If your family doesn’t qualify for Medicaid but still struggles to afford health insurance, the Children’s Health Insurance Program (CHIP) can help. This program provides low-cost health coverage for children in families with incomes too high for Medicaid but too low to afford private insurance. In some states, CHIP also covers pregnant women.
This guide will walk you through who qualifies, what this program covers, and how to apply so your child can get the care they need.
Who Qualifies for CHIP?
CHIP is designed for children under 19 in families that earn too much for Medicaid but not enough for private insurance. Each state sets its own eligibility rules, but in general:
- Children under 19 in households with incomes up to 200%-300% of the Federal Poverty Level (FPL) may qualify.
- In some states, pregnant women can also get this coverage.
- U.S. citizenship or eligible immigration status is required.
- There are no work requirements for parents.
Even if you’ve been denied Medicaid, your child might still qualify for CHIP, so it’s worth checking!
👉 Pro Tip: Many states allow families with slightly higher incomes to buy into CHIP at a reduced cost.
What Does CHIP Cover?
This program provides comprehensive health coverage for kids, ensuring they get the medical care they need. Benefits typically include:
- Doctor visits and check-ups
- Routine vaccinations
- Prescription medications
- Hospital stays and emergency services
- Dental and vision care, including eye exams
- Mental health services
- Specialist visits and physical therapy
CHIP does not have deductibles, and co-pays are usually very low—sometimes even free, depending on your income level.
The downside is that each state runs its own CHIP program with different income limits and coverage options. To find the exact details for your state, visit your state’s Medicaid website. The Insure Kids Now hotline at 1-877-KIDS-NOW (1-877-543-7669) can connect you with the right resources in your state.
How Much Does CHIP Cost?
CHIP is designed to be affordable for families. Costs vary by state, but:
- Many children receive free coverage if their family’s income is on the lower end of the eligibility range.
- Some families may pay low monthly premiums (typically under $50 per child).
- Co-pays for services are usually very low, and preventive care is free in most cases.
The cost of the CHIP program will be different in each state, but it will never cost more than 5% of a family’s yearly income. On average, total out of pocket costs for families with CHIP range from $50-$150 per year per child. For families who qualify, CHIP will be cheaper than a Marketplace plan.
No child will be denied CHIP coverage due to a family’s inability to pay their portion.
Can I Keep My Current Doctor?
In most cases, yes! Physicians who accept Medicaid often accept CHIP as well. In fact, about 70% of office-based doctors nationwide accept new Medicaid and CHIP patients. However, some doctors may limit the number of CHIP patients they see, so it’s best to check with your provider.
Once your child is approved for CHIP, you’ll receive an enrollment card in the mail with a phone number on the back. You can call this number for help finding doctors and specialists in your area who accept CHIP.
How to Apply for CHIP
You can apply for CHIP at any time—there is no need to wait for an open enrollment period like with Marketplace plans. Applying is simple, too!
- Online: Visit HealthCare.gov and fill out an application. Your state will determine if your child qualifies for Medicaid or CHIP.
- By Phone: Call 1-800-318-2596 to apply over the phone.
- In Person: Many community organizations and health clinics can help you apply.
- Through Your State’s Medicaid Office: This program is run by states, so you can apply directly through your state Medicaid office.
Once you apply, approval can take a few weeks, but many states offer temporary coverage for urgent medical needs.
Frequently Asked Questions
This program is confusing, so we get asked a lot of questions about it. Here are some things you should know.
Can my child get CHIP if I have private insurance?
Maybe. Some states allow families to supplement private insurance if their current plan doesn’t cover essential services.
Does CHIP cover dental and vision?
Yes! This program includes dental and vision care in most states, covering check-ups, glasses, and dental treatments.
What happens if my income changes?
If your income increases, your child might move from CHIP to a different insurance program. You’ll receive a notice with new coverage options.
Can legal immigrants get CHIP?
Yes, but rules vary by state. Many states offer coverage to lawfully residing children and pregnant women without a waiting period.
Relief Recap
CHIP is a lifeline for families who can’t afford private insurance but don’t qualify for Medicaid. If you think your child might be eligible, apply today—there’s no penalty for checking, and your child could get the medical care they need.
