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Learn About CHIP Insurance

CHIP, otherwise known as the Children’s Health Insurance Program, provides health insurance to millions of children who would otherwise not have health care coverage. The program is jointly funded by the federal and state governments, though states often have their own version of the program with unique names, such as variations indicating that the program provides health insurance for kids.

CHIP insurance was created to provide health care coverage to children whose families do not qualify for Medicaid but cannot afford private health insurance. In order to qualify for the program, applicants must meet certain criteria regarding their income and the child’s age.  To learn how to get CHIP benefits for your child and find out more about coverage options, costs and the application process, continue reading the information below.

What is the Children’s Health Insurance Program?

CHIP healthcare covers children whose families have incomes too high to qualify for Medicaid but too low to pay for private healthcare. Children with CHIP coverage can receive:

  • Preventive care,
  • Wellness services,
  • Primary care visits,
  • And more.

Since CHIP was first established in 1997, each state has expanded and customized the program based on the needs of its residents. The Affordable Care Act (ACA) granted states the chance to expand CHIP eligibility to provide coverage to more children in 2014. Today, the program covers more than 9.4 million children throughout the United States.

How to Qualify for CHIP

To be eligible for CHIP coverage, applicants must meet all the requirements of the health insurance program. Generally, the program is open to children younger than 19 years of age who do not currently have health insurance coverage. Additionally, families must have a combined annual income that is too high to enroll in Medicaid but too low to afford private healthcare.

CHIP income limits are determined by each state. They are the most important factor in determining eligibility for CHIP. The income thresholds vary across the U.S. but are typically up to or above 200 percent of the Federal Poverty Level (FPL).

In addition to income requirements, applicants must have citizenship or lawful presence within the United States. All applicants must be able to provide the necessary documents to verify this information.

In addition to children, pregnant women may also qualify for coverage through the program. CHIP eligibility for pregnant women is not determined by the woman’s age – only her income and citizenship status. Pregnant women who qualify for the program cannot be charged for preventive care or pregnancy-related services and are not subject to a waiting period before enrolling in coverage.

Note: Other applicants may be subject to a waiting period after applying for CHIP. Learn more in the section provided below.

How to Apply for CHIP

The Health Insurance Marketplace is an online portal for government benefit programs, including CHIP. To apply for CHIP coverage, you can fill out a form through this online portal that will be analyzed by the system to determine if you meet CHIP eligibility requirements. If so, you will automatically be referred to your state’s CHIP agency, where a state representative will contact you about any additional information or documents that you may need to submit during the CHIP application process.

You may also choose to submit a CHIP application directly to your state’s Medicaid agency. The steps of the application process and the acceptable methods by which you may apply vary by state. Your state may allow you to apply for CHIP in the following ways:

  • Online,
  • By mail,
  • Or in person at a local office.

Most CHIP healthcare application forms require you to submit them along with a handful of documents in order to confirm your qualifications for the program. If you do not submit all the necessary documents, your benefits could be delayed, and your enrollment may be denied.

Find Out About CHIP Waiting Periods

Sometimes, an applicant’s CHIP enrollment is subject to a waiting period before he or she can begin receiving benefits. A waiting period is a specific amount of time that an applicant must wait before coverage kicks in. The duration of the waiting period may vary between states, but it typically spans one to three months.

Currently, 15 states implement waiting periods upon the approval of an application. However, many outline certain exemptions for qualified applicants, who may bypass the waiting period and receive coverage immediately.

Learn About CHIP Coverage and Benefits

CHIP health insurance provides coverage for a variety of medical services. While there are some services that vary between states, CHIP does have a few mandatory benefits that all states must provide coverage for.

The following benefits are included in all CHIP plans nationwide:

  • Vaccinations
  • Well-baby and well-child visits
  • Dental care (specific services and coverage can vary)
  • Behavioral health care

Aside from these mandatory benefits, states may choose to add other medical services or coverage options. Similarly, states have the ability to offer CHIP as a separate health care program, a Medicaid expansion program or a combination of both.

States that provide CHIP coverage through a Medicaid expansion offer the same benefits as Medicaid. Otherwise, the program will provide either benchmark or equivalent coverage, which means that coverage must be equal to that of the health care plans provided to state or federal government employees.

Learn About CHIP Costs

The Children’s Health Insurance Program is designed to provide comprehensive medical coverage to children at an affordable cost. If you qualify for CHIP benefits, your cost to maintain insurance coverage depends on the state you reside in as well as your income. You may need to pay the following charges:

  • A premium
  • Enrollment fees
  • Deductibles
  • Coinsurance
  • Copayments

Generally, fees associated with CHIP coverage cannot exceed five percent of your family’s yearly income. Likewise, the cost of coverage cannot be more than the amount allowed for the state’s Medicaid program for families with incomes at or below 150 percent of the Federal Poverty Level.

Note: There are no fees charged for certain medical services provided through the Children’s Health Insurance Program. These include well-baby visits and well-child visits.