What is CHIP and who is eligible?

The Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families whose income is above the Medicaid limit but still too low to afford private insurance. Each state runs its own CHIP program (sometimes under a different name), sets its own income eligibility limits (typically above 200% of the federal poverty level), and determines the benefits offered. Children through age 18 may be eligible. Apply through your state Medicaid and CHIP agency or at healthcare.gov.

What vaccines are children entitled to?

The CDC Advisory Committee on Immunization Practices (ACIP) publishes the recommended childhood immunization schedule, which includes vaccines for diseases including measles, whooping cough, polio, chicken pox, hepatitis, and flu. Under the ACA, plans must cover ACIP-recommended vaccines as preventive care at no cost to patients. The VFC (Vaccines for Children) program provides recommended vaccines at no cost to children who are Medicaid-enrolled, uninsured, underinsured, or American Indian/Alaska Native.

What is a well-child visit?

Well-child visits (also called checkups or wellness exams) are routine preventive visits at defined ages from infancy through adolescence. They include physical examinations, developmental screening, immunizations, and health counseling. Under ACA rules, these visits must be covered without cost-sharing in most plans. The schedule of visits is based on Bright Futures guidelines from the American Academy of Pediatrics.

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is the children's benefit within Medicaid. It requires states to cover comprehensive preventive, diagnostic, and treatment services for all children enrolled in Medicaid — regardless of whether the specific service is covered for adults in the state's Medicaid plan. EPSDT is one of the strongest children's health benefit standards in the US.

How do I keep my child covered during transitions?

Coverage transitions — when a parent changes jobs, the family moves, or a child ages — are common and can create gaps. A birth is a qualifying life event: add your newborn within 30-60 days. When moving to a new state, re-apply for Medicaid/CHIP in the new state as soon as possible — eligibility rules vary by state. Children aging out of CHIP at 18 may be eligible for Marketplace coverage through a special enrollment period.

US Healthcare · Life Stages

Children's Coverage and Vaccines

Health insurance for children in the US — CHIP, Medicaid EPSDT, the VFC vaccine program, well-child visits, and keeping children covered through transitions.

Who this is for

Parents, guardians, and caregivers navigating health insurance and preventive care for children — including finding CHIP, understanding vaccine access, and managing coverage transitions.

Children in the United States have access to some of the strongest health coverage protections in the system, through a combination of the ACA’s essential benefits requirements, Medicaid’s EPSDT standard, CHIP, and federal vaccine programs. Understanding how these programs work and how to navigate transitions helps parents and caregivers ensure their children receive consistent, comprehensive care.

Coverage options for children

Children’s health coverage comes from three primary sources:

Private insurance (employer-sponsored or Marketplace): Children can be enrolled in a parent’s employer health plan or in a family Marketplace plan. Under the ACA, plans must cover children through age 26. ACA-compliant plans must cover pediatric essential benefits, including well-child visits, vaccinations, developmental screenings, pediatric dental, and pediatric vision.

Medicaid: Children from birth through age 18 who meet income requirements are covered under Medicaid. Medicaid for children includes the EPSDT benefit (described below), which is among the most comprehensive coverage standards available anywhere in the US system.

CHIP (Children’s Health Insurance Program): CHIP fills the gap for families whose income exceeds the Medicaid limit but who cannot afford private insurance. Most states cover children up to much higher income levels under CHIP than adults under Medicaid. CHIP benefits typically include doctor visits, hospital care, dental, vision, laboratory services, and immunizations.

If you are unsure which program covers your child, apply through healthcare.gov or your state Medicaid/CHIP agency — the eligibility screening will identify the right program.

EPSDT: comprehensive benefits for Medicaid children

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is unique to Medicaid for children. States must provide all children enrolled in Medicaid with:

Screening: At defined intervals, health and developmental screenings, vision and hearing tests, dental assessments, and lead screenings
Diagnosis: Follow-up diagnostic services for any condition identified by a screening
Treatment: Any medically necessary treatment to correct or ameliorate a condition identified — even if that service is not covered for adults in the state’s Medicaid program

The EPSDT standard is more expansive than standard adult Medicaid — a state cannot deny a child a treatment that would address a health need, even if the same treatment is not covered for adults under the state plan.

Vaccines and the VFC program

ACA vaccine coverage: Under the ACA, most health plans must cover all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) as preventive care with no cost-sharing. This means parents with insurance should generally not pay out of pocket for recommended childhood vaccines when received from an in-network provider.

