Medicaid and CHIP: Affordable health insurance options

Health insurance can be expensive, particularly if you have high premiums, deductibles, or need coverage for a large family. Here's how Medicaid and CHIP programs can help.

Medicaid and CHIP

Medicaid is the largest health coverage program in the U.S., operated jointly by federal and state programs. Along with the Children’s Health Insurance Program (CHIP), it provides healthcare coverage for children, pregnant women, parents, seniors, and individuals with disabilities.

Medicaid and CHIP eligibility

To qualify for Medicaid, federal law requires states to cover specific groups, including low-income families, qualified pregnant women, and children. Eligibility is based on income and certain non-financial criteria, such as being a resident of the state where benefits are received and being either a U.S. citizen or a qualified non-citizen.

CHIP provides coverage for children in families that earn too much to qualify for Medicaid but cannot afford private health insurance. Eligibility for CHIP is determined by both financial and non-financial factors.

How Medicaid supports children's health

Medicaid offers the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, to ensure comprehensive and preventive healthcare for children under 21 enrolled in Medicaid.

EPSDT includes:

• Early: Early identification of health concerns
• Periodic: Conducting regular, age-appropriate health check-ups
• Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screenings to detect potential issues
• Diagnostic: Performing tests to further assess any identified risks
• Treatment: Managing, correcting, or reducing health problems found through screenings

How CHIP supports children's health

CHIP and Medicaid provide essential healthcare services for children. Since states create their own CHIP programs,benefits may vary by state. These CHIP benefits are mandatory in all states:

• Well-baby & well-child visits
• Dental
• Behavioral health
• Vaccines

How to apply for Medicaid and CHIP

Medicaid and CHIP do not have a special open enrollment period—you can apply anytime throughout the year. A parent, grandparent, guardian, or authorized representative can apply on behalf of a child. To apply, visit HealthCare.gov or contact your state’s Medicaid or CHIP agency. For help finding a healthcare provider that accepts Medicaid or CHIP, reach out to your state Medicaid or CHIP agency or call your health plan’s member services department.

How Summer Health can help

Summer Health partners with Medicaid plans in Nevada, Texas and Michigan to offer free preventive and urgent care solutions for all children. If you're not in these states, don't worry—we're expanding and growing fast! Join our waitlist, and we'll notify you when we’re covered by your insurance in your state.

Need care now? Sign up for just $20/month to connect with a pediatrician instantly.