The Children’s Health Insurance Program (CHIP) in Pennsylvania insures residents under age 19 who do not have any coverage. If you do not qualify for Medicaid, you may be able to receive a comprehensive set of health benefits through the same Pennsylvania Medical Assistance providers. Pennsylvanians with income up to 200 percent of the Federal Poverty Level are eligible for subsidized coverage, but any uninsured child or teen may apply regardless of income. CHIP is offered to many families for free, and others have to pay an affordable monthly premium and copays for services. As one of the strongest state programs for health insurance and medical care, CHIP provides a large array of services at a low cost.
CHIP Eligibility & Costs
In order to qualify for CHIP, you must be a resident of Pennsylvania, a U.S. citizen or legal immigrant, and not have access to any form of creditable coverage. This includes health insurance from a parent’s group or individual plan, as well as Medical Assistance or PA Fair Care.
Free coverage is available to children with income above the MA guidelines for each age group, but below 200 percent of the Federal Poverty Level. Premiums also vary depending on income. There is a Low Cost group and a Full Cost group. Refer to the table below to find out which group you qualify for according to annual income.
For Low Cost CHIP members, children ages 0-18 are separated in three income levels, Group 1, who pays an average premium of $43; Group 2, who pays an average $61 per month, and Group 3, who pays $70 per month. Premiums for the Full Cost group average to about $195 per month.
For all members enrolled in Low Cost CHIP, copays are the same, with primary care office visits at $5, specialist visits for $10, prescriptions for either $6 (generic) or $9 (brand name), and emergency care for $25. Full Cost members have slightly higher yet still very affordable copays, covering PCP visits for $15, generics for $10, brand name drugs at $18, specialty care for $25, and emergency room visits for $50.
Benefits & Health Plans
CHIP covers a wide variety of services, from physician services to hospital care and all of the Early Periodic Screening and Diagnostic Testing (EPSDT) required by the state for young people. CHIP also includes care for medical conditions, but if your child is severely disabled or ill, you should consider Medical Assistance. If you need more information about whether a specific service is covered, contact the CHIP program at 800-986-KIDS, or call your local health plan providing CHIP coverage. Find a health insurance company offering CHIP in your area by consulting the list below.
How to Apply
You can apply online with COMPASS for CHIP in Pennsylvania by completing a form and including various pieces of information such as your Social Security number, proof of family income and household size. If you prefer applying by mail, you can also download and print an application or pick one up at a CHIP health insurance company location near you.
Contact CHIP: 800-986-KIDS