Vaccines for Children (VFC) program: The VFC program, administered by the CDC, provides federally funded vaccines at no cost to:

Children enrolled in Medicaid
Uninsured children
Underinsured children (those whose insurance does not cover vaccines, or covers vaccines but does not cover a specific vaccine)
American Indian and Alaska Native children

VFC vaccines are distributed through enrolled healthcare providers. A provider must be VFC-enrolled to administer VFC vaccines. Ask your child’s pediatrician or clinic whether they participate in VFC.

Well-child visits and preventive schedule

Well-child visits follow a schedule developed by the American Academy of Pediatrics (AAP) Bright Futures program. Visits are scheduled at birth, multiple times in the first year of life, annually from ages 2 through 6, then at ages 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, and beyond. Each visit includes:

Physical examination and measurements
Developmental and behavioral screening
Vision and hearing assessments at designated ages
Age-appropriate vaccinations
Anticipatory guidance for parents on nutrition, safety, and development

Under ACA rules, these visits must be covered at no cost to the patient in most plans when seen in-network.

Dental and vision for children

Pediatric dental and vision are ACA essential benefits for children. This means Marketplace plans covering children must include dental and vision. CHIP plans typically include both. Medicaid covers both through EPSDT.

The practical implication: uninsured children or children on very limited plans often still have access to dental and vision through CHIP, Medicaid, or FQHCs, even if their parents do not.

Keeping coverage continuous

Insurance gaps harm children’s access to care and result in missed vaccines, delayed diagnoses, and unaddressed developmental concerns. Key moments when coverage can lapse:

At birth: Enroll your newborn within 30-60 days of birth (qualifying life event)
When parents change jobs: COBRA or Marketplace plans can bridge gaps
When the family moves to a new state: Re-apply for Medicaid/CHIP in the new state; eligibility rules differ
When a child ages out of CHIP at 18: A special enrollment period exists for Marketplace coverage
Annual redetermination: Medicaid and CHIP require annual income verification — respond promptly to renewal notices to avoid unnecessary disenrollment

Key terms

Term	Plain meaning	Glossary
CHIP	Children's Health Insurance Program — low-cost coverage for children in families above the Medicaid income limit	→
Medicaid	Federal-state health program; children are entitled to comprehensive benefits under EPSDT	→
Essential benefits	ACA categories plans must cover; pediatric services, including dental and vision, are included for children	→
FQHC	Federally Qualified Health Center — provides primary and preventive care to all children on a sliding fee scale	→
VFC	Vaccines for Children program — provides free CDC-recommended vaccines to children without insurance	→

Common questions

What is CHIP and who is eligible?: The Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families whose income is above the Medicaid limit but still too low to afford private insurance. Each state runs its own CHIP program (sometimes under a different name), sets its own income eligibility limits (typically above 200% of the federal poverty level), and determines the benefits offered. Children through age 18 may be eligible. Apply through your state Medicaid and CHIP agency or at healthcare.gov.
What vaccines are children entitled to?: The CDC Advisory Committee on Immunization Practices (ACIP) publishes the recommended childhood immunization schedule, which includes vaccines for diseases including measles, whooping cough, polio, chicken pox, hepatitis, and flu. Under the ACA, plans must cover ACIP-recommended vaccines as preventive care at no cost to patients. The VFC (Vaccines for Children) program provides recommended vaccines at no cost to children who are Medicaid-enrolled, uninsured, underinsured, or American Indian/Alaska Native.
What is a well-child visit?: Well-child visits (also called checkups or wellness exams) are routine preventive visits at defined ages from infancy through adolescence. They include physical examinations, developmental screening, immunizations, and health counseling. Under ACA rules, these visits must be covered without cost-sharing in most plans. The schedule of visits is based on Bright Futures guidelines from the American Academy of Pediatrics.
What is EPSDT?: EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is the children's benefit within Medicaid. It requires states to cover comprehensive preventive, diagnostic, and treatment services for all children enrolled in Medicaid — regardless of whether the specific service is covered for adults in the state's Medicaid plan. EPSDT is one of the strongest children's health benefit standards in the US.
How do I keep my child covered during transitions?: Coverage transitions — when a parent changes jobs, the family moves, or a child ages — are common and can create gaps. A birth is a qualifying life event: add your newborn within 30-60 days. When moving to a new state, re-apply for Medicaid/CHIP in the new state as soon as possible — eligibility rules vary by state. Children aging out of CHIP at 18 may be eligible for Marketplace coverage through a special enrollment period.

Sources

Last reviewed: September 2026

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