The Definitive Guide to Child Health Plus

So much goes into raising healthy and happy kids. From diapers and daycare to homework and homecoming, there’s always something going on. On top of all of that, there’s the ever-present worry about their health and happiness.

“Every New Yorker wants what’s best for their kid,” says Dr. Talya Schwartz, MetroPlusHealth’s President and CEO. But when it comes to health insurance it can be tricky to figure out what the best is. It can be tough to know what your options even are! “We’re committed to meeting the needs of New Yorkers of any age and phase of their life,” Schwartz adds.

Launched in 1991, Child Health Plus is a New York State health plan for kids. Child Health Plus is a public insurance program that provides free or low-cost health insurance to children under the age of 19.

As New York City’s Office of Citywide Health Insurance Access explains, Child Health Plus covers kids “who do not qualify for Medicaid” and who “do not have other health insurance coverage.” The program is administered by the state, but individual health care providers like MetroPlusHealth actually carry out and offer the plan.

“Child Health Plus was specifically designed to fill the gap between Children’s Medicaid and private health insurance options,” says Dr. Sanjiv S. Shah, MetroPlusHealth’s Chief Medical Officer. Children’s Medicaid has more strict qualification requirements while private health insurance is usually accessed through an employer or purchased directly from an insurance provider). Child Health Plus serves families making between 222% to 400% of the federal poverty line.

Not every kid qualifies for Child Health Plus, though. There are certain eligibility requirements that have to be met.

There are two sets of requirements that have to be met in order for a child to qualify for Child Health Plus.

The first set of Child Health Plus requirements have to do with the child, who must:

• Be under the age of 19
• Live in New York State
• Not be eligible for Medicaid
• Not covered by other health insurance
• Not eligible for other state benefit programs (like NYSHIP)

It’s important to note that children can be eligible for Child Health Plus regardless of their immigration status.

The second set of eligibility requirements for Child Health Plus have to do with family income. In order to qualify for Child Health Plus, a child’s family must meet the following income limits based on family size:

• $60,240 for a family of one
• $81,760 for a family of two
• $103,280 for a family of three
• $124,800 for a family of four

Unlike other health insurance plans, Child Health Plus has no annual deductible and no co-payments.

Depending on family size and income, premiums (the amount you pay for the plan each month) can be as low as $0 a month. Some families will pay $15 a month while some will pay $30, $45, $60, or perhaps slightly more each month depending on income and family size.

These income tiers provided by New York’s Health Plan Marketplace outline what you might expect to pay based on your family size.

Whether or not a health insurance program is a good fit or not often comes down to what it does (and doesn’t) cover. You might be wondering, does Child Health Plus cover prescription medication? What about dental and vision?

The short answer is, yes! Child Health Plus covers a range of essential health benefits including prescription medication and dental and vision care.

Here’s a more complete list of what you can expect a Child Health Plus plan to cover:

• Physical exams and immunizations
• Well-child exams
• Lab tests and imaging
• Emergency care including ambulance transportation
• Prescription and non-prescription drugs
• Inpatient and hospital and surgical care
• Inpatient and outpatient substance use and mental health services
• Dental and vision care
• Durable medical equipment
• Hospice care