CHIP Children’s Health Insurance: Who Qualifies in 2026

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CHIP children’s health insurance covers kids Medicaid doesn’t — and most families don’t know they qualify.

Millions of uninsured children are eligible right now, in families earning far more than the Medicaid limit.

Keep reading to see if your child qualifies, what the program covers, and how to enroll in minutes.

What Is CHIP — and How Is It Different From Medicaid?

The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but not enough to afford private insurance.

Think of it as the bridge between the two: Medicaid covers the lowest-income households; private insurance covers those with stable employer benefits. CHIP fills the gap in between — and it covers that gap in every state.

In 2026, CHIP continues to be administered at the state level, meaning income limits, program names, and specific covered benefits vary depending on where you live. Georgia calls it PeachCare; New Jersey calls it NJ FamilyCare; Texas calls it CHIP — but the federal standards, coverage requirements, and funding structure are the same nationwide.

The same household income that may disqualify a family from Medicaid frequently falls well within the CHIP eligibility range — so checking CHIP immediately after a Medicaid denial is always worth doing.

CHIP Insurance Eligibility Requirements: Who Qualifies in 2026

To qualify for CHIP insurance coverage, a child must meet the following federal criteria as of 2026:

Age: Under 19 years old. There is no lower age limit — newborns qualify immediately.
Currently uninsured: The child must not be covered by a group health plan, employer-sponsored insurance, or other creditable coverage. If a child recently lost coverage due to a job change or policy lapse, they may qualify immediately.
State residency: The child must live in the state where the application is filed. No minimum residency period is required.
Citizenship status: Must be a U.S. citizen or a qualified non-citizen, including lawful permanent residents. Importantly, parents’ immigration or citizenship status is not asked and has no effect on the child’s eligibility.
Income: Household income must fall within the state’s CHIP range. Most states cover families earning up to 200% of the Federal Poverty Level (FPL), though some states extend coverage as high as 400%.

CHIP Income Guidelines 2026: The Federal Poverty Level Reference Table

The CHIP income guidelines are based on the Federal Poverty Level — and understanding where your family falls determines both CHIP eligibility and whether Medicaid applies instead.

Family Size	100% FPL (Medicaid base)	200% FPL (Typical CHIP limit)
1 person	$15,960/year	$31,920/year
2 people	$21,640/year	$43,280/year
3 people	$27,320/year	$54,640/year
4 people	$33,000/year	$66,000/year

Families earning between the Medicaid base and the CHIP upper limit typically fall into the CHIP coverage zone. Families earning below 100% FPL are usually routed to Medicaid automatically during the application process.

States with higher limits — including California, New York, and several others — extend CHIP insurance coverage to families earning up to 300% or 400% of FPL. A family of four earning up to $132,000 annually may qualify in those states. Always verify your state’s specific limit, since it can be significantly more generous than the federal baseline.

What CHIP Covers: A Full Breakdown of Child Health Insurance Benefits

CHIP provides comprehensive child health insurance coverage — not a limited package. Here’s what’s included under federal minimum standards in every state:

Routine check-ups and immunizations: Well-child visits and all recommended vaccines are fully covered at no cost in all states
Doctor visits: Both primary care and specialist visits are covered, typically with a small co-pay depending on the state
Prescriptions: Prescription drug coverage is required, with co-pays that vary by state and drug tier
Dental and vision care: Full dental coverage — including cleanings, X-rays, and fillings — and vision coverage including eye exams and corrective lenses are included
Inpatient and outpatient hospital care: Both emergency admissions and planned hospital stays are covered
Laboratory tests and X-rays: Diagnostic services are included without prior authorization in most states
Emergency services: Emergency room visits are covered with no prior approval required
Mental health care: Mental health and behavioral health services are covered at the same level as physical health services under federal parity rules

This benefit package makes CHIP one of the most comprehensive low-cost insurance options available to families — more complete than many employer-sponsored plans at comparable income levels.

CHIP Insurance Costs: Premiums, Co-pays, and What’s Always Free

One of the most common misconceptions about CHIP government health insurance is that it comes with significant out-of-pocket costs. In reality, federal law caps family costs at very low levels.

Routine “well-child” visits and dental exams: Free in all states — no co-pay, no premium required for preventive care
Monthly premiums: Some states charge a small monthly premium, but federal law caps total family cost-sharing at 5% of total annual family income. For a family earning $40,000, that’s a maximum of $2,000 in combined annual out-of-pocket costs across all CHIP expenses.
Co-pays for services: Small co-payments may apply for specialist visits or non-emergency services, typically ranging from $5 to $25 per visit depending on the state and service type
Children in Medicaid: For children routed to Medicaid during the CHIP application, co-pays are never required — Medicaid for children is fully free

The combination of low premiums, capped out-of-pocket costs, and free preventive care makes CHIP significantly more affordable than marketplace insurance at similar income levels — even for families who could technically afford a private plan.

CHIP Superior Health Plan and State Managed Care Options

In states with managed care models, CHIP benefits are delivered through contracted health plans. In Texas, for example, families choose from options including CHIP Superior Health Plan and Select Health CHIP — each covering the same required minimum benefits but differing in provider networks and drug formularies.

When selecting a plan, check that your child’s current pediatrician is in-network and that any needed prescriptions are covered. If your state uses managed care CHIP plans and you’re also enrolled in SNAP benefits, community health centers in your area typically accept CHIP plans and offer integrated care coordination for food, health, and social services.

How to Apply for CHIP: Step by Step

There is no single national CHIP application — enrollment happens through state portals, HealthCare.gov, or by phone.

Apply through HealthCare.gov (fastest for most families). Fill out a standard marketplace application at HealthCare.gov. If your child qualifies for CHIP or Medicaid, the system automatically routes your information to your state agency — you don’t need to find the state portal yourself.
Apply directly through your state’s portal. States like California (C4Yourself), Texas (Your Texas Benefits), and Virginia (CoverVirginia) have dedicated CHIP and Medicaid enrollment portals where you can apply, upload documents, and track your application in one place.
Call 1-877-KIDS-NOW. The national CHIP hotline (1-877-543-7669) connects you directly to your state’s program — the fastest path if you want to speak with someone immediately or need language assistance.
Gather your documents before you start. Have ready: Social Security numbers and birthdates for all children applying, proof of income (W-2 forms, 2025 tax return, or pay stubs from the last 30 days), proof of address, and documentation of any existing or recently lost health insurance.
Complete the eligibility review. Most applications are processed within a few days to two weeks. If approved, coverage typically begins the first of the following month.

CHIP enrollment is open year-round — unlike marketplace plans, there is no annual enrollment period. You can apply any time your child becomes eligible, including immediately after a job change causes a loss of employer coverage.

Families enrolling children in CHIP often also qualify for WIC program nutrition benefits and Head Start enrollment at similar income levels — applying for all three simultaneously through a community action agency is the most efficient approach.

This content is purely informational and independent. We have no affiliation with, sponsorship from, or control over CMS, state CHIP agencies, or any health plan mentioned here. Income limits, covered benefits, premiums, and enrollment procedures vary by state and change annually — always verify current information directly with your state’s CHIP office or at HealthCare.gov before applying.

There’s more your family may qualify for. Our Public Assistance section covers food assistance, housing programs, income support, and every federal benefit that frequently applies to the same families who qualify for CHIP.

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