What does CHIP cover in Utah?
What healthcare services, such as doctor visits and hospital stays, are covered by CHIP in Utah?
Yes, families enrolled in CHIP (Children’s Health Insurance Program) in Utah may be required to pay small premiums and out-of-pocket costs such as copayments for certain services. CHIP is designed to offer affordable healthcare coverage for children, and the amount you’ll need to pay depends on your household income. Here’s what you need to know about the premiums and out-of-pocket costs associated with CHIP coverage in Utah.
1. Premiums for CHIP Coverage
CHIP coverage in Utah requires some families to pay a monthly premium, but the amount is based on a sliding scale according to your household income. Families with lower incomes will pay smaller premiums, and the program ensures that these costs remain affordable.
A. How Are Premiums Calculated?
Your income and household size are used to determine the amount of your monthly premium.
Families at the lower end of the CHIP income scale (closer to 138% of the Federal Poverty Level (FPL)) may pay little to no premiums.
Families at the higher end of the income scale (closer to 200% of the FPL) will pay slightly higher premiums, but they are still much more affordable than private insurance premiums.
You will receive information about your premium amount when your child’s CHIP application is approved.
2. Copayments and Other Out-of-Pocket Costs
In addition to premiums, families enrolled in CHIP may also be responsible for small copayments for healthcare services, such as doctor visits, prescriptions, or emergency care.
A. Typical Copayments
Doctor visits: A small copayment, often around $5–$10 per visit.
Prescription medications: Depending on the medication, copays might range from $5–$15 for generic or brand-name drugs.
Emergency room visits: A copayment of around $25–$50 for emergency services, unless the visit is deemed a non-emergency.
B. Out-of-Pocket Maximums
One of the key benefits of CHIP is that it sets a limit on how much you’ll need to pay out-of-pocket each year. This is called the out-of-pocket maximum, and once you reach this limit, CHIP will cover 100% of the costs for covered services for the rest of the year.
The out-of-pocket maximum is based on your household income.
Once you’ve reached the maximum, you won’t have to pay any more copayments or other out-of-pocket costs for the remainder of the coverage year.
3. What Services Are Covered at No Cost?
While some services require copayments, many essential services are fully covered by CHIP at no cost to you. These services often include:
Preventive care: Well-child visits, immunizations, and screenings.
Dental and vision care: Routine dental checkups, cleanings, and eye exams are typically covered with no copayments.
4. How to Find Out Your Premium and Copay Information
Once your child is enrolled in CHIP, you will receive details about your specific premium and copayment amounts in your approval packet. You can also:
Contact Utah CHIP customer service: Call 1-866-435-7414 for more information about your specific costs.
Check your benefits card: Your child’s CHIP benefits card may also list your copay amounts for different services.
5. What to Do If You Can’t Afford Premiums or Copays
If you’re having difficulty paying CHIP premiums or out-of-pocket costs, you have options:
Contact Utah Medicaid: Explain your financial situation to see if you qualify for additional assistance or a lower premium rate.
Explore Medicaid eligibility: If your income decreases, your child may qualify for Medicaid, which typically has no premiums or copays.
Key Takeaways:
Families enrolled in CHIP in Utah may have to pay small premiums and copayments based on their household income.
Copayments are typically low, and CHIP sets an out-of-pocket maximum to limit how much families need to pay in a year.
Many essential services, such as preventive care and dental/vision care, are fully covered by CHIP at no cost.
For help understanding your CHIP premiums and out-of-pocket costs, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
