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CHIP health insurance is for uninsured children. Children whose parents make too much money to qualify for Medicaid.

If you cannot afford health insurance for your whole family and you do not qualify for 

Medicaid, you fall into a coverage gap, but your children possibly do not have to go uninsured.

The Children’s Health Insurance Program is health insurance for uninsured children whose parents make too much money to qualify for Medicaid. According to the federal government, CHIP and Medicaid offer health insurance for more than 35 million children in the United States. Here is what to know about CHIP and Medicaid for kids.

Difference Between CHIP and Children’s Medicaid

CHIP and Medicaid are closely related, and CHIP is often thought of as a part of Medicaid. While that is true, states often design their CHIP plans a bit differently from Medicaid. States may:

• Use CHIP funds to expand Medicaid coverage to CHIP-eligible kids.
• Provide a combination of these two choices.
• Have a CHIP program separate from Medicaid.

Many states have a combination program, according to the Children’s Hospital Association. Nevertheless, states can restructure their programs as funds allow, so children in CHIP one year may become Medicaid beneficiaries the next year, and vice versa.

What CHIP Pays For?

Children’s benefits under Medicaid and CHIP are comprehensive, but the programs vary slightly depending on your state. Whether your state has a CHIP, Medicaid, or combination program will determine your kid’s specific health plan. Nevertheless, all children can get any medically necessary treatment as well as dental, hearing, and vision benefits.

Costs of CHIP

Some families pay premiums for CHIP. In 30 states, parents pay premiums for kids in CHIP or Medicaid, depending on yearly income and according to the foundation. Those who do pay premiums usually pay less than $50 per month per child, although some premiums are higher.

Families that have kids with greater medical requirements are likely to spend more out of pocket, but you would not have to spend more than 5% of your family’s annual income on out-of-pocket expenses. Most families do not reach this cap, according to the Children’s Hospital Association.

Health insurance plans for children.

In 26 states, parents may have to pay some amount, known as cost-sharing, for treatment or medication for children in Medicaid or CHIP. Preventive services are covered free of charge, but other services that might necessitate parents to pay a deductible or copay are:

• Prescription drugs.
• Non-preventive doctor visits, such as a strep throat appointment.
• Non Emergency use of the ER, as determined by a physician at the hospital.
• Inpatient hospital care.
• Emergency room visits.

Applying for CHIP

You do not have to wait for any open enrollment period to apply for CHIP insurance, as you would with private health insurance — you can apply any time of year. What’s more, a Medicaid application doubles as a CHIP application if you have, so you can just submit one application for the whole family.
You can apply in the following three main ways:

• Over the phone, by calling Medicaid’s service line at 1-800-318-2596.
• Online, by submitting an application on Healthcare.gov or your state’s Medicaid website.
• By downloading and filling out an application from your state’s Medicaid website and mailing or bringing it to a local Medicaid office.

In many states, you will hear back in as little as 24 hours, whether your family qualifies for Medicaid or CHIP. If you are not eligible for Medicaid, but your children are eligible for CHIP, you can enroll them immediately.

Resources and References:

• Differences Between Medicaid and CHIP  
• Children’s Health Insurance Program