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Learn How to Change Your CHIP Plan

How to Change Your CHIP Plan

After being enrolled in the Children’s Health Insurance Program (CHIP), beneficiaries gain access to a wide variety of health care benefits and services. CHIP can be operated as either an extension of Medicaid for children, a separate program entirely or a combination of the two. Participants in the program have a lot of information to understand in terms of their coverage and care. Generally, a Medicaid agent will explain the details about CHIP coverage and plan specific information. One of the most important things to know is that program members are not forced to stay with their current plan, especially if they have experienced a qualifying life event for health insurance.

If a participant is unsatisfied with any aspect of CHIP insurance, he or she might want to consider changing the plan. This can include issues with doctors, Medicaid agents and much more. There are numerous other reasons to change a CHIP plan, but it is always best to consider all the options before committing to any change.

Why would you change your CHIP Insurance Plan?

Participants in the Children’s Health Insurance Program (CHIP) may have a variety of reasons for wanting to change their health care plan. There are multiple circumstances where changing a plan is not only allowed but also recommended. For example, beneficiaries who are having trouble receiving or using their CHIP benefits and services may request a change in order to take better advantage of their Medicaid or CHIP. Members are allowed to change their health plans as many times as they want, as long as they continue to meet the CHIP eligibility requirements.

Changes to CHIP insurance plans can be requested:

  • For any reason within three months of enrollment.
    • One more change (for any reason) is permitted after the initial three months.
  • At any time for an appropriate cause.
  • If participants move to a different service area.
  • During the yearly re-enrollment period for CHIP.

Note: Changes cannot be made to a health plan while receiving care from a hospital. Requests for changes musts be made after being discharged.

What to Do After Household Changes

Families and households who experience a change in income that puts them outside of the Children’s Health Insurance Program (CHIP) eligibility requirements will lose their CHIP insurance coverage. If a family receives more income and does not fall within the established limits, it will lose access to CHIP during the renewal period. Once more spaces or funding become available, applicants on the waiting list will be given access to the many benefits and services of CHIP. On the other hand, as funding for CHIP is cut, fewer applicants are selected from the waiting list to receive health insurance.

Participants may also have their CHIP plan changed if they fail to renew their coverage. In these cases, beneficiaries will lose all access to the benefits and services provided by CHIP. Benefits must be renewed annually or they will be terminated. A Medicaid office or CHIP agency will send participants a packet with the required renewal paperwork. These packets must be completed, signed and returned by the due date. If a member fails to renew benefits, she or he will have to reapply for the program.

How to Report Income and Household Changes After Enrollment

Once participants are enrolled and are receiving their CHIP insurance, they are responsible for updating their information if there are any household or income changes. Certain changes, such as increased or decreased income, and adding or losing household members, can affect a participant’s eligibility for coverage. Changes can be reported to a CHIP office or through the online Medicaid portal.

In some cases, changes in household composition or income can result in further savings. Applicants who gain a household member will likely have their income estimate drop, which might qualify them for more savings. In turn, this could lower the monthly premiums for health insurance. On the other hand, losing a household member can result in fewer savings. If a change goes unreported, a household may have to pay the money back on its federal tax return.

When do changes to CHIP health plans go into effect?

Requests for changes to CHIP insurance plans are not immediately processed. A CHIP office will determine the effective date of a change based on when the request was submitted. Any appeal made on or before the 15th of the month will go into effect at the start of the next month. Appeals made after the 15th will become effective at the start of the second month after that. For example, a request made on or before June 15 will go into effect on July 1. Requests made after the 15 will be implemented on August 1.

Changes Requested by Health Plan Providers

States have the final authority over how they want to manage the Children’s Health Insurance Program (CHIP) for their residents. This also includes requesting changes in a program member’s health plan. Certain providers of CHIP insurance may submit a request to the state so that a participant will be dropped from the health plan. While not too common, a provider can drop beneficiaries if:

  • They frequently ignore their doctor’s advice.
  • They abuse the emergency room for non-emergency cases.
  • They continuously visit other doctors or clinics without approval from their primary care provider.
  • They or their children exhibit a pattern of abusive or disruptive behavior (not related to a medical condition).
  • They frequently miss appointments without giving their doctor any notice.
  • They let someone else use their ID card for healthcare benefits.

Note: All beneficiaries of the Children’s Health Insurance Program maintain the right to receive a second opinion.

Download our helpful guide for more information about changing your CHIP health plan.

Learn About Canceling Your CHIP Plan

There are various reasons why CHIP participants might cancel their plan. If they are terminating the coverage for everyone on their health care application, the coverage will end immediately. Some household members may qualify for a special enrollment period that allows them to receive insurance while they look for a new provider.