How to get my child health insurance

How to Qualify For Medicaid and CHIP Health Care Coverage

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

See if you qualify for Medicaid based on income alone

Find out if you qualify for Medicaid based on your income. Enter your household size and state in our savings tool, and we'll tell you if you qualify for Medicaid or savings on a Marketplace plan.

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Even if you don't qualify for Medicaid based on income, you should apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid any time of year — Medicaid and CHIP do not have Open Enrollment Periods.

Note: Medicaid & CHIP program names vary. Learn what they’re called in your state.

Apply for Medicaid and CHIP 2 ways

1. Through the Health Insurance Marketplace®

Fill out an application through the Health Insurance Marketplace®.

If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.
When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.

Create an account to start a Marketplace application.

2. Through your state Medicaid agency

You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.

Medicaid in

Pick your state to start your application for health coverage.

Medicaid & CHIP basics

Medicaid basics

In all states, Medicaid provides coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
In some states, Medicaid has been expanded to cover all adults below a certain income level. Learn more about Medicaid expansion in your state and what it means for you.
Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state.
Some Medicaid programs pay for your care directly. Others use private insurance companies to provide Medicaid coverage.

Children’s Health Insurance Program (CHIP) basics

In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women.
Each state works closely with its state Medicaid program.
In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP.
Learn more about CHIP.

How to Shop for Health Insurance (for Parents)

Note: Some parts of the Affordable Care Act ("Obamacare") are being changed or eliminated via government policies and laws. It is likely that some of the rules and regulations affecting the health insurance marketplace will continue to change over time. To stay up to date on Obamacare and other health insurance issues, visit healthcare.gov and the website of the health commissioner's office in your state.

In America today, we all need health insurance. You do. Your kids do. It's not a "nice to have" anymore — it's a "must-have." And that's the law. In most cases, parents who aren't covered (or don't have their kids covered) by health insurance might have to pay a fine each year. Going without also means that if someone gets sick or is injured, a family might have to pay all the bills for care received. That can cost a whole lot more than paying for coverage.

To help people get health insurance, the federal and state governments set up a health insurance marketplace (also called the health care exchange). This makes it easier than ever to get coverage, but the process can seem a bit confusing.

Here's what to do to get health insurance.

Getting Started

Before you look for a health insurance plan, check to see if you or your child can get coverage some other way. The government considers a person covered if they have Medicare, Medicaid, a state-run child health insurance plan (CHIP), or insurance they get through a parent or spouse's job. Your child could already be covered by or be eligible for free or low-cost coverage through a public program.

If you need to get insurance for yourself or your child, you can go online and visit the U.S. Government's comprehensive health care website (www.healthcare.gov). There, you can apply for CHIP or Medicaid or shop for a plan.

It's important to remember, however, that you can only buy insurance through the health care marketplace during the open enrollment period, which begins in mid-November and lasts until February. If the enrollment period is over, you or your child may have to get insurance through a private insurer to be covered for that year.

In some states, the health care exchange is run by healthcare.gov. Other states run it themselves. If you live in one of those states, you can visit your state's official marketplace website directly or link to it through healthcare.gov.

If you don't have regular access to a computer, you can call the U.S. Government's help line at 1-800-318-2596 to fill out an application, enroll, or compare plans.

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How to Apply for a Plan

Applying for an insurance plan through the health care marketplace can be done online through healthcare.gov or a state site, over the phone, or through regular mail by filling out a form that can be mailed to you or downloaded from the Internet.

Before you fill out an online application, you'll need to create an account on either healthcare.gov or your state's marketplace.

You'll need to know a few things about each person applying for coverage. Be ready to provide:

Social Security numbers (or document numbers for legal immigrants)
information about employers and income
policy numbers for any current health insurance plans

If you have a job that offers health insurance but you're not happy with it, you can choose to get coverage through healthcare.gov instead. But before you apply, you'll need to fill out a form called an Employer Coverage Tool that can be found on the healthcare.gov website.

The application will ask for standard information like your name, your child's name, your address, phone number, and email. You'll need to answer questions about citizenship, dependents, and whether you plan to file a federal income tax return the following year.

If you want help paying for insurance, you will have to provide information about your yearly income (and the income of anyone else applying for coverage). This includes income from jobs and other sources like:

Social Security
unemployment
retirement accounts
property rental
alimony

If you pay alimony or interest on student loans, you can deduct the amount you pay when you fill out your application.

What Happens Next?

Once you've submitted an application, healthcare.gov or your state's site will determine if you or your children qualify for Medicare, Medicaid, or CHIP. It will also determine if you or your children are eligible to get insurance through the health care marketplace. For most people, if you're an American citizen or legal immigrant and you're not in jail, you'll be eligible.

