CHIP Insurance: The Children's Health Insurance Program

CHIP child getting medical care with mom at hospital

 Steve Debenport/E+/GettyImages

Finding low-cost health insurance for children is a priority for anyone with children. There are many options to look into which we will cover in this article, the most popular of which is the Children's Health Insurance Program (CHIP). CHIP provides health care coverage to millions of low-income children who do not qualify for Medicaid.

However, the future of CHIP has been a topic of concern. In January 2018 Congress passed an extension for CHIP for 4 years, followed by a second extension of an additional 6 years in February 2018, allowing the continuation of the CHIP program for at least another decade.

While funding for the program is still at risk, proposed cuts to the program by the Trump administration were not passed by Congress. Medicaid and CHIP coverage combined now cover more than 35 million children, of which CHIP covers health care for approximately 9.6 million children. These two combined programs help families access health care for their children and have brought the uninsured rate of children in America to an all-time low.

Thanks to programs like Medicaid and The Children's Health Insurance Program (CHIP) 95 percent of children in America are insured.

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 normal 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, most states cover families with incomes up to at least 200% of the Federal Poverty Level (FPL): $43,920 per year for a family of three in 2021, but this will vary from state to state. You may check the information for each state here.
2020 Medicaid Eligibility by State
2020 Medicaid Eligibility by State.

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 percent above the poverty level, so CHIP gives many more children the opportunity to get access to care.

What Does CHIP Cover?

Each state has different coverage options for CHIP, you can check here the specifics for your state.

Cost-Sharing: Do You Need to Pay for Services When You Have CHIP?

Even if you have CHIP, in some states, there will be cost-sharing for certain treatments or medication for children covered under CHIP or Medicaid.

Preventative services are normally covered. However, you may need to pay some costs out of pocket, including co-pays or deductibles for non-preventative care such as for emergency room visits, or non-emergency use of the ER, inpatient hospital care, 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, that's not a preventative visit, so it may fall into the category where you may 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 then you will receive a notice explaining this and your application information will be forwarded to the 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 is usually a good option to save money on your health insurance. Be sure and explore the options for each parent because sometimes one parent's plan will 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. Looking at the health insurance options your employer can provide you may also save you money because in many cases 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.

Article Sources

  1. Medicaid and CHIP Payment and Access Commission. "State Children’s Health Insurance Program (CHIP)," Page 3. Accessed April 30, 2021.

  2. 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. Accessed April 30, 2021.

  3. Medicaid. "Children's Health Insurance Program (CHIP)." Accessed April 30, 2021.

  4. Medicaid. "Eligibility Requirements." Accessed April 30, 2021.

  5. Kaiser Family Foundation. "Medicaid in the United States October 2019." Accessed April 30, 2021.

  6. Office of the Assistant Secretary for Planning and Evaluation. "HHS Poverty Guidelines for 2021." Accessed April 30, 2021.

  7. "The Children's Health Insurance Program (CHIP)." Accessed April 30, 2021.

  8. Texas Health and Human Services. "Children’s Medicaid & CHIP." Accessed April 30, 2021.

  9. Idaho Department of Health And Welfare. "Medicaid for Children." Accessed April 30, 2021.