Children's Health Insurance Program (CHIP): Coverage Basics for Families
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CHIP provides low-cost coverage for children in families who earn too much for Medicaid. Here's how the program generally works across states.
What CHIP Is and Who It's Designed For
The Children's Health Insurance Program (CHIP) is a federally funded, state-administered program that provides low-cost health coverage to children in families who earn too much to qualify for Medicaid but can't easily afford private insurance. In some states, CHIP also covers pregnant women.
CHIP sits between Medicaid and the private market — it's designed for the gap families often fall into. For a broader picture of how government health programs compare, see how Medicaid and Medicare differ.
| Age limit | Up to age 19 in most states (Medicaid.gov, CHIP overview) |
| Typical income range covered | 200%–300% of Federal Poverty Level (Varies by state; some states set higher limits) |
| Enrollment period | Year-round (no open enrollment window) (Medicaid.gov) |
| Federal cost-sharing cap | 5% of family annual income (Federal CHIP statute) |
| Program type | Federal-state partnership; rules vary by state (Centers for Medicare & Medicaid Services (CMS)) |
| Covers pregnant women | In some states, through CHIP unborn child coverage (Medicaid.gov) |
Because CHIP is a joint federal-state program, eligibility limits, covered services, and costs vary by state. Families need to check their specific state's rules to understand what applies to them.
Eligibility: Income Limits and Age Ranges
Generally, CHIP covers children up to age 19. Income eligibility is measured as a percentage of the Federal Poverty Level (FPL), and most states set their CHIP cutoff somewhere between 200% and 300% of FPL — though some states go higher. A family of four earning around $60,000–$90,000 annually may qualify in many states, depending on where they live.
Children must be U.S. citizens or meet specific immigration status requirements. Most states do not have an asset test — income is typically the primary factor. For context on how Medicaid eligibility works alongside CHIP, Medicaid eligibility varies meaningfully by state.
Federal Poverty Level (FPL)
A measure of income issued annually by the federal government, used to determine eligibility for many assistance programs. CHIP income limits are expressed as a percentage of FPL, which varies by household size.
CHIP
Children's Health Insurance Program — a joint federal-state program providing low-cost health coverage to children in families with incomes above Medicaid thresholds but below the affordability range for private insurance.
Medicaid Expansion (CHIP context)
Some states run their CHIP program as an extension of Medicaid, meaning children in CHIP are enrolled directly in the Medicaid system with the same benefits and provider networks.
Cost-Sharing
The portion of healthcare costs paid by the enrollee, including premiums, copays, and deductibles. CHIP programs are required by federal law to keep total family cost-sharing under 5% of annual income.
Formulary
A list of prescription drugs covered by a health plan. CHIP programs include a formulary; medications not on the list may require a prior authorization or may not be covered.
Families who are unsure whether they qualify should apply — the application process generally screens for both Medicaid and CHIP simultaneously, so the program will match children to the right coverage tier.
What CHIP Typically Covers
Federal law requires all CHIP programs to cover a core set of services, though the exact scope depends on how a state structured its program. Standard covered services generally include:
- Routine well-child and preventive visits
- Immunizations and vaccinations
- Doctor visits, including sick care
- Prescriptions (formulary-based)
- Dental and vision care
- Emergency services and hospital care
- Mental health and substance use services
- Lab work and X-rays
CHIP plans are not identical across states. Some states run CHIP as a Medicaid expansion, using the same rules and provider networks. Others operate a separate program with different cost-sharing structures. Understanding these distinctions matters — for a foundation on how health coverage generally works, health insurance explained is a useful reference.
Two Types of CHIP: Know the Difference
States run CHIP either as a Medicaid expansion — enrolling children directly into Medicaid — or as a separate state program with its own benefits and provider network. A third approach blends both. Which model your state uses affects which doctors accept your child's coverage and what services are included. Your state's CHIP agency website is the most reliable place to check the current structure.
Costs, Enrollment, and How to Apply
CHIP premiums, copays, and deductibles are intentionally modest compared to private plans, and federal law caps total out-of-pocket costs for families at 5% of annual income. Many lower-income families pay little to nothing in premiums.
7M+
Children enrolled in CHIP nationally
According to CMS enrollment data, CHIP covers more than 7 million children in a typical year.
~$0
Premiums for lowest-income CHIP families
Many families near Medicaid thresholds pay little or no monthly premium under CHIP, depending on the state.
Enrollment is not limited to a specific open enrollment window — families can apply year-round. The primary application route is through the state Medicaid agency, through HealthCare.gov, or through a state marketplace. If a child is already enrolled in Medicaid and the family's income rises, they may transition to CHIP automatically in many states.
For families whose children don't qualify for either Medicaid or CHIP, community health centers are another resource worth exploring — community health centers offer sliding-fee care regardless of insurance status.
This article provides general educational information about CHIP and is not legal, financial, or medical advice. Eligibility rules, covered services, and costs vary by state and change over time. Always consult your state's CHIP agency or a licensed insurance navigator for guidance specific to your situation.
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