Pennsylvania CHIP: Children's Health Insurance Program

Updated August 2026

Pennsylvania's Children's Health Insurance Program (CHIP) provides free or low-cost health coverage to children and teens under 19 who are not eligible for Medical Assistance and are uninsured. DHS administers the program; insurance coverage is provided through participating private insurance companies rather than directly by the state.

317% FPL

Subsidized CHIP limit

Up to ~$68,640 (family of 4)

Free CHIP income ceiling

$90–$115/mo

Low-cost CHIP premium tiers

CHIP coverage does not renew automatically — you must respond to the renewal notice

PA CHIP coverage renews annually. You will receive a renewal notice before your coverage expires — you can renew through COMPASS, the myCOMPASS PA app, by phone at 1-877-395-8930, by mail, or at your local CAO. Coverage does not automatically renew. At renewal, a child whose family income dropped below 138% FPL is automatically moved to free Medical Assistance.

What is Pennsylvania's CHIP and who administers it?

Pennsylvania CHIP carriers include Capital Blue Cross (central and eastern PA), UPMC Health Plan, Aetna Better Health, PA Health & Wellness (Wellkids), Independence Blue Cross (southeastern PA), and others. Your carrier options depend on your county of residence. The carriers deliver full managed care benefits, and each has its own provider network — though covered services are standardized across all carriers by DHS.

Unlike California, which folded CHIP into its Medicaid program, Pennsylvania operates CHIP as a distinct program with its own income guidelines, premium tiers, and insurance carriers. Children whose household income falls below 138% FPL are enrolled in Medical Assistance (Medicaid). CHIP covers the income band from 138% FPL up to 317% FPL — and through a full-cost option, there is no upper income limit at all.

For questions about CHIP eligibility, call the CHIP Statewide Change Center at 1-877-395-8930. Philadelphia residents call 215-560-7226.

Who qualifies for Pennsylvania CHIP?

There is no upper income limit for CHIP enrollment — families above the "low-cost" income threshold can enroll children in full-cost CHIP, which carries a premium of approximately $380/month per child (Capital Blue Cross 2026 rate). Most families qualify for free or low-cost coverage well below that level.

Under 19 years of age
Pennsylvania resident
U.S. citizen, U.S. national, or lawfully admitted alien with permanent status
Uninsured and not currently eligible for Medical Assistance
Household income above the Medical Assistance limit (138% FPL) — children below 138% FPL are enrolled in Medical Assistance instead

CHIP income tiers and what each tier costs (2026)

Pennsylvania CHIP uses four coverage tiers based on household income and child's age. The income guidelines below are effective March 1, 2026 (per pa.gov DHS CHIP eligibility page). Annual income figures shown are for a family of four — check COMPASS or pa.gov for other household sizes.

CHIP tier	Annual income range (family of 4, ages 6–18)	Monthly premium (per child)
Medical Assistance (Medicaid)	Under $43,890/yr	$0
Free CHIP	$43,890 – $68,640/yr	$0
Low-cost CHIP (tier 1)	$68,640 – $86,460/yr	$90/mo
Low-cost CHIP (tier 2)	$86,460 – $95,040/yr	$105/mo
Low-cost CHIP (tier 3)	$95,040 – $103,620/yr	$115/mo
Full-cost CHIP	Above $103,620/yr	~$380/mo (varies by carrier)

Medical Assistance (Medicaid)

Annual income range (family of 4, ages 6–18): Under $43,890/yr
Monthly premium (per child): $0

Free CHIP

Annual income range (family of 4, ages 6–18): $43,890 – $68,640/yr
Monthly premium (per child): $0

Low-cost CHIP (tier 1)

Annual income range (family of 4, ages 6–18): $68,640 – $86,460/yr
Monthly premium (per child): $90/mo

Low-cost CHIP (tier 2)

Annual income range (family of 4, ages 6–18): $86,460 – $95,040/yr
Monthly premium (per child): $105/mo

Low-cost CHIP (tier 3)

Annual income range (family of 4, ages 6–18): $95,040 – $103,620/yr
Monthly premium (per child): $115/mo

Full-cost CHIP

Annual income range (family of 4, ages 6–18): Above $103,620/yr
Monthly premium (per child): ~$380/mo (varies by carrier)

Source: Pennsylvania DHS 2026 CHIP Income Guidelines Chart, effective March 1, 2026 (pa.gov/agencies/dhs/resources/chip/eligibility-and-benefits); Capital Blue Cross 2026 CHIP eligibility chart. Income figures are for children ages 6–18 in a household of 4. Ages 1–5 have a slightly different lower income bound for free CHIP (starts at $51,810/yr for a family of 4). Verify current guidelines at pa.gov or COMPASS.

