CHIP — the Children’s Health Insurance Program — was created in 1997 to fill a coverage gap that left millions of children uninsured: their families earned too much to qualify for Medicaid, but couldn’t afford private health insurance. Today CHIP covers approximately 7 million children in low- to moderate-income families with low monthly premiums, small copays, and comprehensive benefits that rival most private plans.
CHIP is a federal-state partnership, so eligibility rules, income limits, and benefit details vary by state. Some states run CHIP as a separate program; others fold it into their Medicaid program. Either way, one application determines which program a child qualifies for.
CHIP vs. Medicaid: What’s the Difference
- Medicaid covers the lowest-income households — typically up to 133–138% of the federal poverty level (FPL) for children in states that adopted ACA expansion. Coverage is free in most cases
- CHIP covers children in families that earn too much for Medicaid but still can’t afford private insurance — typically between 138% and 200–300% FPL, with some states going up to 400% FPL. CHIP may have small premiums and copays
There’s no sharp cutoff between the two programs in practice — the same application at Healthcare.gov or your state agency determines which program applies to your child based on income. The two programs also have similar benefits, so the distinction matters mainly for cost (Medicaid is generally free; CHIP has modest costs).
Who Qualifies for CHIP
- Age: Children under 19 in most states
- Income: Household income between your state’s Medicaid limit and CHIP limit — typically 200–300% FPL. Use Healthcare.gov’s income screening tool to check your state’s specific limits
- Citizenship: U.S. citizens and certain lawfully present immigrants. Most states require a 5-year waiting period for newly arrived lawful immigrants before they can enroll in CHIP, though some states use state funds to waive the wait
- Other coverage: Most states require that the child not have access to affordable employer-sponsored insurance that meets minimum standards
CHIP for Pregnant Women
Several states have expanded CHIP to cover uninsured pregnant women who don’t qualify for Medicaid — an option called the “unborn child” provision. This allows states to cover prenatal care and delivery through CHIP. Check your state’s Medicaid and CHIP agency to see if this option is available where you live.
What CHIP Covers
CHIP coverage is comprehensive — similar to what many employer plans provide. Standard benefits include:
- Well-child visits and immunizations
- Primary care and specialist visits
- Emergency room and hospital care
- Dental care — both preventive and restorative, included in most CHIP plans (unlike most adult insurance plans)
- Vision care and eyeglasses
- Prescription drugs
- Mental health and substance use disorder treatment
- Laboratory tests and X-rays
How Much CHIP Costs
Costs are kept low by design. In many states, CHIP is free for families below 150% FPL. For families above that threshold:
- Monthly premiums typically range from $0 to about $50 per family, depending on income and state
- Copays are small — often $5–$10 per doctor visit, $0 for preventive care
- By federal law, a family’s total CHIP out-of-pocket costs cannot exceed 5% of family income per year
How to Apply
- Healthcare.gov — complete an application; the system determines whether your child qualifies for Medicaid or CHIP and routes accordingly
- Your state Medicaid/CHIP agency — apply directly online, by phone, or in person
- Anytime of year — unlike marketplace plans, CHIP has no open enrollment window. You can apply whenever your child needs coverage
Common questions
- “My family earns above Medicaid limits. Can we still qualify for CHIP?” Yes — that’s exactly what CHIP is designed for. Run the eligibility screener at Healthcare.gov or your state site
- “Does CHIP affect immigration status?” As of current federal guidance, using CHIP for a child’s healthcare coverage is not considered a public charge factor. If you have immigration concerns, consult a qualified immigration attorney
- “My child turns 19 — what happens?” CHIP eligibility ends at 19 in most states. At that point, your child may qualify for Medicaid (if income is low enough), a parent’s employer plan, or a marketplace plan. Start planning a few months before the birthday
Educational only. CHIP income limits, premiums, and covered services vary by state and change annually. Confirm current details at healthcare.gov or with your state Medicaid and CHIP agency.