Although it's unlikely, sometimes parents are eligible to buy insurance through the health care marketplace but their children aren't. Sometimes kids are eligible but their parents aren't. If either of these apply to you, you would have the right to appeal the decision, and you could still get private insurance for anyone needing coverage.

If you're eligible for coverage but don't qualify for any publicly subsidized programs, the health care marketplace will present you with the insurance plans available in your state based on your income and family situation. It will be up to you to decide which policy to buy.

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What to Look for When Choosing a Policy

The important words to remember when shopping for a policy are "premium" and "deductible." The premium is the amount you pay each month for coverage. The deductible is the amount you need to pay each year for medical services before your health insurance kicks in. As a general rule, insurance plans with low premiums have high deductibles, and plans with high premiums have low deductibles.

These are the basic levels of coverage:

Catastrophic insurance is designed to protect an otherwise healthy person in the event of a major injury or illness. It's available only to people under age 30 and those who are exempt from other plans due to hardship. This type of insurance can have low premiums but very high deductibles. Plans generally cover less than 60% of the costs of health care.
Bronze plans also have low premiums and high deductibles, but they offer better coverage than catastrophic insurance, typically paying for 60% of costs.
Silver plans and gold plans have average-sized premiums and average-sized deductibles. Silver plans cover 70% of costs. Gold plans pay 80% of costs.
Platinum plans, the highest level of coverage, have high premiums and low deductibles. These plans cover 90% or more of health care costs.

All catastrophic, bronze, silver, gold, and platinum plans offer free or discounted visits to the doctor for things like routine checkups or vaccinations and some preventive care. Most plans also offer discounts on prescription drugs and other services. Specific benefits differ from plan to plan, though, so you'll need to learn what each plan offers. Think about what's important to you and your family and make a decision based on how well the plan meets your needs.

When Can I Start Using My Insurance?

Once you've signed up for a plan and paid the first month's premium, you or your child can start using the insurance. The insurance company should send you and everyone covered by your policy insurance cards with your policy number and other information. If you or your child need to see a doctor or go to a hospital before you receive your card, call your insurance company first to make sure your family has been entered into their system.

You should also make sure that any doctor you choose for you or your child is in your insurance plan's network. A network is made up of doctors, specialists, and other health care providers who have agreed to work with your insurance company when it comes to payments and services. If you take your child to a doctor who isn't in your plan's network, you may have to pay full price for some services.

Ask around and learn what you can about the primary care physicians in your plan's network, and then choose a doctor you like. Once you've done that, schedule checkups and use your insurance to help keep your family healthy.

Reviewed by: Steven Dowshen, MD

Date reviewed: July 2018

Obtaining a compulsory medical insurance policy - Child

Compulsory medical insurance of children from the date of birth until the exercise of the child's right to choose the CMO, but no later than 30 days from the date of state registration of birth, is carried out by an insurance medical organization in which their mothers or other legal representatives are insured.

After thirty days from the date of state registration of the child's birth and until he reaches the age of majority or until he acquires legal capacity in full, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or another legal representative. (Federal Law No. 326-FZ, see below in the regulatory framework).

Service conditions

Important! When a child reaches the age of 14 and receives a passport of a citizen of the Russian Federation, the MHI policy must be reissued - a new one must be obtained.

If it is impossible to obtain a ready-made CHI policy, look at its number in the Personal Account of the insured

birth certificate;

identity document of the legal representative;

SNILS child (if available).

To apply for a policy for a child from 14 years of age and until he reaches the age of majority, you must:

application;
passport of a citizen of the Russian Federation or a temporary identity card if you receive or change a passport;
identity document of the legal representative;
insurance number of an individual personal account (SNILS).

On the day of filing an application for choosing an insurance medical organization, a temporary certificate is issued that confirms the execution of the policy (no more than 45 working days) and certifies the right of the insured to free medical care in the event of an insured event.

Options for obtaining the service

Personal visit to the policy issuing point of the medical insurance organization

You can apply for a compulsory medical insurance policy for a child who is a citizen of the Russian Federation through a legal representative at any convenient point of issuing policies of the selected medical insurance organization that operates in the system OMS of Moscow. You can choose a pick-up point on the website www.mgfoms.ru.

Select pickup point

Personal visit to the MFC

To apply for a new CHI policy for a child who is a citizen of the Russian Federation, including for the initial production of a new CHI policy (electronic or paper), you can make an appointment at any branch of the MFC, regardless of the place of registration in Moscow: online (via the link https://www. mos.ru/pgu/ru/md/) or by phone, or get a ticket at the branch confirming the place in the electronic queue. Documents are submitted through the representative of the insured.

