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CHIP program: 5 things you need to know

CHIP program: 5 things you need to know

Families who earn too much money to qualify for Medicaid but cannot afford health insurance may qualify for the Children’s Health Insurance Program, or CHIP. The CHIP program offers low-cost insurance for children from birth through age 18, and in some states pregnant women may also be eligible for coverage!


Who qualifies for CHIP?

Citizenship is not a requirement for the CHIP program, so lawfully present immigrants and non-citizen children may still qualify for coverage. The income criteria for the CHIP program is state-specific, but usually a four-person household making up to $50,000 would qualify. If you struggle to afford insurance for your children, you should apply for CHIP. There is no penalty if you apply and do not quality.

What coverage does CHIP provide?

All “well child” doctor and dental visits are free, but other services might require a co-payment. Copays are determined by each state’s specific plan, but are usually around $3-$25 per service. Note that CHIP coverage in all states includes dental and vision coverage.

Basic comprehensive coverage for CHIP in all states includes:

  • Routine check-ups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental and vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services

How much does CHIP cost families?

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.


Do I need to change doctors to use CHIP?

Not necessarily! Physicians offices that accept Medicaid typically accept CHIP as well, and most pediatricians accept both, though the number of patients may be limited. The CDC reports that 70% of all office-based physicians nationwide will accept new Medicaid and CHIP patients. Those who have qualified for the CHIP program will receive an enrollment card in the mail, which will have a phone number on the back to call for help locating a participating office.

When and how can you apply for CHIP?

You can apply for CHIP at any time – there is no need to wait for a special enrollment period.

There are two ways to apply:

  • Call 1-800-318-2596 (TTY: 1-855-889-4325).
  • Visit, create a Marketplace account, and follow the prompts to file an insurance coverage application. The site will automatically direct you to apply for your state’s CHIP program if your family meets eligibility criteria in your state.

More about CHIP

In 1997, a startling 23% of low-income children in American had no health insurance coverage. President Bill Clinton signed into law the Balanced Budget Act of 1997, which authorized CHIP to provide an insurance coverage option for US children in low-income households. Today 6,694,690 individuals receive insurance through CHIP.

If your family makes too much money to qualify for Medicaid and you cannot afford insurance, the CHIP program may be a low-cost insurance option for children and pregnant women. Citizenship is not a requirement for the program, and you can apply any time – even outside of open enrollment.

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