How to Get Premium Assistance Under Medicaid and CHIP

If you’re having trouble getting health insurance coverage through Medicaid or the Children’s health insurance Program (CHIP), you may be able to get premium assistance. This can help you pay for your monthly premiums.

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Introduction

The Children’s health insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. Medicaid and CHIP offer free or low-cost health coverage to millions of Americans, including some low-income adults, families and children, pregnant women, the elderly, and people with disabilities.

If you are eligible for both Medicaid and CHIP, you will be enrolled in Medicaid. If you qualify for CHIP but not for Medicaid, you will be enrolled only in CHIP. You can apply for both programs at the same time using a single application.

To learn more about how to apply for Medicaid and CHIP in your state, click on your state name below.

What is Medicaid and CHIP?

Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid pays for a wide range of medical services for children and adults.

CHIP is the Children’s health insurance Program. CHIP provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, within guidelines set by the federal government. Each state’s CHIP program has different eligibility requirements.

You can apply for Medicaid or CHIP any time of year. If you qualify, you can enroll immediately.

What are the eligibility requirements for Medicaid and CHIP?

To be eligible for Medicaid or CHIP, you must meet certain income and other requirements.

Income requirements vary by state, but generally, you must have an income (or be a part of a household that has an income) that is at or below a certain percentage of the Federal Poverty Level (FPL).

For example, in 2018, the FPL for a family of four is $25,100. In states that use the Modified Adjusted Gross Income (MAGI) methodology to determine Medicaid eligibility for children and adults, the income level for Medicaid is generally at or below138% of the FPL.

However, some states have higher Medicaid income eligibility levels for certain groups of people, such as pregnant women, children under age 6 or 19, parents and primary caregivers, people with disabilities, and the elderly.

To learn more about your state’s specific Medicaid and CHIP eligibility requirements, visit your state’s website or contact your state’s Medicaid agency.

How to apply for Medicaid and CHIP

To apply for Medicaid or CHIP, contact your state Medicaid office or CHIP office. You can find contact information for your state offices by visiting www.medicaid.gov/contacts or www.insurekidsnow.gov/contacts.

If you live in a state that uses the healthcare.gov application system to enroll people in Medicaid and CHIP, you can apply online at www.healthcare.gov, by mail, or in person with the help of a trained assister (called an “in-person assister” or “navigator”).

How to renew Medicaid and CHIP coverage

You can renew your Medicaid or Children’s health insurance Program (CHIP) coverage by following the instructions in your renewal notice. If you need help, call your state Medicaid or CHIP office. You can find their phone number on your renewal notice or on your state’s website.

If you have questions about renewing your coverage, call your state Medicaid or CHIP office or the national helpline at 1-877-KIDS-NOW (1-877-543-7669).

What are the benefits of Medicaid and CHIP?

There are many benefits to Medicaid and CHIP. Premium assistance can help you pay for health insurance and Medicaid and CHIP also provide free or low-cost care for people with limited incomes. In addition, Medicaid and CHIP can help you pay for long-term care, such as nursing home care.

What are the costs of Medicaid and CHIP?

Most people pay nothing for Medicaid and CHIP coverage. Some people may have to pay a small monthly premium, but even the poorest families pay no more than 5% of their income for premiums. In many cases, there are no premiums at all. If your family has to pay a premium, the amount will depend on your family’s income.

How is Medicaid and CHIP coverage different from private health insurance?

Medicaid and CHIP provide low-cost or no-cost health coverage to eligible children, pregnant women, adults, people with disabilities, and the elderly. Medicaid and CHIP are administered by states within federal guidelines. Each state has its own rules about who is eligible for Medicaid and CHIP.

Contact your state Medicaid or CHIP office to learn more about eligibility requirements in your state. You can find your state’s contact information at:
http://www.medicaid.gov/about-us/contact-us/contact-your-state.html

Generally speaking, people with incomes at or below 138% of the federal poverty level ($16,754 for an individual or $22,955 for a family of two as of 2018) may qualify for Medicaid coverage. Pregnant women and children are often eligible for Medicaid with incomes above these levels. In some states, adults without dependent children may also be eligible for Medicaid. People who qualify for Medicare can’t receive Medicaid benefits.

CHIP provides health coverage to eligible children through age 18. In some states, CHIP covers pregnant women as well. Families that earn too much money to qualify for Medicaid may be able to get CHIP coverage for their children. Each state has different income guidelines for CHIP eligibility that are higher than Medicaid eligibility levels. You can find out if your state offers premium assistance under Medicaid or CHIP at:
http://www.Medicaid.gov/chip/index

What are some frequently asked questions about Medicaid and CHIP?

Q: What is Medicaid?
A: Medicaid is a health insurance program for low-income individuals and families. It is jointly administered by the federal government and the states.

Q: What is the Children’s Health Insurance Program (CHIP)?
A: The Children’s Health Insurance Program (CHIP) helps low-income children up to age 19 get health coverage. CHIP provides comprehensive benefits that include preventive care, immunizations, doctor visits, prescriptions, vision and dental care.

Q: How do I know if I am eligible for Medicaid or CHIP?
A: Eligibility for Medicaid and CHIP is based on income and family size. You can find out if you are eligible for Medicaid or CHIP by contacting your state Medicaid office or visiting www.healthcare.gov.

Q: How do I apply for Medicaid or CHIP?
A: You can apply for Medicaid or CHIP in several ways. You can contact your state Medicaid office or visit www.healthcare.gov to find out how to apply in your state.

Q: What services does Medicaid cover?
A: Medicaid covers a wide range of services, including doctor visits, hospitalizations, prescription drugs, laboratory tests, X-rays, and home health care.

Q: What services does CHIP cover? A: Services covered under CHIP are similar to those covered under Medicaid. In addition, some states offer dental coverage as part of their CHIP program

Conclusion

In conclusion, eligible children and pregnant women can get free or low-cost health insurance through Medicaid and CHIP. If you have questions about your eligibility or need help applying, please contact your state Medicaid or CHIP office.

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