Practice Policies

Affordable Care Act Information

No matter how you feel about the Affordable Care Act, the program’s overall goal is to provide access to affordable, high-quality healthcare—a goal we strive for at CMG every day.

What do parents need to know, and how can you make this work for your family? That can get complicated, depending on your situation. But to start, you need to know…

A Few Basic Details

  • You must have health insurance, or you may face tax penalties.
  • If you already have insurance through your employer, that can stay the same, or your employer may choose to have employees use the online insurance marketplaces.
  • If you don’t already have insurance, you can shop for coverage on the new online insurance marketplaces (also called insurance exchanges) for each state. Plans are surprisingly affordable compared to what we’re used to, and there are subsidies available to help low- and moderate-income families.
  • You can no longer be denied coverage for pre-existing conditions, nor can insurers cancel your coverage if you get sick.
  • We participate with major insurance companies, including New York State Medicaid and Healthy Kids programs. However, each company offers many different plans, and Children’s Medical Group may not participate in each one.
  • You should always know your coverage prior to scheduling your appointment with us, so we recommend you call to make sure we’re in network with your ACA insurance provider.

Important Items for Children & Young Adults

  • All plans must include coverage for basic well-childcare, including immunizations, vision, and dental care.
  • Young adults can remain on their parents’ health insurance until they turn 26 years old.
  • Young adults who aged out of foster care at 18 years or older are eligible to receive coverage through Medicaid until they turn 26 years old. People adopted from foster care may qualify for Medicaid coverage until age 26, depending upon income.

Other Resources

The American Academy of Pediatrics has developed some great resources to explain this information in more detail, and to help you to access Pennsylvania’s online registry.

Check them out here:

Children’s Health Insurance Program
Insure Kids Now
New York State Of Health – The Official Health Plan Marketplace

As always, if you have any questions or concerns, just give us a call in the office. We’re always happy to help in any way we can!