What Is CHIP?
CHIP (Children's Health Insurance Program) is a partnership between the federal government and states. It provides low-cost or free health coverage to children. If your family earns too much to qualify for Medicaid but you still need help paying for insurance, CHIP may be right for you.
CHIP has helped millions of children since 1997. It is one of the largest sources of health insurance for children in working families.
CHIP and Medicaid are different programs, but they work together. It's important to understand how they differ so you know what coverage your children may qualify for.
How CHIP Is Structured
CHIP is run by the federal government (the Centers for Medicare & Medicaid Services, or CMS) and individual states together. Each state runs its own CHIP program using federal guidelines. So eligibility, benefits, costs, and how to apply are different in each state.
States run CHIP in one of three ways:
- As a separate program — Independent from Medicaid, with its own enrollment, eligibility rules, and benefit design.
- As a Medicaid expansion — Covering children at higher income levels than standard Medicaid, but within the Medicaid framework (some or all of the same rules and benefits apply).
- As a combination — Some children are covered through a stand-alone CHIP program, while others are covered through Medicaid expansion, depending on income or other factors.
Because each state is different, you must check your specific state's CHIP program to learn about eligibility, benefits, and how to apply. MediPrimer's State Directory can help you find your state's CHIP contact information and website.
Who Can Apply for CHIP?
CHIP is for children who don't qualify for Medicaid because their family's income is too high. But they still need help paying for insurance. Each state sets its own income limits. These are usually based on the federal poverty level, which changes every year.
In most states, children and teenagers under age 19 can apply if they don't have insurance. Some states also cover pregnant women and parents under CHIP or similar programs, but this varies by state.
To be eligible, a child typically must:
- Be a U.S. citizen or qualified immigrant.
- Reside in the state where they apply.
- Have a family income above the Medicaid limit but below the CHIP income limit for that state (specific income thresholds vary by state and change annually).
- Not have insurance or have only limited coverage.
Income limits differ by state. A child might qualify in one state but not another. To find out if your children qualify, contact your state CHIP program or use the federal InsureKidsNow.gov portal.
CHIP Benefits
All CHIP programs include a full set of health benefits. The exact services vary by state, but all CHIP programs cover these core services:
| Service Category | Typical Coverage |
|---|---|
| Well-child visits and preventive care | Annual check-ups, developmental screenings, and preventive services at no cost |
| Immunizations | All recommended vaccines for children and teenagers |
| Doctor and specialist visits | Primary care and referrals to specialists; minimal or no copay |
| Hospital care | Inpatient and outpatient hospital services |
| Emergency services | Emergency room care and ambulance services |
| Prescription medications | Covered drugs on the state's formulary; copays vary |
| Dental care | Preventive and restorative dental services (coverage levels vary by state) |
| Vision care | Eye exams and glasses (coverage varies by state) |
| Mental health and substance use treatment | Counseling, therapy, and inpatient mental health treatment |
| Rehabilitative services and devices | Physical therapy, occupational therapy, and medical devices |
Most CHIP programs charge very little out-of-pocket. Many states offer free CHIP coverage for lower-income families. Other states charge small copays (your share of the cost) or monthly premiums (the cost to have the coverage) for higher-income families. Some states have no premiums or copays at all. Your state CHIP program will tell you what your family's costs would be based on your income.
How to Apply for CHIP
You can enroll in CHIP year-round in all states. Unlike the ACA Marketplace, there's no annual enrollment deadline. You can apply for CHIP at any time.
You generally have several ways to apply:
- Apply through your state Medicaid agency. Many states let you submit one application for both Medicaid and CHIP. Your state will decide which program your children qualify for based on income.
- Use InsureKidsNow.gov. This federal website helps you find your state's CHIP program. It provides links to online applications, phone numbers, and office locations.
- Contact your state CHIP program directly. You can apply by phone, mail, in person, or online, depending on your state. Find your state's contact information on the State Directory.
- Apply at your school or community health center. Some states and community organizations help families apply for CHIP and Medicaid.
No Waiting Period
CHIP has no waiting period. If you move to a new state, your child can apply for CHIP in that state right away. You don't have to wait for an open enrollment period.
CHIP vs. Medicaid: Key Differences
CHIP and Medicaid work together, but they are separate programs with important differences:
- Income levels: Medicaid covers children at lower income levels. CHIP covers children whose family income is above the Medicaid limit but below the CHIP limit (both set by state).
- Program design: Medicaid is a joint federal-state program that also covers adults, pregnant women, and people with disabilities. CHIP focuses on uninsured children in working families.
- Costs: Medicaid may have no premiums or copays. CHIP programs typically charge small premiums or copays, though many states offer free or very low-cost coverage.
- Funding: CHIP receives dedicated federal funding. Both programs are partially funded by states, but CHIP's federal funding is separate from Medicaid's.
Learn more about Medicaid eligibility and how it compares to other programs in our Medicaid Eligibility guide.
Coverage for Pregnant Women and Parents
Some states cover pregnant women or parents under CHIP or similar programs. This coverage is not required by federal law and varies widely by state. If you are pregnant or a parent seeking coverage, ask your state Medicaid or CHIP agency what programs are available in your state.
Understanding Your CHIP Coverage
Once you enroll in CHIP, your family will get an insurance card and information about:
- Your copay amounts (if any) for doctor visits, emergency care, and prescriptions.
- Any deductibles (the amount you pay before coverage starts) or annual out-of-pocket limits (the most you pay per year).
- Which doctors and hospitals are in your plan's network.
- How to request referrals to specialists.
- How to appeal if a claim or service is denied.
It's important to read these materials carefully so you understand your benefits and costs. If you have questions about your coverage, call the customer service number on your CHIP insurance card.
Finding Help and Support
If you need help understanding CHIP, applying, or managing your child's coverage, these resources can help:
- InsureKidsNow.gov — The federal website for finding and enrolling in CHIP. Also has information in multiple languages.
- Medicaid.gov — Official information about Medicaid and CHIP programs nationwide, with state-specific resources.
- MediPrimer State Directory — Find your state's CHIP program contact information and website.
- Getting Help Paying — Learn about financial assistance and support programs for families.
Important to Know
MediPrimer is an independent educational resource. We are not affiliated with CMS, Medicaid, any state agency, or any health insurance company. CHIP programs and rules change. Eligibility and benefits vary by state. Always check your state CHIP program or InsureKidsNow.gov before making enrollment decisions. Verify the current information with your state.
For more information about how different health coverage programs work and fit together, see our Coverage Basics guide.