What Is the Children’s Health Insurance Program (CHIP)?
The Children’s Health Insurance Program (CHIP) provides medical coverage for individuals age 18 and younger whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. Congress passed CHIP in 1997 during the Clinton administration.
- The Children's Health Insurance Program (CHIP) is a federal healthcare program that provides medical coverage to those age 18 or younger.
- Typically a family of four earning up to $106,000 (before taxes) a year will qualify for CHIP, but the limits vary state-by-state.
- CHIP is designed to help families who make too much to qualify for Medicaid but who can not afford private insurance.
- Many services covered by CHIP are free, but some require a co-payment. Meanwhile, some states require a monthly premium that cannot exceed 5% of annual income.
- Pregnant women who meet eligibility requirements may enroll in the CHIP program for expectant mothers.
Understanding the Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) is a U.S. federal healthcare program administered and named differently by each state. For example, the state of New York calls its program Child Health Plus while Arkansas calls its program ARKids. Similar to the way Medicaid works, the federal government provides matching funds to each state.
Responsibility for managing CHIP programs falls under the state’s Medicaid administration. In many instances, these families are unable to gain health insurance coverage for their children through an employer. Families must apply for CHIP and many are unaware of the program’s existence. In 2009, Congress allocated federal funds to help raise visibility and also help more families enroll. Sometimes children will qualify for children’s Medicaid rather than CHIP. An adult who lives more than half the time with the child may apply for the child.
Many medical services covered by CHIP are free but some require a co-payment. Some states also require a monthly premium that cannot exceed 5 percent of the annual household income. CHIP typically covers annual check-ups, immunizations, doctor visits, hospital care, dental and vision care, prescriptions, laboratory services, X-rays, and emergency services. Some states also extend coverage to parents and pregnant women.
CHIP coverage can begin at any time throughout the year with benefits becoming available immediately. Sometimes parents who qualify for Medicaid can enroll their child in CHIP so they don’t have to buy the coverage.
The benefits covered under CHIP are relatively standard, although some could vary on a state-by-state basis. According to its website, the following CHIP benefits are offered:
- Routine check-ups
- Doctor visits
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
- Mental health services
In most states, children up to age 18 are eligible for CHIP benefits. The income cut-off depends on the size of the family and the state they reside in. In addition, the following criteria for CHIP eligibility are from the Centers for Medicare and Medicaid Services website:
- Uninsured (determined ineligible for Medicaid and not covered through a group health plan or creditable health insurance)
- A citizen or meet immigration requirements
- A resident of the state
- Eligible within the state’s CHIP income range, based on family income, and any other state specified rules in the CHIP state plan
Typically, a family of four earning up to $106,000 before taxes (as of 2021) a year will qualify for CHIP, but the limits vary on a state-by-state basis.
When Congress passed the Affordable Care Act (ACA) in March 2010, many politicians and healthcare officials thought this new mandatory health insurance program would replace the need for CHIP, but that did not happen. Instead, we now have Medicaid, CHIP, and the ACA, so low-income families have increased confusion on which options are best for them.
Benefits and co-payments are not consistent among the various programs, so it's important to explore the many options before choosing one. Given the uncertainty surrounding the ACA, it remains to be seen what additional options and changes may be coming to affordable healthcare options for low-income families.
CHIP Insurance FAQs
What Are the Income Limits for CHIP?
Income limits for CHIP depend on the state, but for the most part, a family of four is covered if their annual income is $106,000 before taxes.
What Services Does CHIP Cover?
CHIP covers basic healthcare, including vision and dental care, prescriptions, emergency services, x-rays, sick visits, immunizations, annual checkups, and mental health services for eligible children age 18 and under.
Who Is Eligible for CHIP Insurance?
U.S. citizens or those who meet immigration requirements up to age 18 are eligible for CHIP benefits if their family meets the CHIP income requirements. You must reside in the state from which you are applying for CHIP benefits.