Your Questions About CHIP Coverage for Children, Answered

The Children's Health Insurance Program, which provides low-cost coverage for children in families that earn too much for Medicaid but cannot afford private insurance.

Key takeaways

• Who it covers: uninsured children up to age 19; some states also cover pregnant people
• Covers: checkups, vaccines, doctor visits, prescriptions, dental and vision care, and hospital care
• Most useful single change: Apply through your state Medicaid or CHIP agency or HealthCare.gov.
• Commonest mistake: Assuming your income is too high without checking your state's limits.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What is CHIP Coverage for Children?

The Children's Health Insurance Program, which provides low-cost coverage for children in families that earn too much for Medicaid but cannot afford private insurance.

Why does it matter?

Coverage gives children regular checkups, vaccines and dental care, and many eligible children are not enrolled.

Who it covers for CHIP Coverage for Children?

Uninsured children up to age 19; some states also cover pregnant people.

When to apply for CHIP Coverage for Children?

Any time of year.

Insure Kids Now for CHIP Coverage for Children?

1-877-543-7669 (1-877-KIDS-NOW).

What is the single most useful thing to do?

Apply through your state Medicaid or CHIP agency or HealthCare.gov.

What is the most common mistake?

Assuming your income is too high without checking your state's limits.

When should I see a doctor?

Call your child's doctor for fever in a baby younger than 3 months, signs of dehydration or illness that is getting worse. Call 911 if a child has trouble breathing, is unresponsive or has a seizure.

More questions, answered

Do I have to be uninsured myself for my child to get CHIP?

No. CHIP eligibility is based on the child, family income and whether the child has other insurance. Parents do not need to be eligible for anything themselves. In some states, parents may qualify for Medicaid or Marketplace coverage, and applying for the whole family at once checks all options.

What if my child already has insurance through my job?

CHIP is generally for uninsured children, so a child with job-based coverage usually does not qualify. If your employer coverage is very expensive, ask your state about its rules. Some states help families pay for employer coverage instead. Do not drop existing coverage before checking eligibility.

Will my child lose CHIP if my income goes up during the year?

Children enrolled in Medicaid and CHIP now generally keep coverage for 12 months even if family income changes during that time. At renewal, the state will look at your income again. If it is higher than the limit, your child may be moved to other coverage.

Does CHIP cover braces or glasses?

CHIP covers dental and vision care, including eyeglasses for children who need them. Orthodontic treatment such as braces is usually covered only when it is medically necessary rather than cosmetic, and the rules vary by state. Ask your plan what is covered and whether prior approval is needed.

Can I apply for CHIP at any time?

Yes. Unlike Marketplace plans, which have a yearly open enrollment period, you can apply for CHIP and Medicaid any time of year. If your child qualifies, coverage can start soon after approval. Apply as soon as your child loses other coverage or your income drops.

Is CHIP coverage worse than private insurance?

CHIP covers a broad range of children's services, including dental and vision care, which many private plans charge extra for. Costs to families are capped by federal rules. As with any plan, networks matter, so check that the doctors and dentists you want to use accept your child's plan.

Related topics

• What the Guidance Really Says About Open and Special Enrollment (Health Insurance and Costs)
• Sexual Health Services: What Published Guidance Supports (Sexual Health)
• What the Guidance Really Says About Benefits and Financial Support (Long-Term Conditions)
• The Evidence on Travel Insurance and Healthcare Abroad, Without the Hype (Travel Health)

Where to go next

• Understanding CHIP Coverage for Children: A Plain-English Explainer
• CHIP Coverage for Children: What to Do, in Order
• CHIP Coverage for Children — the reference entry
• Medicare and Medicaid: The Complete Guide
• Medicare Wellness Visits: What the Evidence Actually Says
• What the Guidance Really Says About Dual Eligibility

When to speak to a doctor

Call your child's doctor for fever in a baby younger than 3 months, signs of dehydration or illness that is getting worse. Call 911 if a child has trouble breathing, is unresponsive or has a seizure.

Where this comes from

• Medicaid.gov — Children's Health Insurance Program (CHIP)
• HealthCare.gov — Medicaid & CHIP coverage

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.