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 benefits in the District, Maryland and Virginia are substantially different. The District and Maryland expanded Medicaid to cover all eligible, low-income adults when the ACA became law. Virginia will expand Medicaid to cover U.S. citizens with incomes becomes below 138% of the Federal Poverty Level beginning January 1, 2019.

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.  Under the ACA, consumers with incomes up to 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.

Individuals with pre-existing conditions cannot be denied health insurance or charged more for health insurance because of their health status. Parents can continue to keep adult children up to the age of 26 on their health insurance plans. Qualified health plans available in the Marketplace must cover essential health benefits. Health coverage plans offered outside the Marketplace are not required to meet the same benefits and standards.

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’s Medicaid program currently covers 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 will expand its Medicaid program, starting January 1, 2019. Under this expansion, eligibility is based on income and immigration status. A single adult citizen making up to $16,754 is now qualified to apply for coverage beginning November 16, 2018 with coverage commencing on January 1, 2019. Virginia consumers are able to purchase qualified health plans on the federal exchange.

Some changes to the Affordable Care Act are expected in 2019.

For 2018, individuals who do not have employer-sponsored health insurance and are ineligible for Medicaid will pay a tax penalty if they did not purchase health care coverage. This penalty is 2.5 percent of annual income or $695 per adult and $347.50 per child, whichever is higher. The fee is pro-rated based on the number of months an individual and/or each family member has been without health coverage during the tax year. Beginning in 2019, there will no longer be a federal penalty for not having coverage. However, several states and the District of Columbia have passed or are considering passing legislation to establish statewide health coverage mandates including financial penalties for individuals without health care coverage.

Individuals are advised to shop for the plans that best meet their needs, both within and outside of state and federal Marketplaces. Most individuals with incomes below 400 percent of the Federal Poverty Level are eligible for tax credits and cost-sharing subsidies when they purchase qualified insurance plans through state and federal Marketplaces. Cost-sharing reductions are only available on Silver plans and will increase at the same rate that the cost of the plans increases. Non-qualified health plans, including short-term, limited duration (STLD) plans, are also available for consumers to purchase. STLD plans only provide coverage for a limited time period. Additional information on these non-qualified health plans can be found at the Commonwealth Institute and the Kaiser Family Foundation.

As a result of recent changes to the ACA, insurance premiums for ACA compliant plans are expected to increase in 2019. However, rates are influenced by a number of market factors and will vary by state and within specific geographic areas. In the National Capital Region, premiums for individuals purchasing insurance within the state marketplaces are expected to decrease in Maryland and increase in the District of Columbia. In Virginia, which uses the federal marketplace, premiums will vary by insurance carrier and health plan. In all cases, the cost of individual or family coverage will vary depending on eligibility for subsidies. The Kaiser Family Foundation provides detailed estimates of variations in insurance premiums, tax credits and cost-sharing subsidies by state.

IMPORTANT ENROLLMENT INFORMATION FOR 2019

Open enrollment for purchasing health insurance varies by state. In Maryland and Virginia, the open enrollment period runs from Thursday, November 1, 2018 to Saturday, December 15, 2018. Plans purchased during this enrollment period begin January 1, 2019. Open enrollment in the District of Columbia is November 1, 2018 to January 31, 2019. However, in order to begin coverage on January 1, 2019, enrollment needs to be completed by December 15, 2018.

 

Individuals with a 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 within 60 days of the qualifying event.

 

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) or 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 at the following locations:

DHHS Silver Spring Center (“Beat the Rush” event)

8818 Georgia Avenue, 2nd Floor, Germantown

November 10, 9 a.m. – 3 p.m.

 

DHHS Office at 1401 Rockville Pike
1401 Rockville Pike, 1st floor, Rockville

Monday – Friday 8:00 a.m. to 4:00 p.m.

 

Germantown Regional Services Center 
12900 Middlebrook Rd, 2nd Floor, Germantown

Monday, Wednesday, Thursday & Friday: 8 a.m. to 4 p.m.
Tuesday: 8 a.m. to 6 p.m.

November 10, 9 a.m. – 3 p.m. (“Beat the Rush” event)

Silver Spring Health Center 
8630 Fenton Street, 10th floor, Silver Spring

Monday – Friday: 8 a.m. to 4 p.m.

 

Silver Spring Services Center 
8818 Georgia Avenue, Silver Spring

Monday, Wednesday, Thursday & Friday: 8 a.m. to 4 p.m.
Tuesday 8 a.m. to 6 p.m

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

Langley Park Community Center (“Beat the Rush” event)

1500 Merrimac Drive, Langley Park

November 10, 11 a.m. – 3 p.m.

 

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 Heights
Last consumer will be seen one hour before closing.
Monday – Friday: 9 a.m. – 4 p.m.

 

PGC Health Connect Enrollment Center
Langley Park Multi-Service Center
LaUnion Mall – Hyattsville
1401 East University Boulevard / Suite G1
Monday –Friday : 9 a.m. – 4 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 in Northern Virginia:

Boat People SOS
6066 Leesburg Pike, Suite 100, Falls Church
703-647-4748 (call for an appointment)

 

Evergreen Health Center 
9705 Liberia Ave, Suite 101, Manassas
703-680-7950 ext. 3219 (call for an appointment)

 

Greater Prince William Community Health Center
4379 Ridgewood Center Drive, Suite 102, Woodbridge
703-680-7950 ext. 3219 (call for an appointment)

 

Legal Services of Northern Virginia
Multiple locations
703-647-4748 (make an appointment online)

HealthWorks for Northern Virginia

  • Herndon
    1141 Elden Street, Suite 300, Herndon
    703-481-8160 (call for an appointment)
  • Leesburg
    163 Fort Evans Road, NE, Leesburg
    703-840-4699 (call for an appointment)

Neighborhood Health
Multiple locations
703-535-5568

 

Neighbor’s Keeper at Workforce Center
13370 Minnieville Road, Woodbridge
703-634-2400 (call for an appointment)

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