CHIP eligibility in Pennsylvania: See if your child qualifies

At Capital Blue Cross, we believe every child deserves access to quality healthcare. The Children’s Health Insurance Program (CHIP) offers free or low-cost coverage for uninsured children and teens in Pennsylvania. CHIP is available for all families who qualify, regardless of income level. Learn more about CHIP eligibility and how to apply for CHIP.

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Who is eligible for CHIP?

CHIP is designed to provide health insurance coverage for children and teens in Pennsylvania who are under 19 years old. To qualify for CHIP, your child must meet the following criteria.

  • Age: Your child must be under 19 years old.
  • Residency: You must be a Pennsylvania resident to qualify for CHIP options in Pennsylvania.
  • Citizenship/Immigration Status: You must be a U.S. citizen, a lawfully admitted alien with permanent status, or a refugee as determined by U.S. Immigration and Naturalization Services.
  • Insurance Status: You must be uninsured and not eligible for (or currently enrolled in) Medical Assistance.
  • Income Level: Eligibility for free or low-cost CHIP is based on household income. If your income is below the CHIP income guidelines listed below, your child could be eligible for Medical Assistance.

What does CHIP cover?

CHIP provides comprehensive healthcare benefits to Pennsylvania kids, including:

  • Routine check-ups and doctor visits.
  • Immunizations.
  • Prescription medications.
  • Dental care.
  • Vision and eye care.
  • Mental and behavioral health services.
  • Emergency care.
  • Hospital visits.
  • Specialist care.
  • Diagnostic tests.

CHIP ensures your child gets the care they need to grow up healthy and strong.

How do I apply for CHIP?

Applying for CHIP is simple. You can apply online through COMPASS, which walks you through the steps to complete an application, including what documentation is needed. When you choose Capital Blue Cross in the Insurance Company Information section, your child will be covered by Capital Blue Cross if they are eligible.

Other ways to apply include:

  • Using the myCOMPASS PA mobile app.
  • Mailing, faxing, or dropping off items in person to your local county assistance office (CAO).

If you need help applying for CHIP, call 800.543.7101 to request a COMPASS callback. Our Member Services team will help you schedule time with a CHIP specialist to complete your application.

Visit our Apply For CHIP page for more information about applying for CHIP coverage.

What are the CHIP income guidelines in PA?

Families qualify for free or low-cost CHIP based on income level. The program offers free, low-cost, and full-cost options to ensure all children have access to health insurance coverage.

CHIP income limits vary by family size. If your income is higher than the listed amounts, you may still qualify for full-cost CHIP.

Check out our listings to see if you are eligible for free or low-cost coverage.

Free CHIP Coverage

Income

Household size

Income level 
Ages 1-51

Income level 
Ages 6-181
1 $ 24,571 — $ 32,552 $ 20,815 — $ 32,552
2 $ 33,206 — $ 43,992 $ 28,130 — $ 43,992
3 $ 41,841 — $ 55,432 $ 35,445 — $ 55,432
4 $ 50,476 — $ 66,872 $ 42,760 — $ 66,872
5 $ 59,111 — $ 78,312 $ 50,075 — $ 78,312
6 $ 67,746 — $ 89,752 $ 57,390 — $ 89,752
7 $ 76,381 — $ 101,192 $ 64,705 — $ 101,192
8 $ 85,016 — $ 112,632 $ 72,020 — $ 112,632
9 $ 93,615 — $ 124,072 $ 79,335 — $ 124,072
10 $ 102,286 — $ 135,512 $ 86,650 — $ 135,512

Cost

Description

Income level 
Ages 1-5

Income level 
Ages 6-18

Monthly premium per child

 $0 $0

Copayments (per child, per visit)

Service

Income level 
Ages 1-5

Income level 
Ages 6-18
Doctor visit $0 $0
Brand name prescription $0 $0
Generic prescription $0 $0
Specialist visit $0 $0
Emergency room visits4 $0 $0

