Question 1

What is CHIP?

Accepted Answer

The Children's Health Insurance Program (CHIP) is a federal-state program that provides low-cost or free health insurance to children in families with incomes too high to qualify for Medicaid but too low to comfortably afford private insurance. CHIP covers doctor visits, prescriptions, dental and vision (in most states), inpatient and outpatient hospital care, lab and X-ray, and emergency services. Income eligibility varies by state — typically 200%-400% of Federal Poverty Level (FPL). In most states the program is called CHIP; some states use a state-specific name (e.g., 'Healthy Kids' in CA, 'Child Health Plus' in NY, 'NC Health Choice' in NC). All children in CHIP receive comprehensive coverage at low or no cost to the family.

Question 2

What are the 2026 CHIP income limits?

Accepted Answer

CHIP eligibility is based on Modified Adjusted Gross Income (MAGI) as a percentage of the Federal Poverty Level. For 2026, FPL for a family of 4 is approximately $32,150. State CHIP upper limits range from 175% FPL (lowest, e.g. North Dakota) to 405% FPL (highest, e.g. New York). Most states fall between 200% and 250% FPL. Below the CHIP threshold, children typically qualify for Medicaid (which has a higher floor — ~138% FPL in expansion states, ~100% in non-expansion). Income above CHIP threshold = ACA marketplace coverage with potential premium tax credit. The calculator handles all three pathways.

Question 3

Is CHIP free?

Accepted Answer

For families below ~150% FPL, CHIP is typically free with no premiums and minimal copays. Above ~150% FPL, families pay modest monthly premiums (typically $10-$60/child/month, capped per family) and may have small copays for non-preventive services. Federal law caps total family cost-sharing at 5% of household income. Compared to a Marketplace plan with subsidies, CHIP is dramatically cheaper for families below the threshold — typically $20-$100/month for a child in CHIP vs $150-$400/month for the equivalent ACA Silver plan after subsidies.

Question 4

What if my income is too high for CHIP?

Accepted Answer

Above the state CHIP income limit, kids enroll in the family's ACA Marketplace plan (with premium tax credit if eligible — generally up to 400% FPL or higher under current law) or in a parent's employer plan. Marketplace child-only plans are also available in some states. If you're just above the CHIP threshold, check whether deductible business expenses or HSA contributions could reduce your MAGI below the limit — small differences can move you across the threshold and save thousands per year.

Question 5

Can my child have CHIP if I have employer health insurance?

Accepted Answer

In most states, yes — CHIP can supplement or replace employer coverage if the family income qualifies. About 25 states have a 'waiting period' or 'crowd-out' rule requiring you to be uninsured for 90 days before CHIP enrollment if you had employer coverage available. Exception: if employer coverage is unaffordable (employee + family premium exceeds 9.12% of household income for 2026 under ACA family glitch fix) or unavailable for dependents, no waiting period applies. Check your state's specific waiting period rule via your state CHIP agency.

Question 6

What does CHIP cover that private insurance might not?

Accepted Answer

CHIP federal minimum benefits: well-child visits + immunizations (free, no copay), dental coverage including preventive and treatment, vision including eye exams and glasses, comprehensive medical and surgical care, inpatient mental health and substance use treatment, prescription drugs, lab/X-ray, hearing services. Most states cover orthodontia for medical necessity. Compared to many private/marketplace plans, CHIP typically has lower out-of-pocket costs for kids and often broader dental coverage. ACA marketplace plans must cover pediatric dental + vision as essential health benefits, but copays and provider networks may be more restrictive than CHIP.

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