Can a Child Born With Heart Problems Get Medical Insurance?

If you have a child who was born with a serious health issue you are under enough stress without having to worry about the healthcare expenses that you will incur with your new bundle's care. Being born with a heart condition does not mean that your child will not be able to get health insurance. Some of the options depend on what the parents have available for healthcare coverage.

Parent's Employer Insurance

• A baby born to a parent who has employer health insurance cannot be denied coverage due to any pre-existing conditions as long as certain criteria are met. The child must be enrolled in the health plan within 30 days of birth. The same conditions also apply to children under 18 who you have adopted, or have had placed with you for adoption even if the adoption is not final. The ban on pre-existing conditions will not apply if the child has had a significant break in coverage, meaning that the child did not have health coverage for 63 days.

Pre-existing Condition Pools

• If you or your child have been denied coverage with an individual plan because of pre-existing conditions, you may get coverage from a special insurance pool that was set up by the Affordable Medical Care Act at a reasonable cost. To qualify, you must not be covered by employer coverage, or by any type of continuing COBRA coverage. Your child must have been uninsured for at least six months, and the child must have either been denied coverage due to pre-existing conditions, or been offered coverage with an exemption for pre-existing conditions. This program lasts until January 1, 2014, when healthcare reform bans pre-existing condition restrictions.

Medicaid Coverage

• If your child qualifies due to a low income, he may be eligible for state medicaid coverage. This coverage is a form of public assistance, and often children are able to qualify more easily than adults. Medicaid offers comprehensive coverage, and generally does not exclude pre-existing conditions. Your state agency that handles public assistance can help see if you qualify for medicaid, and get the process started for coverage.

Other Considerations

• Pre-esisting condition restrictions can only last a certain time period by law, usually 12 months. You receive a one month credit to this time frame for each month that you had continuous coverage prior to the new job, as long as there have not been any significant breaks in the coverage. A significant break is over 63 days without coverage. If you had uninterrupted coverage for nine months before enrolling in a new employer's plan, you would only have a three month exclusion to pre-existing conditions, provided you enroll as soon as you are eligible in your new employer's plan.