The Guide
Family Health Insurance
Getting Family Health Insurance Through a State-Sponsored Plan
For families that cannot afford private or group health coverage, there may be state-sponsored programs available. These programs typically have income requirements related to the federal poverty income level, which may disqualify your family if the combined incomes are too high. There are, however, additional programs available that cater specifically to children and individuals who have been repeatedly denied health coverage because of a pre-existing condition. These programs are not availabe in every state and you should check with your state's Department of Insurance for availability and eligibility requirements.
Every state in the country has a Medicaid program that provides free or low-cost health insurance to families in lower income brackets. In most states, only families that have incomes at or below the federal poverty level will qualify for full Medicaid benefits. However, there are state programs that will provide health insurance to children, pregnant women, and the blind or disabled even if they are part of a family whose income exceeds federal poverty levels. Medicaid is a state regulated health care program and the regulations, qualifications, and optional programs may vary by state. Under Medicaid, your medical bills will be paid for by the government. In some cases, you may be required to make a small co-payment, but most services are provided at no charge to the family. Medical services are available from a limited number of health care professionals, local health clinics or county hospitals. Not all low-income families will qualify for Medicaid because other factors, such as your need for medical attention, may play a role in qualifying for assistance under your state's Medicaid program.
State Children's Health Insurance Program (SCHIP)
As part of the Medicaid program, many families that are not eligible for Medicaid may still qualify for state-sponsored heath care for their children. SCHIP is a state-sponsored program providing health insurance for children from families in low to mid income levels. Most states have a Children's Health Insurance Program, and the qualifications and family income guidelines vary by state. Each state that participates in SCHIP receives federal assistance. Money is allocated to the states based on several factors, including the percentage of children in that state that are without health insurance. Some states will allow children from families of any income to enroll in the program, but the families with higher income levels may be required to pay a monthly premium and/or higher co-payments for office visits and other covered services. Coverage is provided by private health insurance carriers in the state and most states have several carriers to select from depending on geographical location.
SCHIP provides health care for children under the age of 19 to families that are not eligible for Medicaid and do not currently have coverage. Coverage is focused on preventive health care and covers office visits, immunizations, hospitalization and emergency room visits. In most cases, there is no charge to qualified families. Due to the comprehensive coverage, no or low-cost premiums and the flexible income requirements, all families with children should review the State Children's Health Insurance Program available in their state.