Getting Health Insurance for Your Children: Where to Start

The fastest way to cover your kids depends on your income and whether you already have insurance

If you have a job with health insurance, you can usually add your children to your plan during open enrollment or within 30 days of their birth — check your employer's benefits guide or call your HR department to see the deadline and cost. If you don't have employer coverage, or if it's too expensive to add dependents, your state runs a program called Medicaid or CHIP (Children's Health Insurance Program) that covers children at little or no cost based on your household income. The income limits vary by state — some cover children up to 200% of the federal poverty line, others go higher — so a child might may have access to for CHIP in one state but not another.

Start by going to Healthcare.gov and entering your zip code, or call 211 and ask for Medicaid and CHIP programs in your area. Both will tell you what programs exist where you live, what the income limits are, and how to contact the right office. If you're in a hurry because your child needs care soon, call first rather than applying online — a staff member can tell you immediately whether your income qualifies and what documents you'll need to bring.

Key Takeaways

• Employer health plans usually let you add newborns within 30 days, but you must ask HR about the deadline and cost for older children.
• Medicaid and CHIP are state-run programs that cover children based on household income, and the income limits differ by state.
• Call 211 or visit Healthcare.gov to find out which programs exist in your state and whether your income qualifies.
• You will need proof of income, your child's birth certificate or Social Security number, and proof of residency to complete enrollment.
• Coverage can start as soon as the same month you apply, though some programs have a waiting period of a few weeks.

Adding a child to an employer plan

If you have health insurance through your job, your employer's plan almost always lets you add a newborn within 30 days of birth without waiting for open enrollment. You do not need to provide proof of the birth — your HR department will accept a birth certificate or hospital discharge papers. Call or email your benefits administrator as soon as possible after birth to start the paperwork, because the 30-day window closes quickly.

For children born outside your household — adopted children, stepchildren, or children you gain custody of — the rules are stricter. Most plans treat these as a may have access to life event and let you add them within 30 to 60 days if you provide legal documentation like an adoption decree or custody order. Ask your HR department what documents they need before you submit anything, because different plans have different requirements.

If your child is older and you did not add them during open enrollment, you cannot add them to your employer plan until the next open enrollment period, which is usually November through January. The exception is if your plan allows you to add dependents at any time — some do, but most do not. Call your HR department to ask whether your specific plan has this option.

Medicaid and CHIP: income limits and how they work

Medicaid is a joint federal and state program that covers low-income children, and CHIP is a separate program for children whose families earn too much for Medicaid but not enough to afford private insurance. In most states, a child can be on Medicaid or CHIP until age 19, though some states cover them until 21. The income limit for each program depends on your state — for example, some states cover children in families earning up to 200% of the federal poverty line (about $55,000 for a family of four in 2024), while others cover up to 400% or higher.

To find out the exact income limit in your state, call 211 or visit Healthcare.gov and enter your zip code. Both will show you the programs available and the income thresholds. Income limits usually count only the money your household earned in the past month or the past year, depending on the program — they do not count assets like savings or a car. If you are self-employed or your income changes month to month, ask the program how they calculate it, because some average your income over several months while others use your most recent pay stub.

Once your child is on Medicaid or CHIP, you usually pay nothing for preventive care like checkups and vaccines. You may pay a small copay (usually $1 to $5) for doctor visits or prescriptions, and some programs charge a monthly premium if your income is above a certain threshold — but the premium is typically very low, often $10 to $30 per month. Coverage is continuous as long as you report changes in income or household size, so you do not have to reapply every year in most states.

What documents you need to have ready

Before you call or apply online, gather these documents so you can move quickly: your child's birth certificate or Social Security number, proof of your household income (a recent pay stub, tax return, or letter from your employer), and proof that you live in the state where you are applying (a utility bill, lease, or mortgage statement with your name and current address). Some programs also ask for proof of citizenship or immigration status — bring your child's passport or birth certificate for citizenship, and any immigration documents you have if your child is not a U.S. citizen.