Low-Cost CHIP Coverage

Income

Household size

Low-cost 1
Income level 
Ages 0-11

Low-cost 1
Income level 
Ages 1-18

Low-cost 2
Income level 
Ages 0-18

Low-cost 3
Income level 
Ages 0-18

1

 $ 33,648 — $ 41,003 $ 32,552 — $ 41,003 $ 41,003  — $ 45,072 $ 45,072  — $ 49,141
2 $ 45,473 — $ 55,413 $ 43,992 — $ 55,413 $ 55,413 — $ 60,912 $ 60,912 — $ 66,411
3 $ 57,298 — $ 69,823 $ 55,432 — $ 69,823 $ 69,823 — $ 76,752 $ 76,752 — $ 83,681
4 $ 69,123 — $ 84,233 $ 66,872 — $ 84,233 $ 84,233 — $ 92,592 $ 92,592 — $ 100,951
5 $ 80,948 — $ 98,643 $ 78,312 — $ 98,643 $ 98,643 — $ 108,432 $ 108,432 — $ 118,221
6 $ 92,773 — $ 113,053 $ 89,752 — $ 113,053 $ 113,053 — $ 124,272 $ 124,272 — $ 135,491
7 $ 104,598 — $ 127,463 $ 101,192 — $ 127,463 $ 127,463 — $ 140,112 $ 140,112 — $ 152,761
8 $ 116,423 — $ 141,873 $ 112,632 — $ 141,873 $ 141,873 — $ 155,952 $ 155,952 — $ 170,031
9 $ 128,248 — $ 156,283 $ 124,072 — $ 156,283 $ 156,283 — $ 171,792 $ 171,792 — $ 187,301
10 $ 140,073 — $ 170,693 $ 135,512 — $ 170,693 $ 170,693 — $ 187,632 $ 187,632 — $ 204,571

Cost

Description

Low-cost 1
Income level 
Ages 0-1

Low-cost 1
Income level 
Ages 1-18

Low-cost 2
Income level 
Ages 0-18

Low-cost 3
Income level 
Ages 0-18
Monthly premium per child $ 70 $ 70 $ 90 $ 100

Copayments (per child, pr visit)

Service

Low-cost 1
Income level 
Ages 0-1

Low-cost 1
Income level 
Ages 1-18

Low-cost 2
Income level 
Ages 0-18

Low-cost 3
Income level 
Ages 0-18
Doctor visit $ 5 $ 5 $ 5 $ 5
Brand name prescription $ 9 $ 9 $ 9 $ 9
Generic prescription $ 6 $ 6 $ 6 $ 6
Specialist visit $ 10 $ 10 $ 10 $ 10
Emergency room visits4 $ 25 $ 25 $ 25 $ 25

Full-Cost CHIP Coverage

Income

Household size

Income level 
Ages 0-18
1 $ 49,141 — No limit
2 $ 66,411 — No limit
3 $ 83,681 — No limit
4 $ 100,951 — No limit
5 $ 118,221 — No limit
6 $ 135,491 — No limit
7 $ 152,761 — No limit
8 $ 170,031 — No limit
9 $ 187,301 — No limit
10 $ 204,571 — No limit

Cost

Description

Ages 0-18

Monthly premium per child

 $ 343.97

Copayments (per child, per visit)

Service

Ages 0-18
Doctor visit $ 15
Brand name prescription $ 18
Generic prescription $ 10
Specialist visit $ 25
Emergency room visits2 $ 50

Frequently Asked Questions about CHIP

Can my child qualify for CHIP if I have employer-sponsored insurance?

No. CHIP is for uninsured children. If your child is already covered by a private or employer-sponsored plan, they may not qualify.

What happens if my income changes?

Income is reviewed annually at renewal. However, if your income changes before renewal contact the statewide call center at 1-877-395-8930 to report the change in income. This helps ensure your continued eligibility in the free or low-cost CHIP options.

How often do I need to renew CHIP coverage?

CHIP must be renewed every year. Coverage does not automatically renew. You will receive a renewal notice before your coverage expires.

How long can you stay on CHIP insurance?

Children and teens can stay on CHIP as long as they qualify. Coverage must be renewed every year.

What is the Capital Blue Cross service area?

Capital Blue Cross services several counties in central and eastern Pennsylvania. Visit our Service Area page for more information.

