Insurance Through the Children’s Health Insurance Program

Searching for health insurance for your family can be a daunting task.

Additionally, when it comes to your children, you want to make sure that you have explored all of the possible options to get them the best coverage available. If your children are not insured by any form of health coverage and your income is too high for you to qualify for Medicaid, they may qualify for one version of low-budget health coverage known as the Children’s Health Insurance Program (CHIP), which is jointly funded by the states and the federal government. In general, the CHIP aims to provide coverage to the families who find themselves in a middle ground between earning too much to qualify for Medicaid, but too little to obtain a private health insurance plan.

In certain states, in addition to eligible children, the CHIP may even extend to pregnant women. That is because each state offers its own version of CHIP, and the program works closely with Medicaid in order to provide benefits. Therefore, your state may have a specific name for CHIP and offer different types of coverage. Moreover, your state may have different income thresholds for its residents to qualify for the program. Generally, medical expenses can be very costly to a family. Families without health insurance plans are even more exposed to these costs, as they do not have coverage to offset their medical bills. Below are some essentials you should know in order to understand the Children’s Health Insurance Program and how it can help your family.

CHIP Benefits

Enrolling in the Children’s Health Insurance Program (CHIP) can alleviate costs incurred by medical issues that children are often prone to. From routine care to emergency services, you want to make sure that your children will be cared for, and the CHIP is a great way to establish that guarantee. A simple visit to the doctor could potentially place a family in a very difficult financial situation. However, this program can help families to afford these treatments and services. In general, the CHIP includes comprehensive coverage, including:

  • Checkups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental services
  • Vision care
  • Hospital care, inpatient and outpatient
  • Laboratory services
  • X-rays and diagnostic services
  • Emergency services

However, because the CHIP is partially funded by states, this program has several variations that are determined by particular state regulations. These variations may change the types of services that are covered by the program, the companies that are used for coverage and the amount of money allocated to each child in need of health care. Knowing the details and benefits of the CHIP in your state can help you understand how to make the most out of your child’s health insurance and avoid surprises.

Certain states also offer expansion benefits through the CHIP. These benefits include early and periodic screening, diagnostic and treatment (EPSDT) services. Furthermore, this expansion allows insured individuals to receive coverage for services related to dental and mental health.

Separate CHIP Benefits

Separate CHIP benefits are types of coverage that children may receive depending on each state. Thus, different states may choose one of the following three options:

  • Benchmark coverage is based on either a state employee’s coverage, a Blue Cross/Blue Shield preferred provider offered to federal employees or the largest non-Medicaid enrollment health management organization (HMO) plan in the state.
  • Benchmark-equivalent coverage is actuarial-equivalent and includes inpatient and outpatient hospital services. Moreover, this coverage includes services pertaining to physicians, surgeries, laboratory, x-ray and general child care.
  • Secretary-approved coverage is a health coverage deemed acceptable and necessary by the secretary of the U.S. Department of Health and Human Services.

Separate dental benefits pertaining to the CHIPwork similarly to the benefits expansion provided by Medicaid, in that these benefits require EPSDT service coverage. However, these separate benefits provide coverage for dental services promoting oral health, preventing oral diseases, repairing oral functions and treating emergency situations.

Age-appropriate vaccines are always covered under the CHIP. As a matter of fact, they are mandated by the states on a per-case basis. However, the time in which your child should receive these vaccinations is determined by your child’s doctor. Overall, vaccines are considered a very important part of a child’s health profile.

The CHIP provides basic health coverage to your child, but the particularities of each plan may vary from state to state. While many routine and “well child” services are covered under the CHIP, certain states may require patients to incur copayments for other services or a monthly premium for coverage. As a general rule, however, covered individuals must not pay for more than five percent of their family’s annual income. Thus, before enrolling in the CHIP, make sure to understand the specific coverage the program offers in your state.

Eligibility Requirements

In order to qualify for the CHIP, a child must be younger than 19 years of age, not be insured by any health care plan and be a citizen, legal alien or permanent resident of the United States. Moreover, each state may have its own specific rules for the program, which makes it important for enrollees to check the different eligibility requirements in the state where they are applying for the program.

In general, children in a family of four or more that earn an income of up to $49,200 may be eligible for the CHIP. In 46 states, as well as the District of Columbia, children in families with an income of at least 200 percent of the federal poverty level (FPL) are covered. More specifically, 24 of these states offer coverage at or above 250 percent of FPL.

In certain situations, pregnant women can receive coverage through the CHIP. In some states, pregnant women may even be eligible to receive prenatal care. The Affordable Care Act of 2010 allows states to provide the CHIP to state employees’ children, as well.

How to Apply

You can apply for the CHIP at any time and there are multiple ways to do so. For instance, consider these application methods:

  • Online, by visiting the Health Care Marketplace
  • By phone
  • By mail
  • In person

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