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Health Care Coverage for Texas Children

(March 2016)

(En Español)

Employer Group Coverage | Other Coverage | Tax Penalty and Exemptions | Get Help from TDI

Health care coverage can help your child get needed medical treatments if he or she gets sick. It can also allow your child to get regular checkups to stay healthy. Most Americans must have health insurance that meets federal coverage standards. If you don't get health coverage for your children, you might have to pay a tax penalty.

Employer Group Coverage

Many people cover their children by adding them to the health insurance they get at work. These health plans, as well as most state and government health plans, meet the federal requirement to have health insurance.

If your plan covers dependents, you can keep your children on it until they turn 26. Your children may stay on your plan even if they’re married. You can’t add a child’s spouse or dependent children to your plan, however. They’ll have to get separate coverage.

Texas law lets grandparents keep their dependent grandchildren on their health plans until the grandchild turns 25.

Other Coverage

If you don't have insurance through your employer, consider these options to insure your children:

  • individual coverage from an insurance company or health maintenance organization (HMO);
  • coverage through Children's Medicaid; or
  • coverage through the Children's Health Insurance Program (CHIP).

Visit TexasHealthOptions.com to learn more about health insurance and the types of plans available. TexasHealthOptions.com is a free service of the Texas Department of Insurance.

Individual Coverage

You can buy health insurance for your child or your entire family directly from insurance companies and agents. This coverage is called individual coverage because it covers individuals, not members of a group (the employees of a particular company, for instance). Insurance companies can't deny coverage to anyone because of health factors, including a preexisting condition or disability.

Individual health plans have to cover a set of essential health services. These benefits include pediatric, oral, and vision services.

For lists of insurance companies and HMOs that sell health policies in Texas, visit our list of companies and HMOs or call our Consumer Help Line at 1-800-252-3439.

To shop through the federal marketplace, visit HealthCare.gov or call the marketplace at 1-800-318-2596.  If you buy health insurance through the marketplace, you might be able to get subsidies to help you pay for it.

Children's Medicaid and CHIP

Children in Texas might be able to get low cost or free health coverage from the Children’s Health Insurance Program (CHIP) or from Children’s Medicaid. Both programs cover office visits, prescription drugs, dental care, eye exams, glasses, and more. 

Families with children who get Children’s Medicaid pay nothing, and children with CHIP pay no more than $50 a year for coverage. Families with CHIP also usually have to pay copays for some services.  For more information or to apply for Children's Medicaid or CHIP, visit the Texas Health and Human Services Commission website or call 1-877-KIDS-NOW (543-7669). You can use the same application to apply for both programs.

Tax Penalty and Exemptions

If you don't get coverage for your children, and aren't exempt, you'll have to pay a tax penalty. You pay the penalty when you file your federal income taxes. For more information about tax penalties, visit www.healthcare.gov/fees/.

Get Help from TDI

For insurance questions or for help with an insurance-related complaint, call the Consumer Help Line at 1-800-252-3439 or visit our website.

Visit HelpInsure.com to shop for automobile, homeowners, condo, and renters insurance, and TexasHealthOptions.com to learn more about health insurance and your options for coverage.

The information in this publication is current as of the revision date. Changes in laws and agency administrative rules made after the revision date may affect the content. View current information on our website. TDI distributes this publication for educational purposes only. This publication is not an endorsement by TDI of any service, product, or company.



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Last updated: 03/24/2016

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