American children and young adults were the first to benefit from the Affordable Care Act (ACA), also known as Obamacare, as soon as the law went into effect September 2010. But most provisions of the law that affect older adults won’t kick in until 2014.
However, some experts question whether health care reform will actually undermine coverage for kids from low-income families. There’s also speculation that health insurance rates for young adults will skyrocket after everyone has coverage, which is required by the new law.
Obamacare health insurance benefits for children and young adults
The health benefits for children and young adults already in effect under Obamacare include:
• Coverage under their parents' plan until age 26. The ACA allows young adults to remain on their parents' health insurance plan until their 26th birthday. This regulation gives coverage to many young people who may be unemployed, in low-paying jobs, or are employed but don’t get health insurance at work.
• No denial of coverage due to preexisting health conditions.Health care reform prohibits insurers to deny coverage or raise your rates due to an existing illness.
Dr. Marsha Raulerson, a pediatrician in Brewton, AL says, "I had a little boy born in my practice with a major birth defect that's going to require years of surgery." She adds that insurers now cannot deny coverage to the boy, or others like him.
• No more lifetime coverage limits. Many insurance companies have a limit on the amount of coverage a person can receive over their entire life, typically about $1 million. However, starting in 2014, Obamacare prohibits lifetime limits on coverage. Additionally, it also removes any limit on benefits you can receive in a single year.
• Full coverage of preventive services.Children receive free routine vaccinations for a range of diseases including measles, polio, and meningitis. They also receive free, annual well-baby and well-child visits to the doctor.
But there’s a catch. Only new health plans will be required to offer free preventive services, Raulerson says. If you have an older health plan that began before March 23, 2010, it may be “grandfathered” and won’t be required to cover preventive care for free. Check with your employer or plan provider to see if your plan is grandfathered.
The future of Obamacare for children and young adults
One nagging question about Obamacare and children is how it will affect the Children's Health Insurance Program (CHIP). This program provides insurance for nearly 8 million children whose families make too much money to qualify for Medicaid.
Raulerson says it isn't clear whether Congress will continue to support CHIP following full implementation of the Affordable Care Act.
"Most pediatricians see that the CHIP program is well-established and that it works," Raulerson says. "We don't know how the exchanges will work for children."
Another area of concern involves the "rate shock" that could hit young adults once Obamacare is fully implemented in 2014. Some experts worry that young adults will find their rates skyrocketing to help cover the costs of insuring the sick and elderly, says Josh Fangmeier, a health policy analyst with the Center for Healthcare Research and Transformation at the University of Michigan.
"The oldest [people] on the individual market can only pay three times more than the youngest on the individual market," Fangmeier says of the Affordable Care Act's requirements. "That will raise the costs (of health plan premiums for young adults).”
However, this rate shock may affect a small number of young adults only, Fangmeier says. These include young adults who aren't eligible for Medicaid or federal health subsidies, can't get on their parents' insurance or don’t have insurance through their employer.