Written by a parent, not a doctor. Nothing here is medical advice.

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Pennsylvania program

Children's health insurance above the Medicaid line (CHIP)

Pennsylvania's health insurance for children above the Medical Assistance income limit. CHIP can be free or have a monthly premium.

What it is

Pennsylvania's health insurance for children above the Medical Assistance income limit. CHIP can be free or have a monthly premium.

CHIP is another route when a child does not qualify for Medical Assistance. Income sets the premium, and the insurer sets its actual price. Other insurance usually blocks enrollment, so a work-plan offer and actual enrollment need different answers.

Eligibility rules
  • A Pennsylvania child must be under 19 and above the MA income limit for their age.
  • For four people, free CHIP runs to about $5,720 a month. The three low-cost bands run to about $7,205, $7,920 and $8,635 a month, and full-cost CHIP has no upper limit.
  • Those bands are 208%, 262%, 288% and 314% of poverty. Full-cost coverage has no upper income limit.
  • New CHIP enrollment requires that your child not already have other comprehensive health insurance and not qualify for MA. A work-plan offer and actual enrollment are different; access to Pennsylvania state-employee coverage also needs checking. Free or low-cost CHIP already in force has special continuation rules if other insurance starts.
  • CHIP needs your child to be a citizen or to meet an immigration rule. The counselor checks your child's own status, not a parent's.
What you get
  • Free CHIP has no monthly premium.
  • Low-cost coverage has average monthly premiums of $65, $91 or $104 per child.
  • Full-cost CHIP averages $281 per child each month.
  • Full child health coverage through the CHIP insurer you choose.
What the help includes
  • The insurer's own price can differ from the average. Full-cost CHIP costs between about $164 and $381 a child a month, depending on the insurer.
  • Low-cost CHIP premiums run from about $45 to $140 a child a month, depending on the band and the insurer you choose.
  • The oncology group and hospital need to participate in the exact CHIP plan, not just another product from that insurer.
  • The January 2026 CHIP handbook limits covered premiums and copays to 5% of annual family income counted by CHIP. Your insurer can explain which payments count, how to track them and how to request a review or refund. This is not a cap on every medical bill.
If you decide to apply
  1. Ask the financial counselor to compare CHIP and PH95, then complete COMPASS together if you choose CHIP.
  2. Have your child's insurance status and current household income ready.
  3. Check the insurer's price and oncology network before choosing a plan, and ask when its first premium is due.

1-866-550-4355 · Official page ↗

After you ask
  • The county checks MA first and routes the child to CHIP when appropriate. Your chosen insurer handles enrollment.
  • Full-cost CHIP ends at the end of the month other insurance is discovered. Free and low-cost coverage continues until the next redetermination.
  • There is no waiting period for a child who was uninsured. Free CHIP usually starts on the first day of the month after the decision; low-cost and full-cost CHIP start once the first premium is paid.
  • Once low-cost CHIP is in force, later premium nonpayment does not end its continuous-eligibility period. Full-cost CHIP has different termination rules and a 30-day grace period for later premium nonpayment. Your insurer confirms the payment and coverage dates.
Good to know

An offer of work insurance is different from being enrolled: a child who is not on the work plan can still get CHIP, and the offer does not have to be taken first. A child eligible for a state-organized employee plan faces a separate exclusion.

Other details
  • PH95 can provide free MA for an eligible child under 18 without counting parents' income. That review can matter before paying a CHIP premium.
  • A coverage change needs a confirmed start date and a treatment-network check. Losing an existing plan before those checks can leave a gap.

Federal background: Children’s Health Insurance Program.

Official sources
Ask your social worker

“Would CHIP or PH95 work better for our child? Could you compare the premium, treatment network and effect of our current insurance, then help us with the right application?”

Why I’m asking: I want coverage that includes our oncology team without taking on a premium we could avoid.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on COMPASS, answer the insurance question exactly (enrolled, not offered), pick an insurer with the oncology group in its network, and pay the first premium.

Your social worker

The social worker checks each insurer's oncology network and asks the county about PH95 if income is over the MA limit.

The care team

Records and letters when the application asks for them.

Who decides
The state Department of Human Services checks Medical Assistance first; the CHIP insurer you choose signs the child up.
Ask your social worker
“Which CHIP insurer has our oncology group in network, and what tier will we land in? If income is over the MA limit, can we ask for PH95 first?”

