“Child-only” plans are those made available to children age 18 and under with no parent or guardian listed on the same policy. Federal health reform legislation prevents insurers from declining health insurance applications for children due to pre-existing medical conditions.  However, the implementation of the law differs from state to state.  

In some states, insurers offering individual health coverage to adults are required to also offer individual health coverage to children. Separately, certain states have created “open enrollment” periods for child-only plans – specific annual or biannual enrollment windows when applicants can enroll children in individual health insurance plans without danger of being declined due to their medical history. 

The state-by-state summary information and FAQs below represent a snapshot of current rules and processes governing child-only health insurance in select states. This document is not a comprehensive review of every state’s plan for compliance with the federal health reform law, and the information relating to child-only plans may change.   The chart below will also be updated as other states add or adopt any other child only plans.

States offering specific open enrollment periods for child-only individual health insurance

California - Jan 1 - March 1 and Full Calendar month of child's birth month  more info

Colorado - Jan 1 - Jan 31 and July 1 - July 31  more info

District of Columbia - Jan 1 - Jan 31 and July 1 - July 31  more info

Illinois - an 1 - Jan 31 and July 1 - July 31  more info

Kentucky - an 1 - Jan 31 and July 1 - July 31  more info

Maryland - Jan 1 - Jan 31 more info

Massachusetts - an 1 - Jan 15 and July 1 - July 15  more info

Missouri - March 1 - March 31 and possibly at other times determined by carrier more info

Montana- The Calendar month prior to the birth month of the child more info

New Mexico - July 1 - July 31 more info

Ohio - March 1 - March 31 

Oregon - Feb 1 - Feb 28 and Aug 1 - Aug 31  more info

South Dakota - July 1 - Aug 15  more info

Texas - Has a plan all year round - contact us for details or to obtain coverage

Utah- Nov 1 - Dec 15 and May 1 - June 15  more info

Washington - March 15 - April 30 and Sept 15 - Oct 31  more info

Child-only Health Insurance Coverage: Frequently Asked Questions

Rules and regulations may differ from one state to another.  For more information, contact your state’s Department of Insurance. 

Question: “In my state there are only specific times when I can enroll my child in a child-only health insurance plan. Why aren’t children allowed to enroll in individual health insurance any time of year?” 

Answer: Many states have established annual enrollment periods for child-only health insurance policies to prevent parents with uninsured children from simply waiting until a child gets sick to sign them up for coverage.  If children were only enrolled when ill, it could potentially cause a spike in the cost of coverage. It could also discourage some insurers from offering these types of plans.  By creating specific enrollment periods for child-only health plans, individual states may aim to promote broader consumer access to individual health insurance for children, or to keep prices in check.  

Question: “When can I sign up my child for coverage under a child-only individual health insurance plan?” 

Answer: The answer is going to vary depending on your state.  See the chart above.  Some states have instituted annual or biannual enrollment periods.  Others have instituted floating enrollment periods that may depend on your child’s date of birth. 

Question: “Are these special enrollment periods the ONLY time when I can sign up a child for coverage under a child-only individual plan?” 

Answer: Most health insurance companies allow for enrollment of children in child-only plans outside the special enrollment periods under certain circumstances.  Special enrollment opportunities may be triggered throughout the year when a “qualifying event” occurs.  Qualifying events may differ from state to state (contact your state Department of Insurance to learn more), but could include:

• Birth
• Adoption
• Marriage of a parent
• Divorce of a parent
• Loss of employer-sponsored health insurance
• Loss of eligibility for Medicaid or a state-sponsored child plan
• Valid court order mandating the child be covered

Question: “Can I still enroll my child in an employer-sponsored group plan or individually purchased family plan at other times of year?” 

Answer:  Yes.  Special enrollment periods for child-only health plans do not affect your child’s eligibility for coverage under employer-based health insurance plans or under privately-purchased plans when a parent or guardian is covered under the same policy. 

Question: “Are rates for child-only health insurance policies going to change?”  

Answer:  It is not yet clear how this specific provision of the health reform law will affect the overall cost of health insurance for children.  

Question:  “Does this mean that a child with pre-existing medical conditions will pay the same as a healthy child if enrolled during the open enrollment period?”

Answer: Not necessarily. While insurers offering child-only plans may not decline applications for persons with pre-existing medical conditions during a specified open enrollment period, insurers in some states may have the option to charge high-risk children monthly premiums higher than those they charge for healthier children. 

Question: “What counts as a pre-existing medical condition?” 

Answer:  A pre-existing medical condition may be any past or present medical diagnosis, whether or not the child is still suffering from or being treated for the condition.  Not all medical conditions are of concern to health insurance carriers and different carriers may be more – or less – concerned by different conditions. 

Question: “What if there are no child-only health insurance plans available in my state?” 

Answer: While some states have required insurers offering individual health insurance policies to adults or families to also offer individual policies to children only, others have not.  To find out which insurance companies – if any – are offering child-only health insurance plans in your state, contact your state Department of Insurance.  Some insurers offer child-only plans for sale to consumers directly, while others may also make them available through licensed agents. 

If there are no child-only coverage options in your area, you may still be able to apply for a privately purchased family plan covering yourself and your child together.  Be sure, however, not to cancel your current health insurance plan before you’re approved for a new one.

If you have any questions, please feel free to give us a call:  877-769-7654 x 1 or use our contact us form and we will contact you shortly.