Medical costs and health insurance aren’t getting any cheaper, and if you have a child, that thought might scare you. As adults, we might forego a trip to the doctor because we can tough it out. But when your son or daughter has a fever, doesn’t have the language to verbalize what hurts, or has some unexplainable rash, toughing it out doesn’t seem like a safe option.
Fortunately, you may not have to choose between going to the pediatrician and paying this month’s rent. If you meet the requirements of the Children’s Health Insurance Program (CHIP), it may cover all to most of their medical expenses if you can’t afford or don’t have access to health insurance.
What is CHIP, and why does it exist?
CHIP was created for the families who earn too much to qualify for Medicaid, but not enough to cover the costs of private plans or employer-sponsored insurance. CHIP is a partnership program between the federal government and each state. While the federal government sets the ground rules and provides most of the funding, your state runs the program locally.
And since every state has the flexibility to adjust the rules, your state’s might choose one of three paths:
- Medicaid Expansion: Some states use their CHIP funding to simply expand their existing Medicaid program. Your child gets the same comprehensive “Medicaid” benefits and follows the same rules, but the state uses CHIP dollars to pay for it.
- Separate CHIP Program: Other states have a completely separate program. These often have unique names (like PeachCare for Kids in Georgia). Because these are separate, they might have slightly different rules for co-pays or which doctors are in the network.
- The Combination Model: Many states use a hybrid approach. They might use Medicaid to cover younger children or those with very low incomes, while using a separate CHIP program for older kids or families who earn a bit more.
Additionally, this flexibility may mean your state extends coverage to pregnant women.
Since it launched in 1997, CHIP has cut the number of uninsured children in half. In 2025, more than 7 million children were enrolled in CHIP, alongside another 30 million covered by Medicaid.
Studies have shown that when kids have access to medical care, they do better in school and grow into healthier, more productive adults. And for parents, it means lower out-of-pocket costs and a smaller financial burden, which, unsurprisingly, equals less stress.
Who is Eligible for CHIP?
CHIP is run by individual states, so the specific requirements vary. However, there are a few general guideposts to help you figure out if your family is eligible:
- Age: CHIP is primarily for children from birth through their 19th birthday. And in states that offer coverage to pregnant women, there is no age limit.
- Income: Every state sets its income limits based on the Federal Poverty Level (FPL). The income limits vary based on the age of the child and other factors. Typically, the limit is between 100% and 400% of the FPL.
- Uninsured: Your child typically cannot be covered by another health plan. However, if you already have a group plan through work, but the premiums are so high you can’t afford to actually use it, you should still apply, as some states have “hardship exceptions” if your current insurance costs more than 5% of your income.
- Residency and Citizenship: Your child needs to live in the state where you’re applying. They also generally need to be a U.S. citizen or a “qualified non-citizen” (like a green card holder).
- Coverage for Pregnant Women: In many states, “From Conception to End of Pregnancy” is an option. If you are pregnant and don’t have maternity coverage, CHIP can step in to cover your prenatal visits, labor and delivery, and even postpartum care.
The rules can be technical, and the income charts can change every year.
Understanding the CHIP Income Limits and MAGI
When you apply, CHIP looks at your Modified Adjusted Gross Income (MAGI), which is a specific way the program calculates your income. It’s a more accurate sum of what you actually have available to spend on your family’s medical needs.
For most people, your MAGI is going to be very similar to the Adjusted Gross Income (AGI) found on your tax return. To get to your MAGI, the program takes your total income and then adds back a few specific things that the IRS usually lets you ignore, such as:
- Untaxed foreign income
- Non-taxable Social Security benefits
- Tax-exempt interest
- Pre-Tax Deductions: If your employer takes money out of your check for things like 401(k) contributions or childcare flexible spending accounts (FSAs), that money is “invisible” to CHIP.
- Child Support: If you receive child support, that money is generally not counted as part of your MAGI.
- Supplemental Security Income (SSI)
However, when the state looks at your MAGI, it’s looking at your tax household. Generally, this includes you, your spouse (or unmarried partner if you share a child), and anyone you claim as a dependent.
If your teenager has a part-time summer job flipping burgers or mowing lawns, their income usually won’t count toward your household total unless they earn enough to be required to file their own tax return. Likewise, incomes from adult roommates or a non-dependent partner do not count.
CHIP Benefits and Coverage
The federal government requires every state to cover a set of “mandatory” services that address the most common health needs.
- Well-Baby and Well-Child Visits: These are the routine check-ups where the pediatrician tracks your child’s growth, listens to their heart, and checks their milestones. In almost every state, these visits are free, meaning no co-pay and no bill afterward.
- Immunizations: Keeping up with the vaccination schedule shouldn’t be a financial burden. CHIP covers all age-appropriate vaccines to keep your child protected against preventable diseases.
- Dental Care: This includes regular cleanings (usually twice a year), X-rays, fillings, and even medically necessary orthodontics in some cases.
- Vision Care: This covers eye exams and, in most states, the glasses your child needs to see clearly.
In addition to preventive care, CHIP also covers emergency visits, such as if your child needs an ER visit or an ambulance. Should your child need surgery or an overnight stay, the program covers inpatient and outpatient hospital services so you can focus on being at their bedside, not on how you’ll pay for the room.
Federal law also requires that mental health services be covered. This means access to counseling, behavioral therapy, and substance use treatment if they are ever needed.
If your child is covered through a Medicaid Expansion version of CHIP, they receive a benefit called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). It says that if a doctor identifies a problem during a screening, the state must provide whatever treatment is medically necessary to fix or improve that condition. Even if that specific treatment isn’t usually on the standard list of benefits.
How Much Does CHIP Cost: Premiums and Out-of-Pocket Expenses
While Medicaid is usually free, CHIP often operates on a low-cost model, which means you might pay a small amount. By federal law, the total amount a family pays for CHIP (including monthly premiums and any co-pays at the doctor or pharmacy) cannot be more than 5% of your family’s annual income.
So, if your household earns $50,000 a year, the most you would ever pay for your children’s healthcare in a year is $2,500. For many, the actual cost is much lower. If you ever hit that 5% mark, the state usually stops charging you for the rest of the year.
Depending on your state and your income, your costs might look like this:
- Monthly Premiums: Some states charge a small monthly fee, typically ranging from $20 to $50 per family (not per child).
- Co-payments: You may have a small fee when you visit a specialist or pick up a prescription. These are typically very low, maybe just $5 to $25.
- Free Preventive Care: “Well-child” visits, immunizations, and many screenings are almost always 100% free.
