Your Guide to CHIP Health Insurance

The federal government offers a program for affordable health insurance for children called The Children’s Health Insurance Program, or CHIP. This program aims to provide health insurance for children whose parents have an income that does not qualify them for Medicaid coverage but are unable to afford private health insurance for their children.

Since CHIP is managed on a state level, the program can work differently based on where you live. For instance, certain states will extend eligibility to also include pregnant women who fall within the income limit. In some states, CHIP may also go by a different name but this government-run insurance program will typically work alongside state Medicaid offices. Learn more about this government health insurance program and how it can provide coverage to children in need.

What are the benefits of CHIP?

Children and pregnant women who are eligible for CHIP will receive comprehensive benefits that serve to cover a variety of different health care needs. Since the program is federally regulated, the basic types of health care coverage will be provided by each state regardless of how CHIP is operated locally. Based on federal regulations, CHIP participants must receive the following coverage:

  • Regular doctor’s visits and routine checkups
  • Prescription drugs
  • Immunizations
  • Dental services
  • Vision services
  • Emergency services
  • Laboratory services
  • X-ray services
  • Outpatient and inpatient services

As long as the basic coverage options are included, states have a lot of flexibility for how they manage CHIP. For example, some states may decide to offer additional health care coverage types to program participants.

Learn About Requirements for CHIP

In order for families with children to be eligible for CHIP, they are required to meet the program’s requirements for income and age. A majority of states will offer CHIP coverage to any children 18 years of age or younger who are currently uninsured. After a child turns 19 years of age, he or she will no longer qualify for coverage through CHIP. 

Since CHIP is managed by each individual state, the specific criteria to qualify can differ based on the state where applicants currently live. Each state uses the federal poverty level (FPL) in order to determine income limits for eligibility. 

States that have decided to expand CHIP to provide coverage to more families may widen the range of the income limits for participants. For example, some states will accept applicants with an income up to or greater than 200 percent of the FPL, while others may extend it to include residents up to 300 percent of the FPL. Residents interested in CHIP coverage should call a Medicaid office and ask for the income limits to qualify in their area.

Applicants are also required to prove that they are lawfully residing in the United States before they can qualify for CHIP coverage. Moreover, applicants can only receive CHIP in the state where they live. Residents cannot apply for CHIP coverage in any state other than where they currently reside. 

Based on regulations set by the Affordable Care Act, preexisting medical conditions can no longer cause children to be denied coverage through CHIP. Applicants will not be required to undergo a medical evaluation in order to participate in the programs and receive benefits. However, other factors may cause a child to lose eligibility such as an increase in family income or the child turning 19 years of age. 

Learn About Dual Requirements for Medicaid and CHIP

In certain circumstances, children may be eligible to receive health insurance through both CHIP and the Medicaid program. Although adults do not need to qualify to receive CHIP coverage for their children, a family may be able to receive dual coverage if they meet the qualifications for both programs. 

On the other hand, children may qualify for CHIP coverage even if their family does not meet the income requirements for Medicaid. Families who are unable to receive health insurance for a free or affordable cost may need to find coverage on the health care marketplace. Currently, there are a number of different programs that can help adults save money while getting health insurance on the private market. 

How to Apply for CHIP 

Interested applicants have two primary methods of applying for CHIP in their state. First, they have the option to submit an application online or over the phone through the health insurance marketplace. Phone applications can be submitted by calling 1-800-318-2596.

With the online or phone methods, applicants will follow the same process as applying for any other insurance plan on the marketplace. Follow these steps to complete the application process online:

  1. Create an account on the health insurance marketplace.
  2. Begin your application by providing the required information such as your name, state of residency, family size, income and other important details. 
  3. Submit the application form once you have filled it out completely.
  4. Learn about the health insurance plans that you are qualified to receive based on the information you provided during on the application form.
  5. Wait until your state’s Medicaid agency informs you about receiving health care coverage and if any children or pregnant women in your household qualify for CHIP.

The next method to apply for CHIP is by visiting your state’s Medicaid agency, which is responsible for managing CHIP in most states, and completing an application in person. Since each state has different methods to apply, you should ensure to follow the instructions that are provided by your state’s agency. 

CHIP applications are accepted year-round and there is no designated enrollment period like other government assistance programs. Candidates are encouraged to apply as soon as they are eligible for the program.

How much will I have to pay with CHIP coverage?

Unlike Medicaid, CHIP participants will typically be required to pay a monthly premium for coverage. The monthly premium a beneficiary must pay can vary by state, but premiums will never exceed over five percent of a family’s yearly income. 

Participants can receive certain services at no cost such as regular dental visits and check-ups with a doctor. Other medical services may require a copayment from the participant covered by CHIP.