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.

Medicaid

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.

State High-Risk Pool

In many states there are families that are able and willing to purchase their own health insurance, but are unable to do so because of a pre-existing medical condition. This may apply to one or more family members, depending on the eligibility guidelines of the various insurance companies in your state and the severity of the pre-existing medical condition. If you have a family member that is unable to be insured under the family health insurance plan due to their current or past medical history, you may consider looking into the options available through your state's high-risk pool. These are state-sponsored programs that provide an option of guaranteed coverage for persons that have been denied coverage through a private health insurance company and are without health insurance. These are by no means subsidized or low-cost health plans and any person enrolling in a state's high-risk pool will be responsible for paying the monthly premium for the health plan that they select.

The premiums for these guaranteed issue health plans are typically two times the rate that would be paid for similar coverage for a family health plan available to persons that are healthy. Coverage is offered through private health insurance carriers that are required to provide guaranteed coverage under state regulations. Not all states have laws that require guaranteed issue coverage or establish a high-risk health insurance program. If any family member is denied coverage when applying for individual health insurance, your insurance company should notify you of the availability of a high-risk pool in your state. You may also check with your state's Department of Insurance if you are uncertain about the availability of this guaranteed coverage option in your state.

Note: The information and advice provided in this Guide to Family Health Insurance may not provide the best advice for every situation. The best options for your family's medical insurance may be unique and require the advice of a local advisor. We highly recommend that you consult with more than one insurance broker in your state to gather and compare alternative opinions. The owners of HealthInsuranceFinders.com are not responsible for any decisions you make in regards to your family's health insurance through the information provided in this guide.