If you do not have all of these documents yet, you can still start the application. Many programs will let you submit what you have and send the rest within a few days or weeks. Do not wait until you have everything perfect — it is faster to apply with what you have and follow up than to delay. If you are missing your child's Social Security number, you can apply without it and add it later, though some programs will ask you to get one before they finalize coverage.

How long enrollment takes and when coverage starts

If you apply online through Healthcare.gov or your state's Medicaid website, you will usually get a decision within two to four weeks. If you apply by phone or in person at your local health department or social services office, the decision often comes faster — sometimes within a few days. Once you are approved, coverage usually starts on the first day of the month after you apply, though some programs start it immediately or on the date you submitted your application.

If your child needs care before coverage starts, ask the program whether they can backdate coverage to the date you applied. Some programs will cover care that happened in the month you applied, even if you were not officially approved yet. This matters most if your child has already seen a doctor or filled a prescription — you may be able to get the bill covered retroactively.

What to do if your income is too high for Medicaid but you cannot afford private insurance

If your household income is above your state's Medicaid and CHIP limits, you may still be able to get a tax credit or subsidy to help pay for a private plan through Healthcare.gov. These subsidies are based on your income and family size, and they can make a plan affordable even if your income is well above the Medicaid threshold. Go to Healthcare.gov, enter your income and family size, and see what plans are available and what you would pay per month.

Some states also run programs that help families with income above Medicaid limits but below 400% of the federal poverty line. These programs are less common than Medicaid and CHIP, but they exist in a few states. Call 211 and ask whether your state has a program for children whose families earn too much for Medicaid but need help paying for insurance.

Keeping coverage active and reporting changes

Once your child is covered by Medicaid or CHIP, you need to report any changes in your household income, address, or family size within 30 days. If you do not report changes, the program may cancel coverage or charge you the wrong amount. Most programs let you report changes online, by phone, or by mail — check your coverage letter to see which methods are available.

In most states, Medicaid and CHIP coverage does not expire — your child stays covered as long as you report changes and your income stays within the program's limits. A few states require you to renew coverage once a year, usually by filling out a form and sending it back. Check your coverage letter or call your state's Medicaid office to find out whether you need to renew and when.

Frequently Asked Questions

Can I add my child to my employer plan if they were born outside the U.S.?

Yes, but you will need to provide proof of the child's identity and immigration status. Most plans accept a passport or birth certificate. If your child does not have a Social Security number yet, ask your HR department whether they need one before you add the child to the plan — some do, some do not.

What happens to my child's coverage if I lose my job?

If you lose your job, you have 60 days to find new coverage. You can keep your employer plan temporarily through COBRA, though you will pay the full premium yourself, or you can move to Medicaid, CHIP, or a plan through Healthcare.gov. Call 211 or Healthcare.gov right away to see what programs your child qualifies for, because losing your job counts as a may have access to life event that lets you apply outside open enrollment.

Do I have to pay back Medicaid or CHIP if my income goes up later?

No. Medicaid and CHIP are not loans — you do not have to repay them if your income increases. However, you must report the income change within 30 days, and your child's coverage may end or change if your new income is above the program's limit. Once coverage ends, you can move to a private plan or employer coverage without owing anything.

Can my child stay on Medicaid or CHIP if we move to a different state?

No. Medicaid and CHIP are state programs, so coverage ends when you move. You will need to apply for the program in your new state. Call 211 in your new state or visit Healthcare.gov to find out the income limits and how to apply. Coverage in your old state usually ends at the end of the month you move, so apply in your new state before that date.

What if I am not sure whether my child qualifies?

Call 211 or Healthcare.gov and give them your household income and family size — they can tell you in a few minutes whether your child qualifies for Medicaid, CHIP, or a subsidized private plan. You do not have to commit to anything by calling; it is just a way to get information about what programs exist in your area.