Affordable Care Act

The health care environment in the metropolitan Washington region is robust. There are numerous hospitals, health care systems, Federally Qualified Health Centers and primary and specialty health care providers located in the District of Columbia, Northern Virginia and suburban Maryland.  Health care resources are not equally distributed throughout the region, requiring some residents to travel to receive health care that is appropriate and affordable. For the most part, people with health coverage and financial resources can access health care services more easily than those without adequate health coverage, financial resources and social capital.

There are federal, state and local programs to assist low-income individuals and households obtain health coverage. Medicaid is a combined federal/state program that provides health coverage for low-income children, pregnant women, parents of minor children, the elderly, blind, and disabled, and optional populations including people in hospice care, women with breast and cervical cancer, and low-income adults. In order to participate, states must comply with mandatory federal requirements but can establish their own eligibility requirements and benefits packages. Medicaid eligibility and coverage in the District, Maryland and Virginia are substantially different. Both the District and Maryland expanded Medicaid to cover all eligible, low-income adults. The District has among the most generous Medicaid benefits in the nation while Virginia among the least generous.

The Affordable Care Act is the law despite efforts to repeal.

The implementation of the Affordable Care Act substantially increased health coverage for low and moderate income Americans through Medicaid expansion and the availability of subsidies for the purchase of qualified health care plans on state or federal insurance exchanges. The ACA was not implemented uniformly in all states. Cost and coverage, as well as eligibility requirements, vary from state-to-state.

In this region, the District of Columbia and Maryland fully implemented the ACA early on, expanding Medicaid to cover all adults with incomes under 138% of the Federal Poverty Level.  Each also created state-run insurance marketplaces where eligible consumers can purchase qualified health plans and apply for tax credits and cost sharing subsidies.

Virginia did not expand its Medicaid program, which continues to cover low-income children and their parents if the household meets income eligibility guidelines as well as very low-income adults and those who are blind or disabled. Virginia consumers are able to purchase qualified health plans on the federal exchange. Under the ACA, consumers with incomes between 200 and 400% of the Federal Poverty Level are eligible for cost-sharing subsidies and tax credits when they purchase health insurance no matter where they live.

Much of the ACA Remains Unchanged

The individual mandate is still in effect. Individuals who do not have employer-sponsored health insurance and are ineligible for Medicaid will pay a tax penalty in 2017 and 2018 if they do not purchase health care coverage. Currently, the penalty is 2.5 percent of annual income or $695 per adult and $347.50 per child, whichever is higher. The fee will be pro-rated based on the number of months an individual and/or each family member has been without health coverage during the tax year.

Individuals can purchase coverage from insurers through state or federal marketplaces. Individuals with incomes between 200 and 400 percent of the Federal Poverty Level are eligible for subsidies in the form of tax credits. Cost-sharing benefits available on Silver plans will increase at the same rate as the cost of the plans. People receiving subsidies and cost sharing benefits will not see significant cost increases in 2018.

Individuals who are not eligible for subsidies will likely see increases in premiums on Silver plans, and may find bronze or gold plans to be a better value this year. Individuals are advised to shop for the plans that best meet their needs, both within and outside of state and federal Marketplaces.

Individuals with pre-existing conditions cannot be denied health insurance or charged more for health insurance because of their health status.

Important Changes in 2018

Open enrollment for purchasing health insurance varies by state. Open enrollment in Virginia is limited to 6 weeks from November 1 to December 15.  Open enrollment in the District of Columbia is November 1 to January 31 however in order to begin coverage on January 1 enrollment needs to be completed by December 15. In Maryland, the deadline for open enrollment has been extended to December 22.

 

Individuals with qualifying life event such as loss of employment, birth/adoption of a child, marriage, divorce, death of a spouse or other qualifying circumstances can enroll at any time.

 

Access to in-person enrollment assistance will be more limited due to reductions in federal funding. The District, Maryland and Virginia all have state programs that provide in-person enrollment assistance. Federally Qualified Health Centers also have financial counselors and certified enrollment staff to aide with purchasing insurance or enrolling in Medicaid.

