Questions & Answers
Here are some questions and answers that may be helpful for families applying for free or low-cost health insurance for their children and teens.
Q: Is my child eligible for Medicaid or CHIP?
A: States have different income eligibility rules, but in most states, children up to age 19 with family income up to $48,500 per year (for a family of four) may qualify for Medicaid or the Children’s Health Insurance Program (CHIP). In many states, family income can be even higher and children can still qualify. Young people up to age 21 may be eligible for Medicaid. Youth who have “aged out” of foster care can be covered under Medicaid until they reach age 26; there is no income limit for these youth.
Medicaid and CHIP coverage is for U.S. citizens and certain lawfully present immigrants.
To find information about the Medicaid and CHIP programs in your state, go to Learn About Programs in Your State or call 1-877-KIDS-NOW (1-877-543-7669). When you call the free and confidential hotline, you will be connected to someone in your state who can help you learn whether your children may qualify and help you enroll them.
Q: I have teenagers. Are they eligible for coverage, too?
A: Yes, in every state, children from birth until their 19th birthday may be eligible for coverage.
Q: I have a job. Can my children and teens still qualify?
A: Yes, many children who are eligible for Medicaid and CHIP are in families where one or both parents are working. Working parents may not have health coverage through their jobs or the health plans they are offered may not cover their children. Many working families cannot afford health insurance on their own.
Q: Who can apply for Medicaid and CHIP for a child?
A: A parent, grandparent, guardian or other authorized representative can apply on behalf of a child. If you are a teenager living on your own, your state may allow you to apply for Medicaid on your own behalf or any adult may apply for you.
Q: What if my children and teens are covered by Medicaid or CHIP already?
A: That’s great! They already have comprehensive health insurance. If you are having trouble finding the care your child needs, call the toll free number 1-877-KIDS-NOW (1-877-543-7669). If you are looking for a dentist for your child, enter your information in the “Find a Dentist for Your Kid” box on the InsureKidsNow.gov home page.
Q: Is there a limit on the amount of time my child or teen can remain enrolled in Medicaid or CHIP?
A: Children and teens can stay covered as long as they qualify. You will need to renew their coverage once a year.
Q: How do I know when to renew Medicaid or CHIP coverage for my child or teen?
A: The program will contact you to let you know that it is time to renew your child’s coverage.
Q: What do Medicaid and CHIP cover?
A: All states provide comprehensive coverage for children, including:
- Routine check-ups
- Doctor visits
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
Some specific benefits may be different from state to state.
Q: How do I find a health care provider (doctor, dentist or pharmacist) in my area who accepts Medicaid or CHIP?
A: There are several things you can do to find a health care provider:
- If you already have a health care provider for your child, ask if he or she accepts Medicaid, CHIP, or the health plan you selected. If you've been getting care from a provider that doesn’t accept Medicaid, CHIP, or any of its health plans, you may be able to keep seeing that provider for a short time until you can find another provider, but you need to ask your state’s Medicaid or CHIP program, or the health plan you selected.
- Most Medicaid and CHIP programs and health plans have websites that tell you which providers are available.
- Call your state Medicaid or CHIP agency or your health plan’s member services department for help. The phone number is typically on eligibility letters or on the back of program enrollment cards. This information should also be available on your health plan’s website or your state Medicaid or CHIP agency website.
- Be sure to let your provider know that you are enrolled in Medicaid or CHIP, or give the name of your health plan when you make an appointment for care. If you are having trouble getting an appointment to see a doctor, call your state Medicaid or CHIP agency or your health plan’s member services department for help.
Q: What do families pay for coverage under Medicaid and CHIP?
A: Depending on their income, many families will get free health coverage for their children and teens. Other families may be required to pay a modest enrollment fee or premiums, and copayments for specific services. The rest of the coverage is paid for by the federal government and your state.
Q: When can I apply for Medicaid and CHIP? Is there a certain time of year I can apply?
A: You can enroll in Medicaid or CHIP any time. There’s no special open enrollment period for Medicaid or CHIP. You can apply at HealthCare.gov or directly with your state Medicaid/CHIP agency.
Q: How do I apply?
A: You can apply online, by phone, by mail or in person. You can apply using the online application or directly at your state’s Medicaid or CHIP agency. Or, to get more information and help call 1-877-KIDS-NOW (1-877-543-7669), a free and confidential hotline, to be connected directly to your state’s program.