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July 12, 2019
CHIP is a health coverage program for:
Since CHIP varies by state, the exact benefits a particular state covers may differ from other states. However, all states must provide comprehensive coverage including:
These benefits are similar to Medicaid services offered to consumers.
Some states charge small premiums and/or copayments for CHIP coverage. Families with children enrolled in CHIP aren’t required to pay more than 5 percent of their yearly income for CHIP coverage – including out-of-pocket costs – but most programs charge premiums that are far lower. Cost sharing (e.g., deductibles, copayments, and coinsurance) isn’t allowed for certain preventive services like well-baby or well-child visits.
Some states also require that children be uninsured for up to 90 days before they can enroll in CHIP. Remember, MAGI is used to calculate consumers’ financial eligibility for CHIP. Each state’s CHIP program has its own rules about who qualifies for CHIP:
Remember, states also have the option to provide CHIP coverage to some low-income pregnant women. In a few states, CHIP provides coverage to women for the duration of their pregnancy. Infants born to women enrolled in Medicaid or CHIP are automatically eligible for Medicaid or CHIP up to one year of age. Under the Affordable Care Act, new mothers who lose access to healthcare services provided through unborn child CHIP coverage following the birth of their child may qualify for an SEP 60 days before or after their loss of coverage if they are otherwise eligible to enroll in a QHP through a Marketplace. The Affordable Care Act also gives states the option to extend CHIP eligibility to the children of state employees who were previously excluded from CHIP coverage.
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