If you're stuck in that frustrating middle ground where your family earns too much to qualify for Medicaid but not nearly enough to afford a $500-per-month health insurance premium for your kids, you're not alone. That's exactly the gap the Children's Health Insurance Program (CHIP) was designed to fill. This federal and state partnership provides comprehensive, affordable health coverage to millions of children across the country, and there's a good chance your family qualifies.
In this guide, we'll walk you through everything you need to know about CHIP: who qualifies, what it covers, how it compares to Medicaid, and exactly how to apply. Whether you're a parent researching options for the first time or someone who's heard about CHIP but isn't sure if it's right for your family, you'll find the answers you need here.
What Is CHIP and Who Does It Cover?
CHIP is a joint federal and state program that provides health insurance to uninsured children and, in some states, pregnant women. It's specifically designed for families whose income is too high to qualify for Medicaid but too low to comfortably afford private health insurance. Think of it as a safety net that catches families in that uncomfortable middle zone.
Generally, CHIP covers children up to age 19. As of October 2024, approximately 37 million children across the United States were enrolled in either Medicaid or CHIP programs. The program is currently funded through fiscal year 2027, providing stability and peace of mind for families who depend on it.
Each state runs its own CHIP program within federal guidelines, which means the specific name, benefits, and income limits can vary depending on where you live. For example, in Texas it's simply called CHIP, while other states use different names. But the core mission remains the same: ensuring children have access to quality healthcare regardless of their family's financial situation.
Who Qualifies for CHIP?
Eligibility for CHIP depends on both financial and non-financial criteria. Let's break down what you need to know.
Income Requirements
Financial eligibility is based on your Modified Adjusted Gross Income (MAGI), which is the same calculation used for Medicaid and Affordable Care Act tax credits. In most states, children in families earning up to $60,000 per year for a family of four may qualify, though many states set even higher limits.
Income limits vary significantly by state, ranging from as low as 170% of the federal poverty level to as high as 400% in some states. To put that in perspective, North Dakota sets CHIP eligibility between 138% and 175% of the federal poverty level, while New York allows enrollment for families earning up to 405% of the poverty level. This means that in some states, a family of four earning over $100,000 annually could still qualify.
Other Eligibility Requirements
Beyond income, your child must be uninsured and not eligible for Medicaid. They also need to be U.S. citizens or meet immigration requirements such as being lawful permanent residents. Your child must live in the state where they're applying for coverage.
An important 2025 update: states are no longer allowed to terminate a child from CHIP solely because they become incarcerated, though coverage may be suspended. Additionally, as of 2024, all states must provide 12 months of continuous eligibility for children in CHIP. This means if your income temporarily increases during the year, your child won't immediately lose coverage.
CHIP vs. Medicaid: Understanding the Difference
Many families wonder whether their children should be on CHIP or Medicaid. Here's the key distinction: Medicaid serves children from families earning 133% of the federal poverty level or less, while CHIP covers those whose families earn more than that but still can't afford private insurance.
The biggest practical difference is cost. Children's Medicaid is completely free, with no enrollment fees, premiums, or co-pays for services. CHIP, while still extremely affordable, does have small costs: enrollment fees of $50 or less per family per year, and co-pays that vary based on your income.
In terms of benefits, both programs are comprehensive, but Medicaid includes something called Early and Periodic Screening, Diagnostic and Treatment (EPSDT), which guarantees all "medically necessary" services for children. CHIP must provide benefits equivalent to what state employees receive, which is still robust but may have slightly different coverage requirements depending on your state.
When you apply, the system automatically determines whether your child qualifies for Medicaid or CHIP based on your income, so you don't have to figure it out yourself. If you're eligible for Medicaid, you'll be enrolled there first since it has no cost.
What Does CHIP Cover?
CHIP provides comprehensive health coverage that includes everything your child needs to stay healthy. The benefits typically include doctor visits, prescriptions, dental care and teeth cleaning, eye care and glasses, hospital care, laboratory and X-ray services, immunizations, and emergency services.
What this means in practical terms: if your child gets strep throat, CHIP covers the doctor's visit and the antibiotics. If they need braces, the dental portion helps. If they break their arm playing soccer, the emergency room visit, X-rays, and follow-up orthopedic care are all covered. The coverage is designed to handle both routine preventive care and unexpected medical needs.
One significant improvement as of April 2024: the elimination of waiting periods. Previously, some states required families to wait before CHIP coverage could begin. Now, eligible applicants can access healthcare immediately upon approval, which is crucial when your child needs care right away.
How to Apply for CHIP
The good news is that there's no open enrollment period for CHIP. You can apply any time of year, and if you qualify, coverage can start immediately. Here are your application options:
Online through HealthCare.gov: Create an account or log into your existing account and fill out an application. The system will automatically determine if your child qualifies for Medicaid or CHIP and send your information to your state agency, who will contact you about enrollment.
By phone: Call 1-800-318-2596 (TTY: 1-855-889-4325) to speak with someone who can help you through the application process.
Through your state: You can also apply directly through your state's CHIP program or by mail. Visit www.insurekidsnow.gov to find your state's specific application process and contact information.
When you apply, you'll need to provide information about your household income, family size, and your children's citizenship or immigration status. The process is streamlined thanks to a 2024 regulation that simplified Medicaid and CHIP enrollment and renewal procedures.
Taking the Next Step
If you've been putting off getting health insurance for your children because you thought it was unaffordable, CHIP might be exactly what you need. The program has helped millions of families ensure their children can see a doctor when they're sick, get their teeth cleaned regularly, and receive care without creating financial hardship.
Don't assume you won't qualify based on your income alone. With limits ranging up to 400% of the federal poverty level in some states, many middle-class families are eligible. The application process is free, and the worst that can happen is you find out you don't qualify. But if you do qualify, you'll gain access to comprehensive health coverage at a fraction of the cost of private insurance. Start by visiting HealthCare.gov or calling 1-800-318-2596 to see if your family qualifies today.
