Children's Health Insurance Program (CHIP) in Pennsylvania
The Children's Health Insurance Program (CHIP) in Pennsylvania helps children of families whose earnings are too high to qualify for Medical Assistance or Medicaid, but who cannot afford private insurance. CHIP and Medicaid enrollment provides health insurance coverage for millions of low-income individuals, families and children nationwide. Medicaid and CHIP are federal programs that work closely with state governments to provide affordable medical coverage for eligible petitioners. Many PA residents wonder, “Is CHIP considered Medicaid since both programs are government-assistance health care solutions?” While CHIP and Medicaid provide medical assistance in Pennsylvania for eligible residents, each program has different eligibility requirements, costs and coverage. Review the outlined topics to find out what is CHIP Medicaid eligibility and how to enroll in Pennsylvania.
What is CHIP Medicaid in Pennsylvania?
When a household applying for Medicaid does not meet the requirements for Medicaid eligibility children from that household may still qualify for health insurance coverage through the Children's Health Insurance Program. Requirements for CHIP and Medicaid enrollment differ because each offers coverage for a difference population. CHIP and Medicaid are available in each state in the country.
While CHIP is not considered Medicaid, it does provide similar medical coverage for eligible minors. CHIP works closely with the Pennsylvania Medicaid program to ensure children of low-income families get the health insurance they need. However, after CHIP and Medicaid enrollment in PA, beneficiaries may notice the covered services vary between the programs. In addition to differences with covered services, applicants should be aware of
Free CHIP and Low-Cost CHIP.
For more details about the differences between CHIP and Medicaid for children, download our comprehensive and free health care guide.
What is covered by CHIP Medicaid in Pennsylvania?
Services covered by CHIP and Medicaid for children include routine examinations, immunizations, doctor visits and prescriptions. Once the Pennsylvania Children's Health Insurance Program receives an application, it will check the children's eligibility and respond within a reasonable time. If an applicant qualifies for CHIP, then he or she will receive a notice from the local County Assistance Office and will be able to select an insurance provider from one of the CHIP Health Insurance companies in the county. What is covered by CHIP Medical Assistance plans can vary and beneficiaries should select the one that meets their needs best. However, all plans have a set of CHIP-mandatory covered services. Coverage for CHIP Medicaid eligible children will start the following month.
Who is eligible for CHIP in Pennsylvania?
When learning how to apply for CHIP in Pennsylvania, applicants must review the eligibility requirements to receive benefits. Both CHIP and Medicaid enrollment consider the household income when determining eligibility for enrollment. Petitioners will have to meet certain financial requirements to sign up for Medicaid or qualify for coverage through CHIP if their income is too high for PA Medical Assistance. CHIP is available for low-income households with earnings comparable to the Federal Poverty Level.
If a family did not meet the income requirements for Medicaid eligibility, children from that household might still qualify for medical coverage through CHIP. The Children's Health Insurance Program in Pennsylvania has a less strict financial threshold than the limit for Medicaid enrollment. The income of the household will also be a determining factor in whether the children are eligible for coverage at a low cost or free of charge. Free CHIP is available for uninsured children whose family household income is too high to be eligible for Medical Assistance but low enough to be unable to afford private insurance. Low-cost CHIP is available for qualifying families with uninsured dependents who are not eligible for Medical Assistance but whose families can pay a monthly premium and affordable copays for some services.
To enroll in the Children's Health Insurance Program in Pennsylvania, applicants must also be state residents and able to prove residency. CHIP or Medicaid enrollment in another state does not guarantee program enrollment in Pennsylvania. Children must also be 19 years of age or younger to qualify for CHIP benefits. Some adults are eligible for CHIP enrollment because they are pregnant.
There may be other programs such as Medical Assistance or the Health Insurance Marketplace a household may qualify for if ineligible to enroll in CHIP or Medicaid. The local County Assistance Office can help determine which programs might best meet a family's circumstances.
Household income, family size and other factors will help determine which program applicants qualify for.
Download our in-depth Pennsylvania health care guide to find out more about the eligibility requirements for CHIP and Medicaid enrollment as well as other available medical assistance programs.
How to Apply for CHIP in Pennsylvania
Residents can apply for CHIP in Pennsylvania online, by mail or by phone. CHIP and Medicaid enrollment use the same application and petitioners can request health care coverage for both to find out which one they qualify for. Regardless of how petitioners apply, they will need to provide the same information about themselves and their family. Applying for CHIP online is the fastest way to request benefits. To ensure efficiently, applicants should prepare for the process by gathering documents and information needed to sign up for CHIP Medicaid.
To apply by for CHIP by mail, download the application online in either English or Spanish and fill out the forms to mail them to the address listed for the local county. Once the office receives applications, it will let petitioners know within three to four weeks whether their children qualify for CHIP. To apply by phone or for assistance in filling out the online or paper application, call the CHIP helpline.