CHIP Insurance: The Children's Health Insurance Program

CHIP child getting medical care with mom at hospital
The Children's Health Insurance Program provides access to affordable healthcare to millions of children, here are the basics of CHIP and other low cost options. Photo:

 Steve Debenport/E+/GettyImages

Finding low-cost health insurance for children is a priority for anyone with children. Although there are many options a popular choice is the Children's Health Insurance Program (CHIP), which provides health care coverage to low-income children who do not qualify for Medicaid.

Typically, CHIP qualifications are determined, in part, by income and state standards for the program. Read on to learn how to qualify for the Children's Health Insurance Program (CHIP), what CHIP covers, and how you can apply.

Key Takeaways

  • The Children's Health Insurance Program (CHIP) provides health care coverage to low-income children who don't qualify for Medicaid.
  • Qualifications for CHIP are usually determined by the income level of the family and state standards for the program.
  • Children whose family income exceeds the qualification for the entire family or child to be covered under Medicaid can qualify for CHIP.
  • Typically, low-income pregnant women and children of state employees can also qualify for CHIP.

Qualifications for CHIP

Qualifications for CHIP are usually determined by the income level of the family and state standards for the program. However, in general, these are the qualifications for CHIP, in addition to meeting the income thresholds determined by your state:

  • Children whose family income exceeds the qualification for the entire family or child to be covered under Medicaid
  • Low-income pregnant women
  • State employee's children

CHIP takes into account the following factors when looking at eligibility:

  • Annual household income
  • How many people in the family
  • Federal poverty level and your state's specific costs of living and CHIP criteria. For example, states may cover families with incomes up to 200% of the Federal Poverty Level (FPL) or $46,060 per year for a family of three in 2022. However, the eligibility can range from 170% of the FPL up to 400% of the FPL and vary by state.
  • You may check the information for each state through the Kaiser Family Foundation.

Note

In January 2018, Congress passed an extension for CHIP for four years, followed by a second extension of an additional six years in February 2018, allowing the continuation of the CHIP program for at least another decade.

3 Ways to Apply For CHIP

You can apply for CHIP by:

  1. By calling 1-800-318-2596 (TTY: 1-855-889-4325)
  2. By submitting an application online through the Health Insurance Marketplace. If you qualify for Children's Medicaid or for CHIP they will let you know when you complete the application.
  3. By completing a Medicaid application. you can apply here by selecting your state.

When Can You Apply for CHIP?

CHIP does not have an enrollment period. Unlike other health insurance, you do not have to wait for open enrollment, you can apply at any time.

How Long Does It Take to Find Out If You Are Qualified for CHIP?

Normally you can find out if you qualify for CHIP within 24 hours.

What Is the Difference Between CHIP and Children's Medicaid?

Children's Medicaid serves the children in the lowest income families and those in impoverished situations versus CHIP which provides coverage to families who may have income over the poverty level. The requirement varies by state, but many states will allow incomes over 200% above the poverty level, so CHIP gives many more children the opportunity to get access to care.

Note

Medicaid and CHIP combined now cover more than 40 million children, of which CHIP covers health care for more than nine million children.

What Does CHIP Cover?

Each state has different coverage options for CHIP, so be sure to check the specifics for your state. In some states, those who have CHIP may be required to share the costs of certain treatments or medications for children covered under CHIP or Medicaid.

Preventative services are normally covered. However, you may need to pay some costs out of pocket, including copays or deductibles for non-preventative care such as emergency room visits, non-emergency use of the ER, inpatient hospital care, and prescription drugs.

You may also have costs for general doctors visits that are non-preventative. For example, if your child gets sick with a virus, it's not considered a preventative visit, so it may fall into the category in which you need to pay.

CHIP child getting medical care with mom at hospital
The Children's Health Insurance Program provides access to affordable healthcare to millions of children, here are the basics of CHIP and other low cost options.  Steve Debenport

What If You're Not Eligible for CHIP?

If you are not eligible for CHIP or Medicaid, you will receive a notice explaining that you're ineligible, and your application information will be forwarded to the Health Care Marketplace so you can see what other options are available. You may still be able to get lower-cost insurance based on the information in your application due to qualifying for a premium tax credit or saving on out-of-pocket costs.

Other Low-Cost Health Insurance Options for Children

Looking into a family health insurance plan instead of an individual plan can be a good option to save money on health insurance. Be sure and explore the options for each parent because sometimes one parent's plan might be better than the other. Depending on your medical needs, you may also consider both plans and use coordination of benefits to save money too.

Consider your employer's health insurance options, which might save you money. Many employers will pay for a portion of the plan as part of your employee benefits.

Private health insurance for children is another option if you do not have employer-sponsored health insurance plans available. As mentioned above, it is always a good idea to apply for CHIP or Medicaid, and if you are not eligible, your information will be forwarded to the marketplace so you can search for other options. Be sure and look into using HSA's and FSA's to stretch your dollar further or high deductible plans as well.

Frequently Asked Questions (FAQs)

What is the the Children's Health Insurance Program (CHIP)?

The Children's Health Insurance Program (CHIP) provides health care coverage to children of low-income families who do not qualify for Medicaid.

What does CHIP cover?

Although the coverage options for CHIP can vary by state, typically, preventative services are covered. However, you may have some out-of-pocket costs, including copays or deductibles for non-preventative care such as emergency room visits and prescription drugs.

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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Medicaid. "Eligibility Requirements."

  2. Kaiser Family Foundation. "Medicaid in the United States October 2019."

  3. Office of the Assistant Secretary for Planning and Evaluation. "HHS Poverty Guidelines for 2022."

  4. Kaiser Family Foundation. "State Health Facts, Medicaid and Chip Income Eligibility Limits for Children as a Percent of the Federal Poverty Level."

  5. Medicaid and CHIP Payment and Access Commission. "State Children’s Health Insurance Program (CHIP)," Page 3.

  6. Congressional Research Service. "Bipartisan Budget Act of 2018 (P.L. 115-123): CHIP, Public Health, Home Visiting, and Medicaid Provisions in Division E," Page 11.

  7. Healthcare.gov. "The Children's Health Insurance Program (CHIP)."

  8. Texas Health and Human Services. "Children’s Medicaid & CHIP."

  9. Idaho Department of Health And Welfare. "Medicaid for Children."

  10. Medicaid.gov. "Reports & Evaluations."

  11. Medicaid.gov. "May 2022 Medicaid & CHIP Enrollment Data Highlights."

  12. Medicaid.gov. "Federal Fiscal Year (FFY) 2020 Statistical Enrollment Data System (SEDS) Reporting," Page 4.

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