Select MFC

Regulatory framework

Federal Law No. 326-FZ of November 29, 2010 "On Compulsory Medical Insurance in the Russian Federation" (as amended on December 6, 20211)

Order of the Ministry of Health of Russia No. 108n of February 28, 2019 compulsory medical insurance” (as amended on February 21, 2022)

Decree of the Government of the Russian Federation of December 7, 2019 No. 2020)

Decree of the Government of Moscow dated December 24, 2019 No. 1822-PP “On the Territorial Program of State Guarantees of Free Medical Assistance to Citizens in the City of Moscow for 2020 and for the Planning Period of 2021 and 2022” (as amended on September 15, 2020)

Federal Law dated November 21, 2011 No. 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation" (as amended on March 26, 2022)

Additional information

The rights of this group of citizens are established by Article 54 of Federal Law No. 323-FZ:

1. In the field of health care, minors have the right to:

rehabilitation, provision of medical care, including during the period of training and education in educational institutions;
2) provision of medical care during the period of rehabilitation and organized recreation;
3) sanitary and hygienic education, training and work in conditions corresponding to their physiological characteristics and state of health and excluding the impact of adverse factors on them;
4) medical consultation free of charge in determining professional suitability;
5) obtaining information about the state of health in a form accessible to them.

2. Minors with drug addiction over the age of sixteen and other minors over the age of fifteen have the right to informed voluntary consent to medical intervention or to refuse it, except in cases where they are provided with medical care in accordance with Part 2 and 9Art. 20 of the Federal Law.

3. Orphans, children left without parental care, and children in a difficult life situation, until they reach the age of four, inclusive, may be kept in medical organizations of the state health care system and the municipal health care system in the manner established by the authorized federal body executive power, and on the terms established by the state authorities of the constituent entities of the Russian Federation.

Yes, it is possible. Compulsory medical insurance policies are issued by medical insurance organizations (CMOs). For the issue of issuing an electronic MHI policy of a single sample, you should contact a convenient point for issuing policies of an insurance company operating in the MHI system in Moscow, or any branch of the MFC. You must have a passport of a citizen of the Russian Federation, a birth certificate of a child and his SNILS (if available). On the day of contacting the insurance organization and after filling out a standard application for choosing an insurance company, a temporary certificate is issued for the child, which confirms the execution of the policy and guarantees the right to free medical care in the event of an insured event. There is no photo on the electronic policy for a child under 14 years old.

Useful information

After the birth of a child, parents must issue documents for the baby. They are needed not only to verify his identity, but will also be needed for the subsequent registration of all payments and benefits for him, receiving medical care and enrolling in kindergarten.
All documents are issued free of charge.

Birth certificate

The first official document is the child's birth certificate. It must be issued within a month from the moment the baby is born.

The application can be submitted electronically through the Unified Portal of Public Services or at the MFC. You can also contact the registry office.

In this case, both parents, who are married, and the mother, who is not married to the father of the child, can submit an application.

The application must indicate the name, patronymic and surname of the child. If the parents have the same surname, the child will have the same, and if the surnames are different, the child can be given any of them or a double one.

The following documents must be attached to the application:

medical certificate of birth or statement of witness to childbirth outside the hospital;
parents' passports;
marriage certificate of the biological parents to record the father.

The certificate is issued on the same day. From March 2022, it can also be obtained electronically.

Registration of the child at the place of residence

You can register a child at the place of residence after issuing a birth certificate. To do this, you need to contact the territorial body of the Ministry of Internal Affairs or the MFC. Or submit an electronic application on the Unified Portal of Public Services.

Attached to the application:

birth certificate;
parents' passports;
act of the body of guardianship on the appointment of a guardian, if he is appointed.

The territorial body of the Ministry of Internal Affairs issues a certificate of registration of the child. This is a separate document, additional stamps in other documents (in the birth certificate or parents' passport) do not need to be put.

The child is registered at the place of residence of the parents or one of them, if they are registered at different addresses.

If the parents do not own the entire apartment, but a share in it, it is not necessary to obtain the consent of other owners for the registration of a child under 14 years old.

One parent can apply for a certificate of registration of a child, the presence of the second is not required. In some cases, the consent of one of the parents to register the child may be required if they are not married or have different places of residence.

SNILS

SNILS is the insurance number of an individual personal account of a citizen in the system of compulsory pension insurance. It consists of 11 digits and each person has his own. This document will be needed by the child throughout his life: for registration of payments, benefits and other public services, for employment, formation of a pension, etc.

To apply for SNILS, parents may not visit the MFC or PFR in person. If one of them is registered on the Unified Portal of Public Services (has a verified account in the Unified Identification and Authentication System (ESIA)), SNILS will be sent to his personal account.

If SNILS is lost, it is enough to go to the personal account of one of the parents. For the provision of services, a paper document is not required, it is important to know the SNILS number.

Families that have adopted a child draw up SNILS in the same manner, since only the adoptive parents themselves can provide all the necessary information.