If the Children's Health Insurance Program ended, children affected would still be able to get most, but not all, of the coverage options they have with CHIP if they buy a plan from an insurance exchange, according to a report Friday from the U.S. Government Accountability Office.
While there is substantial benefit overlap, qualified plans lack pediatric dental and other services, such as translation and transportation services, that are covered more frequently by CHIP plans.
Federal funding for the CHIP program is set to expire Sept. 30. The SGR fix that passed the U.S. House on Thursday and awaits Senate approval includes a two-year extension for the program.
In addition to differences in benefits, CHIP tends to impose fewer day, visit, or dollar limits than qualified health plans. A selected exchange plan in Utah limited home- and community-based healthcare services to 60 visits a year, for example, while the selected CHIP plan did not impose any limits.
The agency based its findings on a coverage analysis of five states.
Cost sharing and premiums also are generally lower with CHIP, even when considering the application of subsidies under the Affordable Care Act.
For example, an office visit to a specialist in Colorado would cost a CHIP enrollee a $2 to $10 copayment compared with the lowest available copayment of $25 a visit in the selected Colorado qualified health plan.
In another scenario, the premium for a CHIP plan in Illinois for a child whose family income is at 150% of the federal poverty level is $0. By comparison, the 2014 annual premium for an Illinois qualified health plan for the same family was $1,254, which was reduced to $944 after considering federal subsidies.