 

For more information about enrollment in your state, check out the resources below:

In Washington, DC visit DC Health Link or Call 1-855-532-5465. There are many enrollment sites with hours and directions listed on the website.

Maryland residents can visit Maryland Health Connection or call 1-855-642-8572 (Toll Free) TTY: 1-855-642-8573. Montgomery County and Prince George’s County residents can obtain assistance on local websites and at enrollment in their respective counties.

In Montgomery County, in-person enrollment assistance is available on Monday, Wednesday and Friday from 8:30 a.m. to 4:00 p.m. at the following locations:

  • DHHS Office at 1401 Rockville Pike
    1401 Rockville Pike, 1st floor, Rockville
  • Germantown Regional Services Center 
    12900 Middlebrook Rd, 2nd Floor, Germantown

  • Silver Spring Health Center 
    8630 Fenton Street, 10th floor, Silver Spring
  • Silver Spring Services Center 
    8818 Georgia Avenue, Silver Spring

In Prince George’s County, in-person enrollment assistance is available the following locations:

  • CASA – (Appointment)
    8151 15th Avenue, Hyattsville
    301-270-8432 or 240-270-1318
    Monday-Friday: 8 a.m. – 5 p.m.
  • Department of Social Services (Walk – In)
    • Hyattsville
      6505 Belcrest Road, Hyattsville
      Monday-Friday: 8 a.m. – 4 p.m.
    • Landover
      425 Brightseat Road, Landover
      Monday-Friday: 8 a.m. – 4 p.m.
    • Temple Hills
      4235 28th Avenue, Temple Hills
      Monday-Friday: 8 a.m. – 4 p.m.
  • Health Department (Walk- In)
    Landover (Maryland Children’s Health Program)
    425 Brightseat Road, Landover
    Monday-Friday: 8 a.m. – 3:30 p.m.

  • PGC Health Connect Enrollment Center
    9109 Central Avenue ( formerly Sprint store)
    Hampton Mall – Kingdom Square
    Capitol HeightsTues. – Friday 9 a.m. – 5 p.m.
    Wed. 9 a.m. – 7 p.m. (Walk-in)
    Sat. 10 a.m. – 3 p.m.
  • PGC Health Connect Enrollment Center
    Langley Park Multi-Service Center
    LaUnion Mall – Hyattsville
    1401 East University Boulevard / Suite G1
    Monday – Wednesday: 9am – 4pm
    Thursday: 9 a.m. – 7 p.m.
    Saturday: 10 a.m. – 3 p.m.
  • Sowing Empowerment & Economic Development, Inc. (SEED) (Appointment)
    6201 Riverdale Road, Suite 200, Riverdale
    301-458-9808
    Monday 9 a.m. – 3 p.m. (Walk-in)
    Tuesday 10 a.m. – 3 p.m.
    Wednesday and Thursday 9 a.m. – 12 p.m.

In Virginia, residents are eligible to purchase subsidized health coverage through the federal marketplace at Healthcare.gov. For information about eligibility for all of Virginia’s health care programs visit Cover Virginia or call 1-855-242-8282. For help finding in-person assistance with insurance options and enrollment visit Cover Virginia’s Marketplace Assistance Map or call 1-855-242-8282.

 

The following organizations provide in-person enrollment assistance:

  • Boat People SOS
    6066 Leesburg Pike, Suite 100, Falls Church
    703-647-4748
  • Evergreen Health Center 
    9705 Liberia Ave, Suite 101, Manassas
    703-680-7950 ext. 3219
  • Greater Prince William Community Health Center
    4379 Ridgewood Center Drive, Suite 102, Woodbridge
    703-680-7950 ext. 3219
  • Legal Services of Northern Virginia
    Multiple locations
    703-647-4748

  • HealthWorks for Northern Virginia
    • Herndon
      1141 Elden Street, Suite 300, Herndon
      703-538-2190
    • Leesburg
      163 Fort Evans Road, NE, Leesburg
      703-840-4699
  • Neighborhood Health
    Multiple locations
    703-535-5568
  • Neighbor’s Keeper at Workforce Center
    13370 Minnieville Road, Woodbridge
    703-634-2400