Can my child qualify for CHIP if we have private insurance?
Is my child eligible for CHIP if we have other health insurance, but it doesn’t fully cover their needs?
CHIP (Children’s Health Insurance Program) in Utah provides healthcare coverage for children in families that may not qualify for Medicaid but cannot afford private health insurance. However, CHIP eligibility requires that the child is uninsured at the time of application. Here’s what you need to know if your child has other health insurance that doesn’t fully cover their healthcare needs.
1. CHIP Eligibility and Other Health Insurance
To be eligible for CHIP, your child must be uninsured. This means that if your child already has any other health insurance, even if it doesn’t fully meet their needs, they may not qualify for CHIP. Here’s why:
A. Uninsured Requirement
CHIP is designed to provide coverage to children who do not have access to other health insurance. If your child is currently covered by an employer-sponsored health plan, even if that plan doesn’t fully cover their medical needs, they are not eligible for CHIP.
If your child loses health insurance or if you decide to discontinue your current plan, you may become eligible to apply for CHIP.
B. Exceptions and Special Circumstances
There are certain situations in which you may be able to apply for CHIP even if your child previously had health insurance:
Loss of coverage: If your child loses health insurance due to a change in your employment or a reduction in benefits, they may become eligible for CHIP.
Inadequate coverage: If your existing health insurance is considered inadequate (e.g., it doesn’t meet minimum coverage requirements for essential services), you may need to explore other options such as Medicaid or an ACA Marketplace plan.
2. What to Do If Your Child’s Health Insurance Doesn’t Fully Cover Their Needs
If your child’s current health insurance doesn’t fully meet their healthcare needs, but they are not eligible for CHIP, you can explore alternative solutions:
A. Supplemental Health Insurance
If your current plan provides partial coverage, you may want to explore supplemental insurance options. Some plans provide additional coverage for areas your primary insurance might not cover, such as dental or vision care.
B. Medicaid
If your household income falls within the eligibility range for Medicaid in Utah, your child may qualify for Medicaid coverage even if they do not qualify for CHIP. Medicaid provides more comprehensive coverage, often with lower or no copays and premiums.
C. ACA Marketplace Plans
If your household income is too high for Medicaid but your existing insurance doesn’t fully meet your child’s needs, you may qualify for a subsidized health plan through the ACA Marketplace. Depending on your income, you may be eligible for premium tax credits and cost-sharing reductions that can make private insurance more affordable.
3. How to Apply for CHIP If Your Child Becomes Uninsured
If you lose your current health insurance or choose to drop it, your child may become eligible for CHIP. Follow these steps to apply:
Apply online: Submit an application for CHIP at medicaid.utah.gov or healthcare.gov once your child is uninsured.
Provide proof of income: You’ll need to verify your household income to confirm that you fall within the income limits for CHIP (between 138% and 200% of the Federal Poverty Level (FPL)).
Provide proof of loss of insurance: If your child has recently lost coverage, you may need to provide documentation, such as a letter from your employer or insurance provider.
4. When to Reconsider CHIP Eligibility
If your child’s health insurance changes or if you find that you can no longer afford the premiums or copays, you may want to reapply for CHIP:
Income changes: If your income decreases and you can no longer afford private insurance, your child may become eligible for CHIP.
Loss of employer-sponsored insurance: If you or your spouse lose a job that provides health insurance, your child may qualify for CHIP once they become uninsured.
Key Takeaways:
To be eligible for CHIP in Utah, your child must be uninsured. If your child currently has health insurance, they are not eligible for CHIP, even if the coverage is inadequate.
If your child’s current insurance doesn’t fully meet their healthcare needs, you may explore other options, such as Medicaid, ACA Marketplace plans, or supplemental insurance.
If your child loses their health insurance or you choose to drop it, they may become eligible for CHIP, and you can apply at that time.
For help determining whether your child qualifies for CHIP or exploring other healthcare options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