How to apply

First step: Apply at compass.dhs.pa.gov (COMPASS, the state's online application) or call 1-866-550-4355. The county checks Medical Assistance first and moves the child to CHIP if income is above the MA limit. Pay the first premium the day the notice arrives.

  1. Apply on COMPASS; MA is checked first.
  2. Answer the insurance question exactly: enrolled, not offered.
  3. Pick a CHIP carrier the oncology group takes and pay the first premium at once.

Official application / program page ↗

Where it starts: Apply on COMPASS or by phone; the county screens Medical Assistance first and passes the child to CHIP.

What to gather

  • Child's ID and Social Security number
  • This month's income for the household
  • Proof the child has no other insurance, or the date it ended

How long: The county's 30-day COMPASS standard, then the insurer signs the child up. The 2025 CHIP annual report recorded no children placed on a waiting list.

What a yes looks like

A notice with the tier, the premium and the carrier. Check the oncology group is in network before the first premium.

What a no looks like, and the next move

Check whether the reason is other insurance, income (then MA is better: no premium and months back) or the state-employee rule. Keep the appeal date.

Watch out

  • An employer offer is not enrollment. CHIP tests whether the child is covered today. A state worker's child who can join the state employee plan is barred even without enrolling.
  • Full-cost CHIP ends at the end of the month other insurance is found; free and low-cost children keep it until the next renewal.
  • Premiums on the chart are averages. Ask the insurer for its price; some charge less than the rate table.
  • CHIP has citizenship or qualifying-immigration requirements. Emergency Medical Assistance covers qualifying emergency conditions; it is not a full-course cancer coverage promise.

Dates that change this

2026-03-01: Income tiers are the chart effective March 1, 2026; average premiums are effective January 1, 2026; insurer rates revised April 8, 2026.

2025-06-03: No CHIP waiting period anywhere since June 3, 2025; none is in Pennsylvania's January 2026 handbook.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

Free CHIP up to 208% of the poverty line ($5,720 a month for four), low-cost up to 314% ($8,635 for four), full-cost above that at any income. Average premiums $0 / $65 / $91 / $104 / $281 per child per month.

  • $68,640/year — Free CHIP upper income line, family of 4 (208% FPIG, annual)
  • $86,460/year — Low-Cost 1 upper line, family of 4 (262%, annual)
  • $95,040/year — Low-Cost 2 upper line, family of 4 (288%, annual)
  • $103,620/year — Low-Cost 3 upper line, family of 4 (314%, annual)
  • $65/month (chart average; carriers list $44.91 to $87.80) — Average premium per child, Low-Cost 1
  • $91/month (chart average; carriers list $62.87 to $122.92) — Average premium per child, Low-Cost 2
  • $104/month (chart average; carriers list $71.85 to $140.48) — Average premium per child, Low-Cost 3
  • $281/month (chart average; carriers list $163.73 to $380.64) — Average premium per child, Full-Cost
  • $163.73/month — Lowest listed Full-Cost carrier premium per child (Aetna Central)
  • $380.64/month — Highest listed Full-Cost carrier premium per child (Capital Blue Cross)
  • $0/month — Free CHIP premium

Covers: Doctor and hospital care · Prescriptions · Dental and vision · Behavioral health

What it costs the family: Free tier $0. Low-cost tiers average $65, $91 and $104 per child a month; full-cost averages $281 (insurer prices $163.73 to $380.64). Some insurers charge less than the rate table.

The eligibility facts, as published

Age max
18
Income
over the MA line for the child's age; tiers at 208 / 262 / 288 / 314% FPIG; no upper limit for Full-Cost
Insurance status condition
not enrolled in other insurance at application and renewal; a child eligible for or enrolled in a state-organized employee health plan is not eligible
Full cost rule
Full-Cost enrollees are terminated at the end of the month in which other insurance is discovered; free and low-cost enrollees stay until redetermination with CHIP paying last
Waiting period
none found in the January 2026 handbook
Residency
Pennsylvania

The trap: An employer offer is not enrollment. CHIP asks whether the child is covered today. A child who can join a state-organized employee plan (a state worker's plan) is barred even without enrolling.

Where I read this

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