What’s CHIP insurance?

Key points

• The Children’s Health Insurance Program (CHIP) provides health insurance for children 18 and under who don’t have coverage from another source, including Medicaid or a private policy.
• Families must meet income requirements based on family size to qualify.
• CHIP insurance covers the cost of preventive care, immunizations, doctor visits, emergency services, dental, hearing and vision services and more.
• You can apply for CHIP either directly with your state or on the Health Insurance Marketplace, available at HealthCare.gov, for most states.

Many federal and state government safety net programs are designed to protect the most vulnerable members of society, including children, seniors and those with low incomes. One of the programs that set out to accomplish this goal is the Children’s Health Insurance Program (CHIP), a joint federal-state program that provides health insurance coverage to millions of children in the United States.

Read on to learn more about what CHIP is, what it covers, who’s eligible and how you can apply.

What is CHIP insurance?

CHIP is a partnership between the federal and state governments created in 1997 to provide free or low-cost insurance to children who lack other coverage. Like many similar programs, CHIP is income-based, and families must meet certain income requirements to qualify.

CHIP is jointly funded by the federal and state governments. The federal government provides grants to individual states, and those grants are matched with state dollars. Because the program is administered by the states, it looks slightly different depending on where you live. Some states have incorporated CHIP into Medicaid. In other states, CHIP is an entirely separate program.

Since CHIP is technically a temporary program, Congress must periodically provide new funding. In 2018, Congress reauthorized CHIP through 2027.

Who qualifies for CHIP insurance?

CHIP provides health insurance coverage for children in families that don’t have access to other coverage but earn too much to qualify for Medicaid in their state.

In addition to covering children, a small number of states have expanded CHIP to include pregnant women. The states that currently allow pregnant women to enroll in CHIP are Colorado, Missouri, New Jersey, Rhode Island, Virginia and West Virginia.

CHIP rules vary by state, but generally, an applicant must meet the following requirements:

• 18 years of age or younger.
• U.S. citizen, national or non-citizen in the U.S. legally.
• Uninsured and ineligible for Medicaid.
• Household income below a specified limit.

Annual household income limits before taxes

HOUSEHOLD SIZE	MAXIMUM ANNUAL HOUSEHOLD INCOME
1	$58,320
2	$78,880
3	$99,440
4	$120,000
5	$140,560
6	$161,120
7	$181,680
8	$202,240

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For households with more than eight people, add $20,560 per extra person.

What does CHIP insurance cover?

CHIP coverage may vary slightly depending on where you live since each state is responsible for administering its own program. However, in most states you can expect to find these services covered:

• Routine check-ups.
• Immunizations.
• Doctor’s office visits.
• Hospital stays.
• Prescriptions.
• Dental care.
• Vision care.
• X-ray and laboratory services.
• Emergency services.
• Mental health services.

Keep in mind that CHIP enrollees must get treatment from a medical provider that accepts the insurance in order for it to be covered. The agency in your state that administers CHIP can direct you to a list of participating providers.

Tip: To learn about CHIP coverage in your state and for help applying, use the “Find Coverage for Your Family” tool at InsureKidsNow.gov, a website run by the Centers for Medicare & Medicaid Services.

What does CHIP insurance cost?

Depending on your income and your home state, you may face a small out-of-pocket cost for your child or teen’s CHIP coverage. 

• For families with incomes at or below 150% of the federal poverty level, your premiums can’t exceed the amount permitted by Medicaid. 
• For families with incomes above 150% of the federal poverty level, your cost-sharing requirements can’t exceed 5% of your family’s annual income. 

Some states may require copayments for certain services. However, routine check-ups and dental visits are always 100% free.

How to apply for CHIP

One of the benefits of CHIP is that there’s no open enrollment or set time period when you have to apply. As long as your family meets the eligibility requirements, you can enroll in the program, regardless of whether your children are newly uninsured or have been for some time.

“Even if your income is too high to qualify for Medicaid, your child may still be eligible for CHIP,” says Adams. “So it’s worth applying to see how you can save money on their medical, dental and vision care expenses.”

There are two primary ways to apply for CHIP coverage. First, you can apply through the HealthCare.gov marketplace. The federal marketplace will send your application along to the appropriate state agency in charge of enrollment.

The other way to apply for CHIP coverage is directly through the agency in your state that administers Medicaid and CHIP.

Because some states have expanded their Medicaid programs to include CHIP, residents of those states would apply directly for Medicaid. In other states, CHIP is a separate program that you must apply for on its own.