The Children’s Health Insurance Program, also known as CHIP, is designed to provide affordable insurance for children who may not qualify for other types of coverage. Based on family income, CHIP reaches children whose parents make too much to qualify for Medicaid, but do not have enough income to afford private children’s health insurance from the marketplace. 

CHIP works differently depending on were you live. For example, some states extend coverage for pregnant women who meet the income requirements as well. Since each state runs its own program, it is also important to be aware that you may hear CHIP referred to by a different name in your state. In any case, CHIP is a government-run program that works closely with the state Medicaid office to provide the coverage your children need. Learn more about this program below.

What benefits does CHIP provide? 

CHIP offers comprehensive benefits to children, covering a wide range of health care needs. Because CHIP is federally regulated, each state is required to provide the same basic types of coverage, no matter how it chooses to operate the CHIP program. In particular, CHIP must provide coverage for the following by law: 

  • Check-ups and regular doctor’s visits
  • Immunizations 
  • Prescription drugs
  • Dental and vision services 
  • Emergency medical services 
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services

Depending on where you live, your state may also offer additional types of coverage under the CHIP program that go beyond the basics. This is because each state is given flexibility in the way it runs its program. 

Learn About CHIP Requirements 

To qualify for CHIP, families with children must meet the basic age and income requirements. In most states, uninsured children 18 years of age or younger may receive CHIP coverage. In other words, once a child turns 19 years of age, he or she is no longer eligible for this program.   

Because CHIP is run individually by each state, the exact requirements may vary depending on where you live. Income limits, which are based on the federal poverty level (FPL), may differ by state depending on whether a state has chosen to expand CHIP coverage to include more families. With that in mind, the common income requirements for families are as follows:  

  • Up to or above 200 percent of the FPL
  • 250 percent of the FPL or higher
  • Up to 300 percent of the FPL 

In addition to meeting the age and income requirements, you also must demonstrate that you are lawfully present in the United States before you can qualify for CHIP. Furthermore, because CHIP is administered at the state level, it is not possible to get coverage in a state where you do not live. Therefore, you must be a resident of the state where you are applying for coverage.

Under the Affordable Care Act, your children cannot be denied CHIP coverage due to preexisting medical conditions. As such, the application process does not require undergoing a medical evaluation, and you do not need to recertify your eligibility through a benefits review. However, if certain factors change, such as an increase in your income or your child turning 19 years of age, your family’s eligibility will be affected. 

Medicaid and CHIP

You may find that based on your income or other factors, your children are eligible for both CHIP and Medicaid coverage. You do not need to have Medicaid in order to receive CHIP coverage, but your family may receive coverage under each of these programs if you qualify for both. 

In some cases, it is also possible for your children to qualify for CHIP, though you are not eligible for Medicaid based on your income. If you find that you are unable to get free or low-cost insurance for yourself, it may be possible to receive extra savings on your own coverage through the health insurance marketplace. There are several programs available to help adults save while getting health insurance when Medicaid is not an option.

Find Out How to Apply for CHIP 

There are two main ways to apply for CHIP in your state. The first way is to use the health insurance marketplace to submit an application online or by phone. This method is the same as applying for any other type of insurance coverage through the marketplace. 

Applications may be submitted over the phone by calling 1-800-318-2596. To complete the process online, you will need to take the following steps: 

  1. Log into your marketplace account or, if you are a new user, create an account. 
  2. Start an application by filling out the required information, including your name, income, family size, state of residency and other details. 
  3. Submit your completed form. 
  4. Learn what plans you qualify for based on your income and other information provided on your application. 
  5. Wait to receive information from your state’s agency about getting coverage, if anyone in your household is deemed eligible for CHIP.

The second method for getting CHIP coverage is to apply directly through your state Medicaid agency, which is in charge of administering CHIP in most cases. The application steps and methods may be different in each state, so it is necessary to follow the specific instructions provided by the agency in your state. Some states may accept applications online, by phone and in person, but methods will vary. 

No matter which CHIP application method you choose, it is important to be aware that you can enroll at any time of the year. There is no specific enrollment window in which you must sign up for CHIP coverage. Therefore, you can apply for this type of insurance as soon as you become eligible. 

How much does CHIP coverage cost?

It is important to keep in mind that CHIP, unlike Medicaid, usually requires paying a premium. Certain types of visits, such as regular doctor’s check-ups and dental visits, are provided at no cost. However, you may need to make copayments in order to receive some medical services that are covered under your children’s insurance. 

CHIP premiums vary by state, so it is necessary to contact your local agency for more information on the exact costs you may need to cover. No matter where you live, though, your premiums will not exceed five percent of your family’s annual income.

Using Your CHIP Coverage 

Once you receive CHIP insurance for your children, it is important that you learn where you can use your coverage. Each state has its own network of health care providers that accept CHIP coverage. Therefore, you will need to review the list of local providers when scheduling appointments and seeking medical care for your children. Seek out the CHIP and Medicaid resources provided by your state to learn more about using your low-cost health coverage.