What is CHIP Insurance?

Children’s Health Insurance Program (CHIP) is a national program run by state governments in the United States to provide affordable health coverage to children from low-income families who do not qualify for Medicaid. Since its inception in 1997, CHIP has provided health coverage to millions of children who would otherwise be uninsured. The program covers a wide range of services, including doctor visits, hospital care, routine check-ups, immunizations, dental and vision care, and prescription drugs.

Who Qualifies for CHIP?

CHIP provides affordable health coverage to children under the age of 19 whose parents earn too much to qualify for Medicaid but cannot afford private health insurance. Eligibility for CHIP varies by state, but generally, children in families with incomes up to 200% of the federal poverty level are eligible for the program. In some states, children in families with incomes up to 300% of the federal poverty level may also qualify.

CHIP is available to children regardless of their immigration status. Children who are citizens, permanent residents, refugees, or undocumented immigrants may be eligible for CHIP coverage.

How Does CHIP Work?

CHIP is administered by state governments, which receive funding from the federal government to operate the program. States have flexibility in designing their CHIP programs, but they must provide certain core benefits required by federal law. States may also choose to offer additional benefits and services, such as hearing aids, speech therapy, and chiropractic care.

CHIP benefits vary by state, but they generally cover a wide range of preventive and essential health services, including:

CHIP benefits are typically provided through managed care organizations (MCOs), which are private companies that contract with states to provide health care services to CHIP enrollees. In some states, CHIP benefits are provided through fee-for-service arrangements, where doctors and other health care providers are paid on a per-service basis.

How to Apply for CHIP?

The process for applying for CHIP varies by state, but generally, families can apply online, by phone, by mail, or in person at their local Medicaid or CHIP office. Families will need to provide information about their income, household size, and citizenship or immigration status to determine eligibility for the program. In some states, families may need to provide additional documentation, such as proof of income or residency.

Once a family is determined to be eligible for CHIP, they will need to select a health plan from the options available in their state. Families can choose from several managed care organizations (MCOs) that contract with the state to provide health services to CHIP enrollees. Families can choose the MCO that best meets their health care needs and preferences.

FAQ

What is the difference between CHIP and Medicaid?

CHIP and Medicaid both provide health coverage to low-income individuals and families, but they serve different populations. Medicaid covers certain low-income individuals and families, including pregnant women, children, and people with disabilities. CHIP provides health coverage to children under the age of 19 whose families earn too much to qualify for Medicaid but cannot afford private health insurance.

Is CHIP free?

No, CHIP is not free. Families enrolled in CHIP may be required to pay premiums, copayments, or deductibles, depending on their income and the benefits provided by their state’s CHIP program. However, CHIP premiums and cost-sharing are generally much lower than those of private health insurance plans.

What happens if my income changes while my child is enrolled in CHIP?

If your income changes while your child is enrolled in CHIP, you may need to report the change to your state’s CHIP program. Depending on the nature and extent of the income change, your child may become ineligible for CHIP or may need to switch to a different level of coverage.

What services are covered by CHIP?

CHIP benefits vary by state, but they generally cover a wide range of preventive and essential health services, including doctor visits, hospital care, routine check-ups, immunizations, dental and vision care, and prescription drugs.

Can my child stay on CHIP if I get a job that provides health insurance?

It depends on the state and the specifics of the job-based health insurance. In some cases, children enrolled in CHIP may be eligible to continue receiving coverage even if their parents or guardians obtain health insurance through their employer. However, in other cases, CHIP coverage may end automatically when a child’s parent or guardian obtains job-based health insurance.