than these rates from Cover Colorado.
Option #3 – CHP+
If families are unable to afford Cover Colorado, they may be able to qualify for Medicaid or Child Health Plan Plus. Children in a family of four can qualify for CHP+ if the family income is less than $55,128/year (and some expenses – alimony, child support, health insurance premiums, child care, elder care, medical expenses and dental expenses – can be subtracted from income before eligibility is determined). It would seem reasonable to expect that if a family of four is earning more than the $55,128 cut off, they could afford the premiums for Cover Colorado.
As I said, I have no knowledge of this particular family’s situation. But child-only policies have always been rare, and there is usually another option for those children to obtain coverage. They can be covered as a dependent on a parent’s policy (which can now include policies in the individual market), by Cover Colorado, or possibly by Medicaid or CHP+. Even situations like Thomas Wilkes, who was maxing out the lifetime caps, now has a solution because Healthcare Reform has removed lifetime maximums.
There is a long way to go, and this situation is frustrating. But if you ever hear anybody say they have no options to get their child covered in Colorado, please pass this information along. I hope Mr. Serrano signs Maria up for some health insurance immediately, whether it is on a family policy with him, Cover Colorado, or CHP+. We should not be hearing anymore stories about uninsured children simply because their parents aren’t aware of the options available.
