Learn About Medical Services for Children Ineligible for Medicaid

About the Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) is a partnership between the state and federal governments that offers low cost health care to children who are members of families that do not qualify for Medicaid yet do not earn enough to pay for private health insurance coverage. While benefits may vary in different states, all states must provide comprehensive coverage, which includes the following: immunizations, prescriptions, dental care, vision care, laboratory services, emergency services, check-ups, doctor visits, inpatient hospital care and outpatient hospital care.

Typically, in order to qualify for CHIP, beneficiaries must be 18 years of age or younger and be members of a family with an annual income that is equal to or less than 200 percent of the federal poverty level. Currently, this means that a household of two may earn no more than $64, 080 in annual income, while a household of five can make no more than $113,760 in annual income, in order for a child in the household to qualify for CHIP coverage. However, these eligibility requirements may occasionally vary by state. Furthermore, while the CHIP program is available in all U.S. states, the name of the program may change depending upon the individual state. Additionally, some states may extend CHIP coverage benefits to pregnant women.

Potential beneficiaries may submit an application and enroll in CHIP at any time of the year. Once an applicant is determined to be eligible, his or her coverage may begin immediately. Depending on the state, CHIP may require a low monthly premium. Sometimes, families will have to pay around $15 to $20 per month for CHIP coverage, but the total monthly premiums for a year will never add up to more than 5 percent of a household’s annual income. To apply or simply find out if they qualify for CHIP, families can submit an application for health insurance through healthcare.gov. Alternatively, families may apply though the state’s Medicaid agency.

Find a Plan through Healthcare.gov

Many children may qualify for a low cost private health insurance plan by applying through the Healthcare Marketplace (healthcare.gov). Many applicants will qualify for savings based on income, and many successful applicants will find health coverage plans with premiums that do not cost more than $75 per month. Although some households will earn too little to qualify for savings on a private health care plan, interested applicants may still consider applying. Applicants may only submit an application for health care during a window that is typically open from November to January. However, applicants who experience a qualifying “life event,” including new employment or the addition of a new household member, will be able to apply outside of this period.

Other State Programs

Most states have their own additional low cost health care programs for children who come from families that do not qualify for Medicaid assistance. These programs have different names and eligibility requirements, but interested residents in need of health insurance coverage for their children should check to see what their states offer.