The Children’s Health Insurance Program (CHIP) in Pennsylvania offers health coverage to uninsured children and teens who do not qualify for Medicaid. This program acts as a bridge for families who may not have access to affordable, employer-sponsored insurance options. CHIP operates on a tiered structure, where the monthly cost is directly tied to household income and size. This structure ensures comprehensive health coverage remains accessible. This article details the costs and coverage provided under the highest tier, known as “Full Cost CHIP.”
Understanding Pennsylvania’s CHIP Tiers
Pennsylvania’s CHIP is broadly categorized into three cost levels: Free, Low-Cost, and Full Cost, determined by a family’s modified adjusted gross income (MAGI). The vast majority of families fall into the Free or Low-Cost tiers, which receive significant federal and state subsidies. The Full Cost tier is designed for families whose income exceeds the cutoff for these subsidies but who still seek a health insurance option for their children.
For a family of four, the Full Cost CHIP tier begins when the household’s annual income exceeds $100,951 (based on the income guidelines effective March 1, 2025). This highest bracket is identified by having “No Limit” on income, confirming that no family is considered too wealthy to enroll a child. Families in this tier pay the entire premium cost without any subsidy, making it a purchase of state-regulated, comprehensive coverage. The program serves as a guaranteed option for Pennsylvania residents regardless of income, provided the child is not eligible for Medicaid.
The Specific Costs of Full Cost CHIP
Since the Full Cost tier is not subsidized, the family is responsible for the entire monthly premium, which varies based on the specific insurance company and the county of residence. For a single child, these premiums typically range from approximately $190 to over $227 per month, depending on the specific CHIP plan chosen. Families enrolling multiple children pay this per-child premium for each enrolled dependent.
Beyond the monthly premium, families in the Full Cost tier are also responsible for low co-payments for certain medical services, such as doctor visits or prescriptions. These co-payments are modest and vary between the participating insurance companies. A significant federal parameter limits the total amount a family must contribute to the cost of coverage, including premiums and co-payments, to no more than five percent of the family’s annual income. This cap functions as a financial safeguard for families.
Comprehensive Coverage Details
The value proposition of Full Cost CHIP lies in the breadth and depth of its coverage, which is comparable to a high-quality commercial health insurance plan. The plan covers all categories of essential health benefits, providing financial protection and access to necessary medical care.
Covered services include routine well-child checkups and all necessary immunizations. The plan also covers:
- Prescription drugs
- Dental care
- Vision care
- Mental health services, including substance abuse treatment
- Emergency services
Enrollment and Payment Procedures
Families can apply for CHIP through the Commonwealth of Pennsylvania’s online portal, COMPASS, or by calling the CHIP helpline directly. Once a family is determined eligible for the Full Cost tier, they must select a participating insurance company. Coverage officially begins only after the first month’s premium payment is successfully processed by the managed care organization.
Full Cost CHIP requires timely monthly payments to maintain active coverage. Acceptable payment methods typically include mailing a check, paying online via a secure portal, or utilizing a phone payment system. Unlike the Free and Low-Cost tiers, the Full Cost tier is not subject to continuous eligibility rules, meaning coverage can be terminated if premium payments are missed. Families must also complete an annual renewal process to continue coverage beyond the 12-month period.