A Guide To Applying For Medicaid And Marketplace Insurance In The D.C. Region And a reference to the eligibility requirements for health insurance in D.C., Maryland and Virginia.
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NPR logo A Guide To Applying For Medicaid And Marketplace Insurance In The D.C. Region

A Guide To Applying For Medicaid And Marketplace Insurance In The D.C. Region

If you're uninsured or unemployed, you may be eligible for low-cost health coverage through Medicaid or the Children's Health Insurance Program (CHIP). Marco Verch/Flickr hide caption

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Marco Verch/Flickr

If you're uninsured or have been recently laid off, you and your family members might be eligible for free or low-cost health coverage through Medicaid or the Children's Health Insurance Program (CHIP) or premium subsidies through the Affordable Care Act marketplace coverage.

Here are general guidelines regarding income and other requirements for D.C., Maryland and Virginia. Please contact individual enrollment websites or hotlines for details.

DISTRICT OF COLUMBIA

Medicaid and CHIP

Children and pregnant women in a family of three earning up to $68,043 and parents in a family of three earning up to $48,001 are likely eligible for Medicaid or CHIP coverage. Children are generally eligible regardless of immigration status – please check the Immigrant Children's Program website here.

Single adults without dependent children and a household income of up to $27,434 annually are likely eligible for Medicaid.

Medicaid is open for enrollment all year long and there are no premiums. It looks at monthly income, so recently unemployed people with precipitous changes and drops should be able to enroll.

Apply for Medicaid or CHIP coverage through DC Health Link: www.dchealthlink.com
Phone: 855-532-5465

Marketplace Insurance

DC Health Link is holding a special enrollment period for those currently uninsured until June 15, 2020.

Individuals in D.C. earning up to $49,960 and a family of three with a household income up to $85,320 are eligible for subsidies that lower monthly premium costs on health plans purchased through DC Health Link. Individuals making between $17,236 and $31,225 and a family of three earning between $29,435 and $53,325 are eligible for additional subsidies to lower costs of coinsurance and deductibles.

For these applications, people should estimate their income for all of 2020 and not income earned in 2019. You should include income you've already earned this year, lost wages and any unemployment insurance benefits in your income estimate on the application for premium subsidies. You may have to verify income if it's substantially different from last year.

Residents who have lost their job-based coverage are eligible for a 60-day special enrollment period beginning the day their job-based health coverage is terminated.

Another category is people who have private insurance — but didn't get it through their employer or on the exchange. If your income drops a certain amount due to job loss or reduced hours, you are eligible for a 60-day special enrollment period beginning the day your lost wages started. You qualify if your household income is less than $85,320 for a family of three and $49,960 for an individual.

While most immigration statuses qualify for premium subsidies, D.C. residents who are undocumented are ineligible for premium subsidies. However, the District operates a locally funded health program for such residents, called the DC Healthcare Alliance for District residents. Find more information on the DC Health Link website.

Apply for premium subsidies through DC Health Link:
www.dchealthlink.com
Phone: 855-532-5465

MARYLAND

Medicaid and CHIP

Children in a family of three earning up $69,936, pregnant women in a family of three earning up to $57,336 and parents in a family of three earning up to $29,976 are likely eligible for Medicaid or CHIP.

Single adults without dependent children with household income up to $17,616 annually are likely eligible for Medicaid.

Medicaid and CHIP are open for enrollment all year long. It looks at monthly income, so recently unemployed folks with precipitous changes and drops should be able to enroll.

Some children in families at higher income levels are asked to pay monthly premiums of $54 and $68 — but most children or adults do not pay premiums.

Apply for Medicaid or CHIP through Maryland Health Connection:
www.marylandhealthconnection.gov
Phone: 855-642-8572

Marketplace Insurance

Maryland Health Connection is holding a special enrollment period for those currently uninsured until June 15, 2020.

Individuals in Maryland earning below $49,960 and a family of three with a household income below $85,320 are eligible for subsidies that lower monthly premium costs on health plans purchased through Maryland Health Connection. Individuals making below $31,225 and a family of three earning below $53,325 are eligible for additional subsidies to lower costs of coinsurance and deductibles.

As in D.C., use estimated income for all of 2020, and not income earned in 2019. You should include income you've already earned this year, lost wages and any unemployment insurance benefits in your income estimate on the application for premium subsidies. You may have to verify your income if it's substantially different from last year.

Residents who have lost their job-based coverage are eligible for a 60-day special enrollment period beginning the day their job-based health coverage is terminated.

Another category is people who have private insurance — but didn't get it through their employer or on the exchange. If your income drops a certain amount due to job loss or reduced hours, you are eligible for a 60-day special enrollment period beginning the day your lost wages started. You qualify if your household income is less than $85,320 for a family of three and $49,960 for an individual.

While most immigration statuses qualify for premium subsidies, Maryland residents who are undocumented are ineligible. Maryland residents without eligible documentation status may be eligible for Emergency Medicaid benefits. Find more information on the Maryland Health Connection website.

Apply for premium subsidies through Maryland Health Connection:
www.marylandhealthconnection.gov
Phone: 855-642-8572

VIRGINIA

Medicaid and CHIP

Children and pregnant women in a family of three earning up to $44,526 annually and parents in a family of three earning up to $29,974 are likely eligible for Medicaid or CHIP coverage (known as FAMIS in Virginia).

Single adults without dependent children with household income up to $17,628 are likely eligible for Medicaid.

Medicaid is open for enrollment all year long and there are no premiums. It looks at monthly income, so recently unemployed folks with precipitous changes and drops should be able to enroll.

Apply for Medicaid or FAMIS:
www.commonhelp.virginia.gov
Phone: 1-855-635-4370

Marketplace

Unlike its neighbors, Virginia uses the federal platform, HealthCare.gov, as its marketplace, and the Trump administration has indicated that it will not open a special enrollment period in response to COVID-19. The next open enrollment period begins in November.

Residents who have lost their job-based coverage are eligible for a 60-day special enrollment period beginning the day their job-based health coverage is terminated.

Residents who are uninsured and do not meet the criteria for a special enrollment period — such as certain life changes — are not eligible to apply for premium subsidies until Nov. 1, 2020.

While most immigration statuses qualify for premium subsidies, Virginia residents who are undocumented are ineligible. Those who need health care services and are ineligible to buy insurance on the federal marketplace can find health services on a sliding-scale fee at community health centers and clinics. Find more information on the Virginia Health Care Foundation website.

Apply for a special enrollment period and premium subsidies through HealthCare.gov:
www.healthcare.gov
Phone: 800-318-2596

Research courtesy of Georgetown University's Center for Children and Families and Center on Health Insurance Reforms.

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