Eligibility

For most families, CHIP is free. A household with income above a certain level can receive CHIP at low-cost or full-cost.

Boy with a frog

Key requirements

To qualify for CHIP, your child must be:

  • Under the age of 19.
  • A resident of Pennsylvania.
  • A U.S. citizen, a lawfully admitted alien with permanent status or a refugee as determined by U.S. Immigration and Naturalization Services.
  • Uninsured and not eligible for or enrolled in Medical Assistance.

Family of four CHIP income limits and eligibility:

  • Free coverage if you earn up to $57,720
  • Low-cost coverage if you earn up to $72,705
  • Full-cost coverage if you earn more than $87,135

CHIP eligibility guidelines

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

  1. Locate the number of people in your household.
  2. Find the box that matches your household's annual gross income and age of your children.
  3. Look down the column to see your monthly cost per child and the copay per child, per visit.

Example: A four-person household with an annual income of $69,840 will have an average monthly premium of $75 per child, plus any co-pays for services.

Income

Effective March 1, 2022

Household size

Income level 
Ages 1-51

Income level 
Ages 6-181

1 $ 21,337  $ 28,268 $ 18,075  $ 28,268
2 $ 28,747  $ 38,085 $ 24,353  $ 38,085
3 $ 36,158  $ 47,903 $ 30,630  $ 47,903
4 $ 43,568  $ 57,720 $ 36,908  $ 57,720
5 $ 50,978  $ 67,538 $ 43,186  $ 67,538
6 $ 58,389  $ 77,356 $ 49,463  $ 77,356
7 $ 65,799  $ 87,173 $ 55,741  $ 87,173
8 $ 73,210  $ 96,991 $ 62,018  $ 96,991
9 $ 80,620  $ 106,808 $ 68,296  $ 106,808
10 $ 88,030  $ 116,626 $ 74,574  $ 116,626

Cost

Description

Income level 
Ages 1-5

Income level 
Ages 6-18

Average 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

Income

Effective March 1, 2022

Household size

Income level 
Ages 0-11

Income level 
Ages 1-18

Income level 
Ages 0-18

Income level 
Ages 0-18

1

$ 29,219  $ 35,606 $ 28,268  $ 35,606 $ 35,606  $ 39,140 $ 39,140  $ 42,673
2 $ 39,367  $ 47,973 $ 38,085  $ 47,973 $ 47,973  $ 52,733 $ 52,733  $ 57,494
3 $ 49,515  $ 60,339 $ 47,903  $ 60,339 $ 60,339  $ 66,327 $ 66,327  $ 72,315
4 $ 59,663  $ 72,705 $ 57,720  $ 72,705 $ 72,705  $ 79,920 $ 79,920  $ 87,135
5 $ 69,811  $ 85,072 $ 67,538  $ 85,072 $ 85,072  $ 93,514 $ 93,514  $ 101,956
6 $ 79,959  $ 97,438 $ 77,356  $ 97,438 $ 97,438  $ 107,108 $ 107,108  $ 116,777
7 $ 90,107  $ 109,805 $ 87,173  $ 109,805 $ 109,805  $ 120,701 $ 120,701  $ 131,958
8 $ 100,255  $ 122,171 $ 96,991  $ 122,171 $ 122,171  $ 134,295 $ 134,295  $ 146,419
9 $ 110,403  $ 134,537 $ 106,808  $ 134,537 $ 134,537  $ 147,888 $ 147,888  $ 161,239
10 $ 120,551  $ 146,904 $ 116,626  $ 146,904 $ 146,904  $ 161,482 $ 161,482  $ 176,060

Cost

Description

Income level 
Ages 0-1

Income level 
Ages 1-18

Income level 
Ages 0-18

Income level 
Ages 0-18

Average monthly premium per child $ 55 $ 55 $ 75 $ 80

Copayments (per child, pr visit)

Service

Income level 
Ages 0-1

Income level 
Ages 1-18

Income level 
Ages 0-18

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

Income

Effective March 1, 2022

Household size

Income level 
Ages 0-18

1 $ 42,673  No limit
2 $ 57,494  No limit
3 $ 72,315  No limit
4 $ 87,135  No limit
5 $ 101,956  No limit
6 $ 116,777  No limit
7 $ 131,598  No limit
8 $ 146,419  No limit
9 $ 161,239  No limit
10 $ 176,060  No limit

Cost

Description

Ages 0-18

Average monthly premium per child

$ 318.47

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

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 21, 2022, Federal Register. FPIGs are effective for CHIP for March 1, 2022.

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.