Is there CHIP coverage for adults?

CHIP is only for uninsured children up to age 19. Adults can apply for health insurance with Capital Blue Cross or through Pennie.

If I enroll in a health insurance plan through my employer, do I have to remove my child from CHIP?

No, your child must be uninsured at the time of application and at the time of renewal. If your child is enrolled in another health insurance plan at those times, your child will not qualify for CHIP. If you enroll your child on your health plan during their 12 months of continuous coverage, they may remain enrolled in CHIP. In this situation any claims for services must be paid by the other insurance first.

Can I get portions of this coverage that are not covered under my own health insurance?

No, children eligible for CHIP must receive all of the CHIP benefits. They cannot only enroll in just dental or just vision, etc.

I live in another state. Can I get coverage for my children with CHIP through Capital Blue Cross?

No. Our CHIP plans are only available to residents living in the Capital Blue Cross service area.

Is grandparent's income used to determine CHIP income eligibility?

Grandparent’s income is only used if the grandparent has custody or guardianship of the CHIP member(s).

May a child have other insurance coverage and remain on CHIP?

Yes, if your child is enrolled in another health plan during their 12 months of continuous coverage, they may remain enrolled in CHIP. In this situation any claims for services must be paid by the other insurance first.

Does CHIP offer guest membership for CHIP members?

Yes. Guest membership is only available for detached families and students. The guest membership only applies if the child will be out of the area for 3-6 months.

Are children’s Social Security benefits used to determine income for CHIP applications or renewals?

Social security benefits of children are not counted when determining eligibility for CHIP unless the child has other income requiring them to file a tax return.

Does CHIP coverage continue beyond the age of 19?

Typically, CHIP coverage ends at the end of the month of the child’s 19th birthday. However, a CHIP member who has a baby is guaranteed 12 months post-partum coverage. This means if a CHIP member were to have a baby prior to turning 19 it is possible that they could have coverage past their 19th birthday.

My child is 18 and will be attending college in the fall. Can my child stay enrolled in CHIP while going to school in another state?

Families apart
  • CHIP members are eligible for limited families apart type guest memberships.
  • As long as the CHIP member resides with the CHIP head of household (HOH) for a minimum of 6 months in a year, the HMO residential requirements are met.
  • The specific guest membership start and stop dates are required for CHIP members who request this type of guest membership.
  • Guest membership only applies if the child will be out of the area for a period of at least 90 days but not more than 180.
Students
  • HMO residential requirements for CHIP members are met by the HOH. Note: Technically CHIP students still reside within our coverage area, and as such are eligible for student type guest membership.
  • This is available to:
    • college students
    • boarding school students
    • grade school students
  • As long as the CHIP HOH resides within the KHP Central service area, this type of guest membership can be maintained.

Can I appeal if CHIP says I’m ineligible?

If you do not agree with the eligibility decision, you may appeal the decision and request a fair hearing. DHS provides the fair hearing form with all eligibility notices or call the Statewide Customer Service Center (CSC) at 1.877.395.8930.

If your income is below any amount listed, your child could be eligible for Medical Assistance. For more details, please call 800.543.7101.

1 If your income is below the lower income limit, your child could be eligible for Medical Assistance.

2 Income guidelines according to the January 16, 2025, Federal Register. FPIGs effective for CHIP for March 1, 2025. Rates effective July 1, 2025

The bottom income limit for CHIP forms the upper income limit for Medicaid. The Affordable Care Act permits an income disregard of 5% of the upper Medicaid limit for applicants with incomes near the limit. This provision could result in some CHIP applicants being referred to the Department of Public Welfare if the household income is near the upper Medicaid limit.

CHIP coverage is issued by Keystone Health Plan® Central through a contract with the Commonwealth of Pennsylvania. Blue Cross Dental℠ and Blue Cross Vision℠ are issued by Capital Advantage Assurance Company®. Capital Advantage Assurance Company and Keystone Health Plan Central are subsidiaries of Capital Blue Cross. All are independent licensees of the Blue Cross Blue Shield Association. Communications are issued by Capital Blue Cross in its capacity as administrator of programs and provider relations.

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