Health insurance considerations to plan for when adopting a child
6 min read •
30 sec brief
Thousands of parents open their homes to children in need each year through national and international adoption programs. Following a successful adoption, adoptive parents completely take over care from the state or adoption agency. Notably, that includes the provision of healthcare through insurance. Individuals and couples seeking to adopt should consider what healthcare options are…
Thousands of parents open their homes to children in need each year through national and international adoption programs. Following a successful adoption, adoptive parents completely take over care from the state or adoption agency. Notably, that includes the provision of healthcare through insurance. Individuals and couples seeking to adopt should consider what healthcare options are currently available to them, any unique medical needs the children possess, and whether any special insurance provisions exist that may aid the process.
Healthcare Considerations Before Adopting
Prior to adopting a child, it’s important to understand the adoptive child’s healthcare needs. Adoptive parents should inquire about the child’s medical history and any current or recurring medical treatments or any medications the child receives. The type of information you can receive may vary, depending on the type of adoption. Similarly, the type of medical care the child is currently receiving may also vary based on the child’s situation.
For example, if you’re adopting through open or semi-open adoptions (e.g., directly from the biological parents and facilitated by a third party), you’ll likely receive a full or more complete medical report prior to adoption. Many open adoptions involve newborns or children yet to be born, so adoptive parents may work out agreements to help fund prenatal and postnatal care for the biological mother.
Other forms of adoption — such as closed adoption, foster care adoption or international adoption — may result in more limited information about the child’s medical history. In these cases, you may need to spend time with the child in order to get a full history of the child’s health records.
The type of medical information you’ll want to obtain before adopting a child can include:
- Current medical condition
- Known prescribed medications
- Past medical treatments
- Biological parents’ medical history and any diseases that may run in the child’s family
- Whether the child’s mother used any illicit drugs or alcohol during pregnancy
- Up-to-date immunization records
- Emotional and physical development
- Type and extent of the healthcare the child has received up to this point
Adoptive parents should seek to gather as much information as possible. This gives the opportunity for prospective parents to consider what type of medical conditions they can and are willing to take on upon the adoption of a child. Prospective parents and the adoption agency can work to determine whether the fit is right for each child under consideration.
How to Get Health Insurance When Adopting a Child
Not all children have adequate healthcare or health insurance coverage prior to adoption. Parents utilizing open adoptions may be adopting children from parents who could not afford sufficient coverage, for example. As well, adopting internationally at times means adopting children from countries with far more limited access to healthcare than in the United States.
Adopted children are legally considered family in the United States. By consequence, adopted children are also eligible to receive medical care and health insurance coverage through all available means just the same as biological children, so most adoptive parents can add adopted children to their current health insurance plan immediately. Insurance providers will consider both the birth or adoption of a child to be an addition of dependents and a qualifying event that allows for enrollment outside of the typical open enrollment period.
The health care costs and needs of adopted children can be covered through traditional health insurance or other financial accounts such as health savings accounts (HSAs), flexible spending accounts (FSAs), Medicaid or other legally available funding sources. Understand the best options available for your family — for example, if you open an HSA for your child, they cannot also be considered a dependent on another individual’s tax return.
Prospective parents adopting from the foster care system (currently the most common adoption avenue in the U.S.) will find that most children within the system already receive medical coverage through Medicaid. This coverage may end post-adoption if the adoptive family does not also qualify for Medicaid. Adoptive parents may need to obtain separate health insurance coverage for the child or may need to use other funding methods to help their child receive the care that they need.
When to Add an Adopted Child to a Health Insurance Plan
Adding children to any health insurance plan will increase premium amounts. Some parents may find that their health insurance rates change dramatically with the addition of an adopted child. Since adopting a child is considered a qualifying life event, it may be beneficial to change insurance providers or shop around for providers that offer better rates for families.
For example, in Texas, health insurance increases by approximately $300 a month when adding one child to the average couple’s plan.
Under current federal law, adopted children with pre-existing conditions cannot be denied health insurance. That said, adding an adopted child with a pre-existing condition may have a large enough impact on rates that adoptive parents could benefit from changing to a different provider, or utilizing alternative methods for healthcare spending.
Unlike with foster care, which provides foster families financial assistance to help cover costs, adoptive parents assume the full cost for medical care and insurance coverage. Families considering adoption should analyze what they can afford to pay in medical coverage and insurance and review this information with the adoption agency.
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