Choosing the right health insurance plan for yourself is a fraught experience on its own. When there's a new child in your life whose needs you have to consider as well, the stakes start to feel much higher. Whether you just gave birth, adopted, or gained a new kid by marriage (congratulations!), making sure your child is covered by health insurance is one of the (many) responsibilities you'll want to tackle sooner rather than later.
Of course, when it comes to health insurance in the U.S., nothing's simple. To help you navigate the process of shopping for health insurance as a new parent, we've put together a guide on some of the main steps to take and information to know.
Be sure to make a decision during the special enrollment period
If you have a newborn, or even if you've gained new kids that already have a few years under their belt, you're probably exhausted. Kids tend to have that effect on people. Obviously, you'll be tempted to move as many tasks to the "to deal with later" list as possible (relatable). Unfortunately, this particular task has a hard deadline.
A new kid qualifies you for a special enrollment period, but it only lasts 60 days. So whether you decide to stick with your current plan and add your child to it or enroll in a new one, you need to make the decision within the first few weeks of bringing your child home. The good news is that even if it takes time to get around to getting it done, as long as you're within the enrollment period, your coverage can start the day of the event (in this case, your child's birth or adoption date).
Consider whether to stick with your current plan
If you specifically chose a health insurance plan when you were pregnant (or planning to be) you may have already done the research to ensure it meets your needs now that the baby's here. In that case, you'll probably just want to add your newborn to your existing plan (more on that below).
If not, start by evaluating your current plan first to decide whether it's worth shopping around for a new one. If you have a partner with a separate plan, evaluate both to determine if adding your new child to one or the other makes more sense.
Do some research to figure out what adding a dependent to the plan would look like. A few questions to consider at this stage:
- How does it change your monthly premiums (the cost of your plan)?
- If you're on a marketplace plan and accepting subsidies, how does that affect the subsidies you qualify for?
- What is the coverage and deductible for your child's plan? Remember, babies visit the doctor often in their first year, so be sure to check the cost of primary care visits.
- If you have a specific pediatrician in mind (maybe that doctor your sister or best friend raves about), are they in-network?
- If your child has any specific needs you know of (like a particular medication or recommended procedure), is it covered?
If you have any difficulty finding this information on your health insurance company's website, don't hesitate to pick up the phone and call their support staff to ask them directly.
How to add your child to your current plan
If you decide to stick with your existing health insurance plan and add your child to it, the next step is to call up your insurance company. Find out what they need to know to make the update. They'll likely ask for some paperwork, like your child's birth certificate or adoption papers. If the existing plan you're adding the child to is an employer-sponsored plan, you may need to go through your company's HR department to complete this step.
Shopping for a new plan? Tips for choosing the best health insurance plan for your kid
If you'll be going the new plan route, you want to make a good choice now, since you won't have the opportunity to switch again until the next open enrollment period at the end of the year. When evaluating your options, here are a few good tips to keep in mind:
- The lowest premium isn't always the best choice.
When you're reeling from all the costs of bringing a new child into your home, your impulse may be to pick the option with the lowest monthly fee. But kids, especially newborns, often have a lot of healthcare needs in their early years. According to the OASH (Office of Disease Prevention and Health Promotion), new babies should see a doctor or nurse six times before their first birthday—and that’s not counting if they get sick.
Saving money on premiums could cost you big in higher expenses throughout the year. When deciding which plan makes the most sense financially, pay at least as much attention to the deductible (the lower, the better), and copays and coinsurance.
- Review what's in-network.
If you have specific doctors, pharmacies, or hospitals you know you prefer using (for yourself and your child), check to see if they're included in your plan's in-network directory. Then call as well to be extra sure—insurance directories are sometimes outdated.
Even if you don't have any specific healthcare providers in mind, get a feel for how big the plan's network is before committing. If the plan has a small network of pediatricians or other specialists, or most of the in-network doctors are a long drive away, you want to know that before signing up.
- Check what's covered.
The good news is that certain services have to be covered under all ACA-compliant plans. That includes wellness visits, immunizations, and screenings for a number of potential health issues. But it's up to you to research what else your plan will cover (and what it won't). Review the plan's SBC (summary of benefits & coverage) to get a feel for what’s included, and what the typical cost for certain services is likely to be. For any specific tests, treatments, or procedures you anticipate needing, you can ask the insurance provider for a cost estimate.
Use the benefits you get
Once you and your baby are set up with health insurance (well done!), you still have an additional important step to take: start using it. Health insurance plans are required to cover services that will help you and your child stay happier and healthier. Don't let that go to waste!
Take your child in for wellness visits with your (in-network) pediatrician. Take advantage of all the recommended immunizations and screenings your plan covers. Immunizations will help them avoid serious illness; while those screenings will help you catch any issues early so you can start treating them as soon as possible.
You want to give your kid every advantage possible. Making sure they get basic healthcare early on is an important part of setting them up for success throughout their life.
