What CHIP Costs and Premiums Look Like in Your State
CHIP premiums and costs vary widely by state, and some states charge nothing at all
CHIP is run by each state individually, which means what you pay — or whether you pay anything — depends entirely on where you live. Some states have no premiums at all. Others charge monthly premiums that range from a few dollars to over $100, depending on your household income. Most states also charge small copays when you use care, though the amounts differ. A few states waive copays for preventive visits like checkups and vaccines.
The income level at which your state stops charging premiums is also different in every state. In some places, families earning up to 200% of the federal poverty line pay nothing. In others, premiums don't start until you reach 250% or higher. This matters because it determines whether CHIP is truly free for your family or whether monthly costs will be part of your budget.
The best way to know what your state charges is to contact your state CHIP program directly or use the CHIP program locator on the Centers for Medicare & Medicaid Services website, which links to every state's program with current fee information.
Key Takeaways
- Premiums range from zero to over $100 per month depending on your state and household income level.
- Most states charge small copays for doctor visits and prescriptions, but preventive care is often free.
- The income threshold where premiums begin varies by state, from 200% to 300% of the federal poverty line or higher.
- Your state CHIP program website or a 211 call can tell you the exact costs for your family's income level.
- Some states have waiting periods before coverage begins, while others enroll immediately.
How premiums are structured across states
Most states that charge premiums use a sliding scale based on your household income. This means families earning less pay lower premiums, and premiums increase as income rises. A family at 150% of the poverty line might pay $15 a month, while a family at 250% of the poverty line might pay $50 a month in the same state.
Some states charge a flat fee per child or per family regardless of income, once you cross the income threshold where premiums begin. Others charge per-child premiums that increase with each additional child. A few states have stopped charging premiums altogether in recent years, though this can change depending on state budget decisions.
The income cutoff where premiums start is the key number to find out. If your household income is below that threshold, you pay nothing. If you're above it, you pay according to your state's formula. This cutoff is usually between 200% and 300% of the federal poverty line, but some states go higher.
Copays and out-of-pocket costs when you use care
Most CHIP programs charge small copays when your child sees a doctor, gets lab work, or fills a prescription. These copays are typically $1 to $5 per visit or prescription, though some states charge more. Emergency room visits usually have a higher copay, often $25 to $50, to discourage unnecessary ER use.
Preventive care — checkups, vaccines, screenings — is almost always free in every state's CHIP program. This includes well-child visits, immunizations, and developmental screenings. The idea is to catch problems early without cost barriers.
Inpatient hospital stays and specialist visits usually have no copay or a very small one. Some states waive copays entirely for children under a certain age, often under 6 years old. Check your state program's summary of benefits to see the exact copay structure, because it varies.
What happens if your income changes during the year
If your income rises above your state's CHIP income limit, your child's coverage will end. Most states give you a grace period — usually 30 to 60 days — to report the change. If you don't report it and your child continues to receive care, you may be billed for services after coverage ends.
If your income drops and you fall below the CHIP limit, you can report the change and your child can stay on CHIP. Some states allow you to update your income information online, while others require a phone call or a form sent by mail. Your state CHIP program can tell you the fastest way to report changes.
Many states also allow you to stay on CHIP for a set period even if your income rises slightly — sometimes called a "continuous may be able to access" period. This protects your child from losing coverage mid-year if your income fluctuates. Ask your state program whether this applies to you.
Comparing CHIP costs to Medicaid and private insurance
CHIP premiums and copays are designed to be lower than what private insurance costs, but higher than Medicaid. If your child qualifies for Medicaid instead, Medicaid has no premiums and usually no copays. If your child doesn't may have access to for either program, private insurance through your employer or the marketplace will almost certainly cost more than CHIP.
Some families are caught between programs: their income is too high for Medicaid but low enough for CHIP. In those cases, CHIP is usually the most affordable option. Other families have access to employer coverage but find that CHIP costs less and covers more. There's no single answer — it depends on your state's rules and your specific situation.
A few states allow families to choose between CHIP and Medicaid if they may have access to for both. If that's an option where you live, comparing the copays and covered services in each program can help you decide which works better for your family.
How to find your state's current premium and copay schedule
The fastest way is to call your state CHIP program directly. The number is on your state's CHIP website, which you can find through the CMS CHIP locator. When you call, have your household size and approximate income ready, and ask for a written summary of costs.
You can also visit your state's CHIP website directly and look for a "costs" or "premiums" page. Most states publish a fee schedule that shows exactly what you'll pay based on income level. Some states also have an online tool where you enter your income and it calculates your premium.
If you're having trouble finding the information online, calling 211 (a free helpline) can connect you to a local CHIP enrollment specialist who knows your state's current rules. They can also tell you whether your family's income qualifies and what the enrollment process looks like in your area.
Frequently Asked Questions
Do I have to pay CHIP premiums if my income is below the poverty line?
No. Most states charge no premiums for families below a certain income threshold, usually 150% to 200% of the federal poverty line. Once your income rises above that threshold, premiums begin. Your state CHIP program can tell you the exact cutoff for your state.
What if I can't afford the CHIP premium?
Contact your state CHIP program and explain your situation. Some states have hardship waivers or can reduce your premium if you're experiencing financial difficulty. A few states also allow you to pay premiums in installments rather than all at once. Don't skip paying — unpaid premiums can lead to loss of coverage.
Are CHIP copays the same in every state?
No. Copays vary by state and sometimes by type of service. Preventive care is free everywhere, but a doctor visit copay might be $1 in one state and $5 in another. Check your state's summary of benefits or call your state CHIP program to see the exact copay amounts.
If I lose my job, will CHIP premiums go down?
Yes, if your household income drops. Report the change to your state CHIP program as soon as possible. Your premium will be recalculated based on your new income. Some states allow you to report changes online, while others require a phone call or form.
Does CHIP cover dental and vision care?
Most states include dental and vision coverage in CHIP, though the scope varies. Some states cover routine cleanings and exams with no copay, while others charge small copays. Check your state's benefits summary to see what's covered and whether there are copays for dental or vision services.