Wednesday, June 27, 2012

Health Insurance for Babies with Down Syndrome

Today Ryan McCostlin, a team member at Bernard Health, is going to share the Top 5 Health Insurance Tips for new parents of babies with Down syndrome.

When new moms and dads have a beautiful new baby, the questions can seem endless. What are the right foods? ...the right child care? I need to buy Kidz Bop records, or is it okay if I play The Rolling Stones?

And while learning how to be a new parent can be a heck of a lot of fun, finding the right health insurance strategy... well... isn’t. . I happen to be someone who spends most of his time thinking about health insurance, and even I can admit that on the fun spectrum, shopping for health insurance can fall somewhere between tax audits and root canals.

That said, all parents spend time thinking about how to plan for expected and unexpected medical expenses. And for parents of babies with Down syndrome, there can be additional costs associated with neurological exams, cardiology exams, thyroid screening, etc. So while finding the right health insurance strategy might not be very much fun, it is important.

So, what should new parents of a baby with Down syndrome know as they begin to research health insurance options? Here are the top 5 tips:

ikn1. Depending on your income and your state’s rules, your child may qualify for a government subsidized health insurance program called Medicaid. The name for the program varies from state-to-state... for example, it’s called MediCal in California and TennCare in Tennessee, but each state’s program is a version of the federal Medicaid program. If your annual income is too high to qualify for Medicaid in your state, your child may qualify for another government program called CHIP. To research government subsidized options in your state, you can click here.

2. If you have group health insurance through an employer, most employers have a 30 day window from the birth of your child to add him/her to your plan as a dependent. If you choose to add your child to your employer’s health plan, make sure you share your good news with your HR representative so you can fill out the appropriate paperwork!

3. If you don’t have access to insurance through your employer and you don’t qualify for a government program, you can still get coverage for your child through an individual health insurance plan. Child-only plans aren’t available in every state, but because of healthcare reform, children cannot be denied coverage by health insurance companies as long as at least one eligible parent also applies.

4. Consider enrolling in a Health Savings Account based health insurance plan if your employer offers one... and especially if you’re enrolling in an individual plan for your family. At first glance, it may seem like a co-pay based health insurance plan is a better option, but Health Savings Account based plans often have a true annual out-of-pocket limit on spending. After you meet your deductible, your child’s healthcare is free for the rest of the year. Families with lots of healthcare expenses often find that Health Savings Account based plans can help them come out ahead

5. Health insurance can be complicated, and it’s especially important for new parents of Down syndrome babies to consider all of the available options. If you need more help, there are several resources available who can provide guidance. As you consider where to seek additional help for your family, know that there are three basic categories of advisors:

First, each state has a State Health Insurance Program (SHIP) that can answer basic questions about health insurance eligibility. Advice from SHIP employees is free, and you can find your state’s SHIP contact information online.

Second, you can find a health insurance salesman who may be able to help you research private health plans. Health insurance salesman don’t charge you anything up front, but they get paid when they sell you an insurance policy.

Finally, many families find it helpful to work with fee-based health insurance advisors who, for a flat fee, can help you navigate the complexities of the individual health insurance market. This option is similar to a tax advisor or CPA who helps you prepare your taxes. While the flat fees vary, health insurance advisors usually don’t work on commission, so their only incentive is to help you get the right strategy in place for your new child.
More about the author: Ryan joined Bernard Health in 2010 to help families save time, save money, and get peace of mind as they consider affordable health insurance options. Through a network of retail stores, Bernard’s team of licensed, non-commissioned health insurance advisors provide face-to-face advice to families across the country. He earned a BS from Vanderbilt and an MBA from Yale. Ryan can be found on LinkedIn and Twitter.


  1. Everyone should certainly have equal access to comprehensive and quality health insurance regardless of pre-existing conditions as well as physical or mental illness. Quality healthcare is a fundamental right and not just a privilege.

  2. We are having such a problem getting our son health coverage. He has health insurance through my husband's employer, however they do not cover any of his therapies. These are all out of pocket for us and getting very expensive.

    We have applied for our state Medicaid and have applied for the disability waivers. There is a 10 year waiting list for the disability waivers and we aren't sure if he will receive the Medicaid it's under review. We don't qualify for SSI because of our income. I suggest that when parents first learn of their child's diagnosis to apply for coverage immediately in their state. If we would have been given correct information about the disability waivers, my son may be getting benefits in the next few years, but we were told our income disqualifies us. It's a very frustrating and difficult system to work, and it's sad. Everyone should have the same access to health insurance but it doesn't appear that's true.


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