What is CHIP in Healthcare?

What is CHIP in Healthcare – Overview

The Children’s Health Insurance Program (CHIP) is a federally funded program administered by states.

CHIP offers insurance coverage for uninsured children under 19 years old whose families earn too much to qualify for Medicaid but cannot afford private insurance. Congress passed CHIP in 1997, during the Clinton administration.

CHIP benefits are awarded to a family of four that earns less than US$ 106,000 per year (before taxes). However, the limits vary from state to state. This insurance initiative is designed to help families who do not qualify for Medicaid but cannot afford private health insurance coverage. Several services are provided under CHIP, and some may require co-payments.

In addition, some states require beneficiaries to pay a monthly premium that cannot exceed 5% of their family’s annual income. While CHIP primarily covers children, some states extend CHIP coverage to pregnant women under CHIP’s unborn child option.

What is the Children’s Health Insurance Program (CHIP)

What is CHIP in Healthcare

What is CHIP in Healthcare – What is the Children’s Health Insurance Program (CHIP)?

The Children’s Health Insurance Program, or CHIP, is a US Federal healthcare program administered in every state and may be known by another name. The state’s Medicaid administration also handles the CHIP program.

Many families cannot obtain health insurance coverage for their children through employers. In such a case, the family must apply for CHIP, but many are unaware that the program exists. Depending on the family’s income, children can qualify for Medicaid instead of CHIP.

In addition, an adult who lives more than half the time with their child can apply for a CHIP policy for the child.

CHIP offers coverage for several medical services, but some may require co-payments. Some states also require CHIP policy-holders to pay a monthly premium, which cannot exceed 5% of the household’s annual income.

CHIP covers a range of services, including check-ups, immunizations, dental and vision care, inpatient/outpatient hospital care, and emergency services. Some states use CHIP funding to provide coverage for pregnant women.

CHIP enrollment is open year-round, and coverage starts immediately upon approval. Parents eligible for Medicaid can also have their children covered by CHIP, eliminating the need for additional private insurance.

What Are the Benefits of Chip

CHIP offers coverage for standard medical benefits, though the specific benefits may differ slightly from state to state.

Here are the expected benefits offered under CHIP:

  • Normal check-ups
  • Prescriptions
  • Dental care
  • Vision care
  • Doctor visits
  • Inpatient and outpatient hospital care
  • Emergency medical care
  • Laboratory services
  • X-ray tests
  • Mental health services

How to Be Eligible for Chip

Usually, states consider children below 18 years to be eligible for enrolling in CHIP and getting benefits. The income criteria depend on the size of the family and the state of residence. Apart from this, the following criteria determine the eligibility for CHIP benefits for applicants:

  • U.S. citizen or lawful resident meeting specific immigration criteria
  • A resident of the state offering the CHIP coverage
  • Uninsured and not eligible for Medicaid or other group health coverage
  • Eligible within the individual state’s income range, family income, and other state-specific rules that may apply

What Is the Income Cut-off for Chip Eligibility

Though different states have varying income cut-off limits for eligibility for CHIP benefits, a family of four that earns less than US$ 106,000 per year (pre-tax) can enroll in the CHIP program.

How to Apply and Enroll in Chip

There are two main ways that you can apply for, enroll in, and receive CHIP benefits. These are:

1 – Call Directly

You can call 1-800-318-2596 (TTY: 1-855-889-4325) and talk to the state’s CHIP representative.

2 – Health Insurance Marketplace

You can also fill out an online application form through the Health Insurance Marketplace. If you think that a child in your household qualifies for CHIP or Medicaid, you will need to contact the Marketplace so they can send your information to the state agency. The state agency will then contact you for enrollment.

Once you submit your Marketplace application, you can find out if you qualify for an individual insurance plan with savings, according to your income.


The U.S. Congress established the Children’s Health Insurance Program (CHIP) to provide health insurance to children whose families do not qualify for Medicaid and cannot afford private insurance. Low-income families of four earning less than US$ 106,000 per year are usually eligible to enroll their children in CHIP.

See Also

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Medical Insurance for Children

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Current Version
October 8, 2022
Written By
Shubham Grover
March 18, 2024
Updated By
Andrea Morales G.

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