Adding adopted child to family health insurance?

Question

We are very close to finalizing adoption for a special needs child. He is currently on medicaid and will continue to receive that coverage. It is expected we will use that as a back-up to our own family policy.

It has been suggested to us by someone in the adoption field that we may be better off NOT adding him to our policy because of the amount of care he may need going forward and the battles which may come between our insurer and medicaid.

I am asking ONLY from the standpoint of avoiding hassles & potential confusion-I'd rather be spending my time with him in the coming years than on hold repeatedly fighting yet another broken system! We love this child and want what's best for him. We will get his needs met.

Can we keep him off our family policy? Do you see any potential pitfalls with that scenario? Medicaid has been good at meeting his needs (weekly therapies and meds running over 500/month) and we have no plans to change his providers. Anyone dealt w/this before?

Answer 1

We did not have to add our adopted son to our insurance, so we chose not to for alot of the same reason you heard. .He currently has MIchild (medicaid).

The only problem that we had is some Doctors only accept so many Medicaid recipients a month. I made an appointment with an allergist for my bio son and adopted son at the same time. They could get my bio child in almost immediately and the adopted child had to wait almost 3 months for an appointment. So you might also want to take that into consideration.

Answer 2

Yes, we encountered the same situation. We had always planed on putting the kids on my husbands insurance once they were adopted. After finding out that they would still qualify for Medicaid and weighing the pros and cons we decided to have them use only Medicaid. Once you put him on your insurance it becomes the primary and Medicaid is the secondary. You will be paying co-pays and your usual prescription prices.

You do not have to put him on your insurance. Medicaid will be his primary/only insurance.

From the standpoint of avoiding hassles and potential confusion I would just keep him off of your insurance.

Sometimes it is harder to find a provider and a bit embarrassing to use Medicaid, but the benefits out way that.

Answer 3

There is no right or wrong to your question.  You should do as you please.  However, I do have experience in this area. Both my children qualify for Medicaid because of their family background.  However, we did add our daughter to my husband's policy because the addition was so inexpensive.  It turned out to be very fortunate, because the therapist we worked so hard to choose doesn't accept Medicaid.  Our son's therapist is excellent for his needs, and she does accept Medicaid.  But when we looked for therapists, we looked, based on the needs of our children, not on whether or not they accepted Medicaid.  You might want to keep that in mind.  In my experience, all adopted children need to benefit from lots of therapy--not just a little, but pretty much all their childhood and adolescence.  Especially if they came from abusive or  neglectful situations.  Those children have wounds that require healing, and they deserve every bit of help we can give them.  Let me also say that the wounds are not always obvioius.  My daughter did a really good job of pushing her pain down inside until she hit puberty, and then she let her anger and pain out in inappropriate behavior.

Answer 4

I think you need to speak with his caseworker about this and see their view. The only problem I can see is medicaid finding out you chose not to add him to your policy to use medicaid. Then down the road they could end up dropping him from medicaid and you will be unable to add him to your private insurance until open enrollment. You only have the 30-60 day window right after adoption to add him to your insurance.

Answer 5

I was a licensed insurance agent for about 20 years and I am the adoptive mother of two special needs children.

You may choose to add your child to your private or group health insurance and if you do so your policy will be the "Primary" insurance and it will be billed first.

You will not lose the medicaid or state health insurance by adding the child to your policy. What will happen is any medical facility, doctor or other health need that IS covered by the medicaid or state insurance will be paid as medicaid will come in and cover any co payments.

For example medications at the pharmacy our primary (employer provided group health insurance) Pays for the medication as it would in any ordinary situation. Our Health insurance requires us to pay either $10.00 (generics) or $25.00 co-payment for prescriptions. Medicaid covers the $10 or $25 and we do not pay for medications.

But: Our daughters Psychiatrist does NOT accept Medicaid or state health insurance so--any co-payments his service requires we need to pay out of pocket...

You can keep your child off your health insurance but, I would suggest NOT doing this. The truth is the depending on your child's special need--Medicaid is not always going to offer families the Best Care---having your private insurance as an option for children with special needs is an advantage for getting the services your child may need.

Depending on only the publically funded system may cause you to have to use it the same as any other family on Medicaid--in some cases this would mean that you have to work with a County or State provided case worker and be part of the CPS system in order to access things like Mental Health.... With private insurance you will continue to have control over what happens and what care you get....

With Both you have both options and can use a combination of services depending on your child's needs.

Answer 6

you should just keep medicaid but i wanted to congrats on the new adoption espesially a special needs i i work for a special ed class and i would love to adopt a little boy or girl with down syndrome