No, children who qualify for the Children's Health Insurance Program (CHIP) are not eligible for premium tax credits on a Marketplace health plan. CHIP is typically viewed as a more affordable and thorough option for eligible children.
If your child is eligible for the Children's Health Insurance Program (CHIP), it affects your eligibility for federal subsidies like premium tax credits for a few key reasons:
No Double Subsidies: The government does not provide a federal subsidy, such as a premium tax credit, for a child who already qualifies for another form of government-sponsored coverage, including Medicaid or CHIP.
Most Affordable Option: For those who meet the qualifications, CHIP is considered by the government to be the most appropriate and affordable healthcare option. Therefore, it is the default choice for eligible children.
CHIP Eligibility and Premium Tax Credits: The Waiting Period Exception
Generally, children who qualify for CHIP are not eligible for premium tax credits for a Marketplace health plan.
However, an exception exists: If your state has a waiting period before CHIP enrollment begins, your children may qualify for premium tax credits during this specific waiting period. Once the waiting period concludes and they are able to enroll in CHIP, they will no longer be eligible for the tax credit.
What CHIP Eligibility Means for Your Family:
Marketplace Plan Option: You can include your children in your family's Marketplace health plan. However, their portion of the premium will not qualify for financial assistance, likely making this a more expensive option than CHIP.
Potential Savings for Other Family Members: If you and other family members (not eligible for CHIP) enroll in a Marketplace plan, you may still qualify for premium tax credits.
Consider Split Coverage: Many families choose to have parents covered by a Marketplace plan with premium tax credits, while their children are covered by CHIP.
While CHIP benefits vary by state, all states offer comprehensive coverage, including:
Routine check-ups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Laboratory and X-ray services
Emergency services
Behavioral health services
States may provide more CHIP benefits. Learn more about covered services in your state.
Need Help?
If you need assistance understanding or updating your information, our Consumer Advocate team can help. Call 855-772-2663, Monday–Friday, 6 a.m.–4 p.m. PT, or visit www.healthsherpa.com to log into your account and make updates.