CHIP is a separate program from Medicaid, though the two often work together

CHIP (the Children's Health Insurance Program) covers children whose family income is too high to meet Medicaid limits but too low to afford private insurance. It is a federal program run by states, meaning each state sets its own income thresholds, copays, and covered services. CHIP is not Medicaid, but many states use Medicaid to deliver CHIP coverage — so your child might be enrolled in "Medicaid" on paper while actually receiving CHIP benefits.

The key difference: Medicaid covers low-income people of any age. CHIP covers only children and teenagers, usually up to age 19. If your child's income level makes them ineligible for your state's Medicaid program but you cannot afford private insurance, CHIP is often the next step.

Because CHIP is state-run, the income cutoff, what it covers, and what you pay out of pocket vary significantly by state. A family that qualifies in one state may not may have access to in another. The federal government sets a floor — states must cover children up to at least 200 percent of the federal poverty line — but many states go higher.

Key Takeaways

  • CHIP covers uninsured children and teenagers whose family income exceeds Medicaid limits but falls below the state's CHIP threshold, which varies by state.
  • Each state runs CHIP differently: some use the Medicaid program to deliver CHIP benefits, while others run it as a separate insurance plan.
  • CHIP typically covers doctor visits, hospital care, prescriptions, dental, and vision, though the exact benefits and copays depend on your state.
  • You can enroll in CHIP year-round in most states, unlike private insurance, which has open enrollment periods.
  • If your child loses other coverage (such as employer insurance), you may be able to enroll in CHIP outside the normal enrollment window.

How CHIP income limits work and why they differ by state

The federal government requires states to cover children up to at least 200 percent of the federal poverty line, but states can and do set higher limits. Some states cover children in families earning up to 400 percent of the poverty line or more. This means a family of four might may have access to in one state but not in another, even if their income is identical.

Your state's CHIP program publishes its current income limit on its Medicaid or CHIP website. You will need to know your household size and gross monthly or annual income to see whether your child falls within the range. If your income is borderline, it is worth checking your specific state's rules rather than assuming based on another state or a general figure.

Some states also have asset limits — a cap on savings, vehicles, or property you can own and still may have access to. Other states have eliminated asset limits entirely. Again, this varies by state.

What CHIP covers and what you pay

CHIP must cover doctor visits, hospital stays, emergency care, lab work, X-rays, and prescriptions. Most states also cover dental care, vision care, and mental health services. Some states cover therapy, hearing aids, or durable medical equipment. The exact list depends on your state's CHIP plan.

You will typically pay a small copay for doctor visits or prescriptions — often $1 to $5 per visit or prescription, though some states charge nothing. Some states charge a monthly premium, usually between $10 and $50 per child, though many waive premiums for families below a certain income. A few states charge nothing at all.

Because CHIP is designed for families who cannot afford private insurance, out-of-pocket costs are kept low. If you cannot afford even small copays, tell the program when you enroll — some states waive copays for families in financial hardship.

How CHIP enrollment works and when you can enroll

You enroll through your state's Medicaid or CHIP agency, usually online, by mail, or in person. The process is similar to applying for Medicaid: you provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship or immigration status, and proof of your child's age and residence.

Unlike private insurance, CHIP has no open enrollment period — you can enroll your child at any time during the year. If your child loses other coverage (such as employer insurance), you may be able to enroll immediately rather than waiting for an enrollment window. This is called a "may have access to life event."

Processing time varies by state, but enrollment typically takes two to four weeks. Some states approve you conditionally while they verify your information. Your child's coverage usually starts on the first day of the month after you enroll, though some states backdate coverage to the date you applied.

CHIP and Medicaid: when your child might be in both

Some states use Medicaid to deliver CHIP benefits, which means your child's enrollment letter might say "Medicaid" even though they are actually receiving CHIP coverage. This happens because Medicaid is the existing infrastructure in many states, and using it is simpler than running two separate programs.

In other states, CHIP is a completely separate insurance plan with its own card, provider network, and rules. Your child will receive a CHIP card and a separate enrollment letter that says CHIP, not Medicaid.

Either way, the coverage and cost are the same. The name on the letter does not change what your child receives. If you are unsure whether your child is in Medicaid or CHIP, call your state's program and ask — they can tell you in one call.

What happens if your income changes

If your income rises above your state's CHIP limit, your child's coverage will end. Most states give you a grace period — usually 30 to 60 days — to report the change. If you do not report it and your child is still enrolled, you may be asked to repay the cost of coverage during the period you were over the limit.

If your income drops, you may become may be able to access for Medicaid instead of CHIP. When you report the income change, your state will check whether your child now qualifies for Medicaid. If so, they will move your child to Medicaid automatically. There is usually no gap in coverage during the switch.

You are required to report income changes within 30 days in most states. Check your state's rules when you enroll so you know the deadline and how to report.

CHIP versus private insurance: when each makes sense

If your employer offers health insurance, you may wonder whether to enroll your child in CHIP or take the employer plan. CHIP is usually cheaper — copays and premiums are lower — but the employer plan may have a larger provider network or cover services CHIP does not.

Some families use both: they enroll the child in the employer plan and CHIP at the same time. CHIP then acts as secondary insurance, covering costs the employer plan does not. This is called "coordination of benefits," and it is legal in all states.

If your employer plan is very expensive or has a high deductible, CHIP alone may be a better choice. If the employer plan is affordable and covers what your child needs, it may be simpler to use that alone. There is no penalty for choosing one over the other.

Frequently Asked Questions

Does CHIP cover dental and vision care?

Most states cover both, but the scope varies. Some states cover two dental cleanings per year and basic fillings; others cover more extensive work. Vision coverage usually includes one eye exam per year and glasses or contacts. Check your state's CHIP website or call the program to see exactly what is covered.

Can my child stay on CHIP after they turn 18?

CHIP covers children up to age 19 in most states, though a few states cover up to 21. Once your child ages out, they will need to enroll in Medicaid (if they still may have access to by income) or find other coverage. Your state will send a notice before coverage ends, usually 60 days in advance.

What if I am not a citizen but my child is?

A child born in the United States is a citizen and can enroll in CHIP regardless of your immigration status. You will need to provide proof of your child's citizenship (a birth certificate or passport) but not your own. Your income will still be counted to determine whether your child qualifies.

Can I enroll my child in CHIP if they already have Medicaid?

No. If your child is already on Medicaid, they do not need CHIP — Medicaid covers the same services and usually costs less. If your income rises above Medicaid limits but stays within CHIP limits, your state will move your child from Medicaid to CHIP automatically when you report the change.

How do I find my state's CHIP program?

Search "[your state] CHIP" or "[your state] children's health insurance" online, or call 211 and ask for CHIP. You can also visit healthcare.gov and enter your state to find a link to your state's program. Each state's website has an enrollment form and a phone number to call with questions.