What is CHIP in Healthcare?

What is CHIP in Healthcare What is CHIP in Healthcare

What is CHIP in Healthcare – Overview

The Children’s Health Insurance Program (CHIP) is a federal affordable healthcare insurance program run by the federal government in collaboration with state authorities.

CHIP offers insurance coverage for medical expenses for individuals below 18 years of age, especially those youngsters whose parents earn enough income to not qualify for Medicaid but not enough income to pay for private insurance coverage. 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 change that is less than 5% of their annual income. This program also offers coverage to pregnant women who meet the specific eligibility criteria for CHIP enrollment.

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

What is CHIP in Healthcare

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

The Children’s Health Insurance Program, known as 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.

Often, families cannot get health insurance coverage for their children through employers. In such a case, the family needs to apply for CHIP, but many are unaware that the program exists. At times, children may qualify for Medicaid but not for 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 types of medical services, but some may require co-payments. Some states also require CHIP policy-holders to pay a monthly premium, which cannot be more than 5% of the household’s annual income.

Some of the medical services covered under CHIP include annual check-ups, x-rays, laboratory services, immunization, dental care, vision care, hospital care and emergency medical services. Some states also extend CHIP coverage to include parents or pregnant women.

CHIP coverage can begin at any time throughout the year and the benefits become available immediately. At times, parents who qualify for Medicaid can enroll their children in CHIP, so they don’t need to buy additional private insurance coverage for their children.

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:

  • US citizen or meet immigration requirements
  • A resident of the state
  • Uninsured individuals (determined ineligible for Medicaid, group or creditable health insurance)
  • 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 use to 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 and qualify 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 US Congress launched the Children’s Health Insurance Program (CHIP) to provide health insurance coverage to children who do not qualify for employer-sponsored Medicaid or private health insurance policies. Low-income families of four who earn less than US$ 106,000 per year are usually considered eligible to enroll their children in CHIP.

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