Coverage under Medicaid and CHIP

Many Americans have access to free or low-cost health coverage through Medicaid and the Children’s Health Insurance Program (CHIP), including some low-income people, families, children, pregnant women, the elderly, and people with disabilities. Medicaid & CHIP programs differ in names in different states, so find out what they’re called in your state to find out what they’re called.

Medicaid may be able to help you even if you don’t qualify based on your income. If you have children, are pregnant, or have a disability, you may qualify for your state’s program. Medicaid and CHIP do not have Open Enrollment Periods, so you can apply at any time.

What is the process for applying for Medicaid and CHIP?

1. Apply through the Health Insurance Marketplace®.

  • A state agency will contact you about enrollment if anyone in your household qualifies for Medicaid or CHIP.
  • If you apply for Marketplace coverage, you’ll also find out if you qualify for an individual insurance plan based on your income instead. Plans may be more affordable than you think.

What Medicaid expansion means for you

Some states have expanded Medicaid to cover all people with household incomes below a certain level, but others haven’t.

Depending on your income, household size, disability, family status, and other factors, you may qualify for Medicaid in all states.

If your income is below 133% of the federal poverty level in a state that has expanded Medicaid coverage: You qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. Some states use a different income limit.)

If your state hasn’t expanded Medicaid, but your income is low

  1. Community health centers provide primary care to millions of Americans. The health care law has increased funding to these centers, which offer services on a sliding scale based on your income. Find out how you can get low-cost care near you.
  2. If you are under 30 years old, you can enroll in a “Catastrophic” plan. If you are 30 or older, you must claim an exemption to qualify. 
  3. If your expected yearly income is between 100 and 400% of the federal poverty level, you can be eligible for a Marketplace plan with advance payments of the premium tax credit. Even if your income rises above 400%, there may be savings available to you when you put in an application. For those who make up to 150% FPL, a Special Enrollment Period may be accessible at any time of year. You just have to contact the Marketplace Call Center within 60 days of when the change in salary occurred. Additionally, it will be required that you attest that you:
    • When you first applied for Medicaid, you weren’t eligible because your state hadn’t expanded Medicaid
    • Your income was too low to qualify for a Marketplace plan with tax credits
    • An increase in expected yearly income qualifies you for a Marketplace plan with tax credits

The Children’s Health Insurance Program (CHIP) application process

In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its Medicaid program.

There are different rules for who qualifies for CHIP by state. If you apply for Medicaid coverage to your state agency, you’ll also find out if your children qualify for CHIP. You can apply now, any time of the year, and find out if you qualify. It won’t be necessary for you to buy an insurance plan to cover them if they qualify.

CHIP can be applied for in two ways:

In order to apply for Medicaid or CHIP, please call 1-800-318-2596 (TTY: 1-855-889-4325).

If your household qualifies for Medicaid or CHIP, your information will be sent to your state agency. You will be contacted by your state agency about enrollment after you submit your Marketplace application. You will also find out if you are eligible for an individual insurance plan with savings based on your income.

What does CHIP cover?

State-specific CHIP benefits vary by state, but all provide comprehensive coverage, including:

  • Checkups on a regular basis
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Providing dental and vision care
  • Hospitalization and outpatient care
  • X-ray and laboratory services
  • Services for emergencies

Check with your state for details about covered services under CHIP.

CHIP costs how much?

Routine “well child” doctor and dental visits are free under CHIP. However, some states charge a monthly premium for CHIP coverage. In each state, the costs are different, but you won’t need to pay more than 5% of your annual income.

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