Health insurance is not optional — especially for children who are still growing and vulnerable to a wide range of injuries and illnesses. For parents who live paycheck to paycheck, private health insurance is simply a luxury they just can’t afford.
And for this reason, CHIP puts health coverage within reach for uninsured children in low-income families — the group arguably the most in need of health insurance.
CHIP, which had 9.6 million children enrolled in 2018, complements Medicaid by covering uninsured children above Medicaid eligibility limits.
CHIP & Medicaid
Both programs are an effort from the national federal government and local state governments to provide free or low-cost health coverage for our nation’s children, covering nearly 40% children overall.1
Medicaid is the first choice for many low-income families, as this program deals specifically with insuring children from low-income families — those with income up to 133% of the poverty level.
However, some families may earn ‘too much’ to qualify for Medicaid benefits but whose income is ‘too little’ to afford getting insurance on their own.
For those above the Medicaid limit, CHIP comes in to bridge the gap, as it aims to cover uninsured children in families that fit into this stuck-in-the-middle category.2 In some states, CHIP covers parents and pregnant women.
CHIP Premiums & Cost-Sharing
States set CHIP premiums within federal guidelines. CHIP premiums are often determined on a sliding scale and cost-sharing is capped at 5% of total family income.
For example, more than half of states do not charge premiums for separate CHIP coverage for families at 151% FPL. In the 11 states that charge premiums for separate CHIP coverage at this income level, the average monthly premium is about $18 per child per month.
For families at 201% FPL, half of states with separate CHIP charge premiums of less than $10 per child per month. In the 22 states charging premiums at this income level, the average monthly premium is about $24 per child per month.3
Are my KIDS eligible for CHIP?
These programs are state-specific, but in most states, uninsured children under the age of 19 in families with incomes up to 249% of the federal poverty level, are likely to be eligible for coverage.4
Under the Affordable Care Act, more than half of the states (27, including D.C.) cover children in families with incomes at or above 250% FPL and 20, including D.C., cover children in families with incomes at or above 300% FPL.
While the funding is a collaborative effort from both federal and state governments, it is usually up to the states to design their policies and eligibility standards.
Currently, 7 states including District of Columbia operate CHIP through their Medicaid program; 15 states operate a separate CHIP program; and 28 states use a combination approach.
What CHIP Covers?
The benefit packages vary among states, but all tend to include
- regular checkups,
- eye exams and glasses,
- dental cleanings and filings,
- prescription drugs,
- access to medical specialists,
- mental health care,
- hospital care,
- lab tests,
- treatment of pre-existing needs and
- treatment of other special health needs.
How do I Apply for CHIP?
To get started, make a free call to 1-877 KIDS NOW (1-877-543-7669) where you’ll be connected directly to a representative from your state who will help you apply.
You may probably want to use this screener tool at HealthCare.gov to see if you and your family qualify for CHIP and Medicaid.
What if I’m denied for Medicaid or CHIP coverage?
If you’ve been denied for Medicaid or Children’s Health Insurance Program (CHIP) coverage by your state, you may be able to buy “subsidized private coverage” through the Marketplace instead.