Pennsylvania CHIP: children's health coverage up to 317% FPL

Last verified: June 2026

What is Pennsylvania's CHIP and who administers it?

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.

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.

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?

A child qualifies for CHIP if they meet all of the following:

• 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

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.

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.

Source: Pennsylvania DHS CHIP Eligibility & Benefits page (pa.gov/agencies/dhs/resources/chip/eligibility-and-benefits); Capital Blue Cross 2026 CHIP eligibility chart; PA Health & Wellness 2025 CHIP Federal Income Guidelines. 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 $50,476/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.

CHIP coverage must be renewed annually. You will receive a renewal notice before your coverage expires. Renewals can be completed through COMPASS, by phone, by mail, or at your local CAO — the same four options as the initial application. Coverage does not automatically renew without action on your part.

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:

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.

What Pennsylvania CHIP covers

Pennsylvania CHIP provides a comprehensive benefit package through contracted private insurance carriers. Benefits are standardized by DHS across all carriers — the coverage does not vary based on which plan you are enrolled in, though carrier networks and customer service differ.

• Routine well-child visits, physicals, and immunizations on the recommended schedule
• Sick visits — primary care, urgent care, and specialist visits
• Emergency room and inpatient hospital care
• Prescription drugs — brand-name and generic
• Dental care — cleanings, fillings, and medically necessary orthodontics
• Vision care — eye exams, eyeglasses, and contact lenses (medically necessary)
• Hearing services and hearing aids
• Mental health and substance use disorder services
• Physical, occupational, and speech therapy
• Autism Spectrum Disorder services
• Medical equipment and home health care
• Maternity care for CHIP members who become pregnant before turning 19

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.