Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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The lowdown...

  • The Children’s Health Insurance Program, also known as CHIP, is an insurance program that can help provide low-cost insurance for children
  • It is designed for families that have an income high enough to disqualify them for Medicaid but may still need help covering the cost of their children’s insurance
  • Depending on your state, CHIP may also cover pregnant women
  • There are a few different ways to apply for CHIP and you can apply at any time

When was this program implemented?

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The Children’s Health Insurance program was first passed along with the Balanced Budget Act of 1997 and is listed under Title 21 of the Social Security Act. In 2009, it was reauthorized with the CHIP reauthorization.

Act and has been extended several times since then. Currently, the program is authorized to stay in place through September 2017. Congress will need to approve and extend the act again in order for the program services to continue beyond this expiration date.

Although the program is administered by the states, there are some federal restrictions in place, such as the restriction against imposing eligibility standards and other similar procedures that may limit access to the program. However, there may be waiting lists for children depending on the state and the amount of children eligible for coverage.

Some states will cover pregnant women due to the established link between infant health and the health of the pregnant mother. Prenatal care may be covered in these states and the mother’s eligibility will be determined by her income in relation to the federal poverty line.

Your child deserves the best healthcare out there; now you can get it for them. Click here to enter your zip code and compare free health insurance quotes online for the whole family.

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How do I apply?

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There are several different ways that you can apply for the Children’s Health Insurance Program. Each state determines their own rules for eligibility and coverage. You can apply through your local Medicaid office because when you apply for Medicaid, you will also be notified of your eligibility for CHIP, if applicable.

You can also call the CHIP phone number and speak to a representative who will explain your options to you and help you with the application procedure. Your other option is to fill out an application on the Affordable Care Act Health Insurance Marketplace website. If it looks like you are eligible for either Medicaid or CHIP, they will send your information to your state’s Medicaid office who will then contact you about enrollment.

You can apply for and enroll in this program at any time. There is no enrollment period and deadline like there is with many Healthcare Marketplace plans. If you are eligible and enroll, your insurance coverage can start right away, so there will be no waiting period for your children.

You do have the option to decline coverage through the Children’s Health Insurance Program and enroll in a Marketplace plan or some other type of health insurance, as long as it meets the minimum essential coverage requirements. However, you will not be eligible for any savings for a Marketplace plan for your children if they can have CHIP coverage.

Under these circumstances, it would probably be most cost effective for you to enroll your children in CHIP. You can still purchase a plan for yourself through the Marketplace if you are not eligible for Medicaid.

What does the Children’s Health Insurance Program cost?

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Check up visits with your child’s primary care physician are free under CHIP coverage, as are routine dental visits. Any additional medical services may require a copayment. Additionally, some states do charge a monthly premium amount for your child’s coverage through the Children’s Health Insurance Program.

It is mandatory that any costs for CHIP do not exceed any more than five percent of your family’s total income for the year, so you can have some assurance that your out-of-pocket costs will not be too excessive.

What medical services does it cover?

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Again, benefits are different in each state. However, there are a few mandatory services that all states must cover for your children. These include all well check ups, vaccinations, sick visits to the doctor, emergency medical care, and visits to the hospital, lab tests, and x-ray services, and prescriptions.

Additionally, dental and vision care must be covered. Some states provide more than just these basic services. You can check your state’s specific CHIP benefits using the state index on the insurekidsnow.gov website.

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Using CHIP coverage

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If you are having any issues with your coverage, you should contact your local Medicaid or CHIP agency. There should be a member services phone number located on the back of your insurance card or your letter of eligibility if you have not yet received a card. You should also contact them if you are having trouble finding a doctor who accepts this insurance or you can not get an appointment.

Your state agency should have a list of providers who accept the program and be able to assist you in this matter. If you are having issues filling your prescription because you have not received an enrollment card yet, but the pharmacy accepts the program, take your eligibility letter to the pharmacist.

In a worst case scenario, most pharmacies will be able to give you enough medicine for three days with a prescription, during which time you can contact a CHIP representative for help.

The Children’s Health Insurance Program was implemented to help families pay for health coverage for their children at an affordable rate. Although each state outlines its own eligibility and benefits guidelines for the program, it is available in each state and will cover basic health services for your child if you qualify.

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