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All About CHIP Insurance


Having to face healthcare expenses without insurance coverage is impossible for most families. Families who need help paying for healthcare for their children may qualify for CHIP insurance coverage. CHIP stands for Children’s Health Insurance Program. 

What Is CHIP Insurance?

Since 1997, low-income families with children who aren’t eligible for Medicaid have been able to apply for insurance coverage through CHIP. While CHIP typically provides affordable insurance for children and teens, it’s available for pregnant women in certain states, too.

CHIP benefits vary from state to state. But at the very least, the coverage provided through every state’s program is considered minimum essential coverage. That’s the kind of insurance coverage you need to have in order to avoid paying a fine. Having minimum essential coverage means that your health insurance plan provides basic benefits.

Anyone with CHIP insurance coverage can visit a doctor and receive prescriptions and immunizations. Children (and pregnant women) enrolled in CHIP also have access to emergency services, lab services, hospital care and dental and vision care.

How Children’s Health Insurance Programs Operate

All About CHIP Insurance

States primarily have control over their own Children’s Health Insurance Programs and the way they operate. But because they’re funded at the state and national level, they’re required to abide by rules and guidelines created by the federal government. Each state receives a certain amount of federal funding each year once it agrees to match a percentage of those funds.

Each state has its own version of CHIP. In three states, Connecticut, Washington and Arkansas, CHIP and Medicaid act as two separate programs. But most states have a program that offers a mixture of both kinds of health insurance coverage.

In a handful of cases, CHIP is run in tandem with Medicaid as an extension of the state’s program. In these instances, children enrolled in CHIP receive the same benefits as Medicaid recipients. And any premiums and healthcare costs that they must pay out of pocket are either low or non existent.

In some states, parents have to pay a monthly premium when their children have CHIP insurance. But premium costs are never more than 5% of a family’s annual household income. Generally, children with CHIP insurance coverage can go to the dentist or see a doctor for a routine checkup for free.

Qualifying for CHIP Insurance Coverage

According to the Medicaid and CHIP Payment and Access Commission, 9.46 million people had health insurance coverage funded through CHIP in fiscal year 2017. To find out whether your children are eligible for CHIP insurance coverage, you’ll need to check with your state’s individual program. If you’re pregnant, it’s best to find out whether you’ll be covered under your state’s program before applying for CHIP.

In general, in order to qualify for CHIP, your child must fall under the age of 19 and be a U.S. citizen, a permanent resident or a legal alien. The child must also be a dependent. So any legal guardian or relative who spends more than half the year with a child without insurance may be able to apply for CHIP insurance.

In order for a child to be eligible for CHIP coverage, a family’s pre-tax annual household income must also fall under a certain threshold, depending on the size of that household. If your children are eligible for CHIP, your income level determines whether you’re required to pay a premium and cover other costs such as a deductible or a copayment.

How to Apply for CHIP Insurance

All About CHIP Insurance

With most health insurance plans, you apply for coverage during the open enrollment period. If you’re getting insurance through your employer, the open enrollment period usually takes places in the fall, and open enrollment for the Affordable Care Act begins Nov. 1 and ends on Dec. 15.

But anyone who wants CHIP coverage (or Medicaid) for a qualifying child or pregnant woman can apply for health insurance at any point during the year. You can begin your application over the phone (by calling 1-800-318-2596) and have it mailed to your home. Or you can complete an application online through the Health Insurance Marketplace.

Tips for Improving Your Financial Life

  • Unexpected medical expenses can wreak havoc on your finances, which is why it’s so important to have an emergency fund in place. Stash three to six months worth of expenses in CDs or a high-yield savings account. That way, you’ll have a cushion if something comes up.
  • It’s essential to plan for medical expenses when you consider your retirement income needs, and a financial advisor can be a big help here. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

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