What Pennsylvania CHIP covers

CHIP benefits cover far more than basic preventive care. Per the pa.gov CHIP eligibility and benefits page, covered services include:

Routine checkups, well-child visits, and sick visits
Immunizations on the recommended schedule
Prescription medications (brand-name and generic)
Dental care including cleanings, fillings, and medically necessary orthodontia
Vision care: eye exams, eyeglasses, and contact lenses when medically necessary
Hearing services and hearing aids
Emergency care and urgent care visits
Inpatient and outpatient hospital care
Mental health and substance use disorder services
Durable medical equipment and home health care
Autism Spectrum Disorder and related services
Rehabilitation therapies (physical, occupational, speech)
Maternity care for CHIP members who become pregnant before turning 19

How to apply for Pennsylvania CHIP

A single application through COMPASS evaluates a child for both Medical Assistance and CHIP. You do not need to know in advance which program applies — the eligibility system routes the child to the correct program based on income. This means lower-income children are enrolled in Medicaid automatically when CHIP is applied for.

Apply at compass.dhs.pa.gov online, through the myCOMPASS PA app, by phone at 1-866-550-4355, or in person at your County Assistance Office. After approval, you select a CHIP carrier available in your county.

Copayments for CHIP

Free CHIP has no copayments — no charges for doctor visits, specialist visits, prescriptions, or emergency care. Low-cost CHIP tiers carry small copayments per visit or service.

Service	Free CHIP	Low-cost CHIP (all tiers)
Primary care doctor visit	$0	$5
Specialist visit	$0	$10
Generic prescription	$0	$6
Brand-name prescription	$0	$9
Emergency room visit	$0	$25

Primary care doctor visit

Free CHIP: $0
Low-cost CHIP (all tiers): $5

Specialist visit

Free CHIP: $0
Low-cost CHIP (all tiers): $10

Generic prescription

Free CHIP: $0
Low-cost CHIP (all tiers): $6

Brand-name prescription

Free CHIP: $0
Low-cost CHIP (all tiers): $9

Emergency room visit

Free CHIP: $0
Low-cost CHIP (all tiers): $25

Source: Capital Blue Cross 2026 CHIP eligibility chart (low-cost copayment schedule). Emergency services cannot be denied due to an unpaid premium or copay. Copay amounts are per visit per child.

Income below any CHIP amount? Your child may qualify for Medical Assistance instead

When you apply through COMPASS, the system checks Medical Assistance eligibility first. If your household income is below 138% FPL, your child will be enrolled in Medical Assistance (Medicaid) rather than CHIP — with no premiums and no copays. If your income is slightly above the Medical Assistance limit, the Affordable Care Act allows a 5% income disregard, which can move some children from CHIP back into Medical Assistance. COMPASS applies this calculation automatically.

Pennsylvania CHIP vs other large states

Comparison approximate as of 2025–2026. Pennsylvania's 317% FPL CHIP limit makes it one of the more generous states. Verify current income thresholds at pa.gov or COMPASS before applying.

Feature	Pennsylvania CHIP	New York (CHP)	Florida KidCare
Upper subsidized income limit	317% FPL	400% FPL	210% FPL
Free CHIP threshold (family of 4)	~$68,640/yr	Varies by income	133% FPL (Medicaid)
Low-cost tier monthly premium	$90–$115/child	$0–full cost	$15–$20/child
CHIP administered by	Private carriers (CBC, UPMC, etc.)	Managed care (NYSOH)	Florida Healthy Kids Corp.
Dental included	Yes (full)	Yes (no copays)	Yes (via MCO)

Upper subsidized income limit

Pennsylvania CHIP: 317% FPL
New York (CHP): 400% FPL
Florida KidCare: 210% FPL

Free CHIP threshold (family of 4)

Pennsylvania CHIP: ~$68,640/yr
New York (CHP): Varies by income
Florida KidCare: 133% FPL (Medicaid)

Low-cost tier monthly premium

Pennsylvania CHIP: $90–$115/child
New York (CHP): $0–full cost
Florida KidCare: $15–$20/child

CHIP administered by

Pennsylvania CHIP: Private carriers (CBC, UPMC, etc.)
New York (CHP): Managed care (NYSOH)
Florida KidCare: Florida Healthy Kids Corp.

Dental included

Pennsylvania CHIP: Yes (full)
New York (CHP): Yes (no copays)
Florida KidCare: Yes (via MCO)

Pennsylvania Medical Assistance (Medicaid)

COMPASS application portal: compass.dhs.pa.gov
COMPASS phone application line: 1-866-550-4355
CHIP Statewide Change Center: 1-877-395-8930

Visit the official Pennsylvania Medicaid website