CHIP Eligibility and Costs

Am I eligible?

Most children receive CHIP for free. For children who live in a household with a higher income, out-of-pocket costs like monthly premiums and copays may apply.

Your children are eligible if they're:

  • 18 years old or under.
  • A U.S. citizen, U.S. national, or a qualified legal resident.
  • A resident of Pennsylvania.
  • Uninsured and not able to receive medical assistance.
Please call 1-800-543-7105 for eligibility questions.

Income guidelines

Your household income will determine your monthly premium and copays.

DOWNLOAD INCOME GUIDELINES

What do I pay?

Once you know which CHIP coverage you're eligible for, you can use the following charts to estimate your monthly premium and copays for care.

Monthly premiums

One Child
Two Children
Three or more
Children
Free CHIP

$0

$0

$0

Low-Cost CHIP 1

$59.73

$119.46

$179.19

Low-Cost CHIP 2

$83.62

$167.24

$250.86

Low-Cost CHIP 3

$95.56

$191.12

$286.68

Full-Cost CHIP

$282.70

$565.40

$848.10

*Highmark Blue Cross Blue Shield monthly premium does not increase after three kids, regardless of how many are in your household.

**Rates effective July 1, 2020.

Copayments for visits and prescriptions

PCP
Specialist
Emergency
Brand Name Drug
Generic Drug
Free CHIP

No cost

No cost

No cost

No cost

No cost

Low-Cost CHIP 1

$5*

$10

$25*

$9

$6

Low-Cost CHIP 2

$5*

$10

$25*

$9

$6

Low-Cost CHIP 3

$5*

$10

$25*

$9

$6

Full-Cost CHIP

$15*

$25

$50*

$18

$10

*No copay required for preventive health services on the Highmark Preventive Schedule when provided by a PCP. Preventive Schedules are available to Highmark members on their member portal. Log in to your Highmark account.

**Emergency Room copay is waived if admitted.