How Much Is Full-Cost CHIP in PA?
Understand the financial aspects and accessibility of Pennsylvania's full-cost CHIP for your child's healthcare coverage.
The Children’s Health Insurance Program (CHIP) in Pennsylvania provides health coverage for children and teens up to age 19. This program aims to ensure that all uninsured children have access to necessary medical care. While many families qualify for free or low-cost CHIP based on their income, a “full-cost” option is available for families whose incomes exceed the thresholds for subsidized coverage.
Who Qualifies for Full-Cost CHIP
Eligibility for CHIP in Pennsylvania is primarily determined by family income and household size. Uninsured children under 19 who are Pennsylvania residents and are not eligible for Medical Assistance or other private insurance typically qualify. While specific income limits exist for free and low-cost CHIP tiers, there is no upper income limit for CHIP itself, meaning families with higher incomes can still access the full-cost option.
Families whose incomes are above the federal poverty level (FPL) percentages for free or low-cost CHIP may be eligible for the full-cost tier. For instance, in 2025, the FPL for a family of four is $32,150. Families earning more than the income thresholds for subsidized CHIP may opt for full-cost coverage to ensure their children remain insured. This provision ensures that a health insurance option remains available for children even when family income levels are higher.
Determining Your Monthly Premium
The monthly premium for full-cost CHIP in Pennsylvania is typically structured on a sliding scale, influenced by the family’s income, household size, and sometimes the child’s age. While termed “full-cost,” these premiums are often more affordable than comparable private health insurance plans. The total annual cost-sharing, including premiums, for a family cannot exceed 5% of their annual household income, as mandated by federal guidelines.
Families should consult official state resources or specific CHIP providers to obtain the most current and precise premium figures applicable to their household.
Covered Benefits and Additional Costs
Full-cost CHIP provides comprehensive health benefits designed to cover a wide range of medical services for enrolled children. These benefits include, but are not limited to, routine check-ups, doctor visits, immunizations, and prescription medications. Dental care, vision care, mental and behavioral health services, emergency care, and hospital visits are also typically covered.
Beyond the monthly premium, families enrolled in full-cost CHIP may encounter other expenses, such as co-pays for certain services like doctor visits or prescriptions. However, these out-of-pocket costs are generally low, and the program is structured to limit financial burdens.
Steps to Apply for CHIP
Applying for CHIP in Pennsylvania involves gathering specific financial and personal documentation to determine eligibility and cost. Applicants need to provide details on all household income before taxes, including wages, Social Security benefits, pension income, and any other forms of financial support. Information regarding any private health insurance held by household members within the last 90 days, along with Social Security Numbers for all children requiring coverage and the head of household, is also necessary.
Once the required information is prepared, families can apply through several convenient methods. The most common approach is applying online via the COMPASS website, which guides users through the application questions. Alternatively, applications can be submitted by phone through the CHIP helpline or by mailing a completed paper application. After submission, processing typically takes four to six weeks, and applicants are notified of their eligibility and next steps by mail.