Hi there, responding to Noel’s post about what options there are for folks without insurance. I’m focusing specifically on ER visits, since that’s mostly what we’ll be seeing.

Options for Immediate Cost Relief:

  • Hospitals will reduce costs and offer payment plans based on someone’s income. They usually will make someone fill out a “charity application”. Folks have to call the billing department to get access to this.

Options for Getting Coverage:

Medicare

Medicare has two parts that relate to this:

  1. Medicare Part A: Covers inpatient hospital stays. This is free if folks have worked enough hours in the US with taxable income.
  2. Medicare Part B: Covers outpatient hospital stays. This has a premium, but folks can qualify for a cost-reduction program that covers their premiums and reduces co-pays. This is called Qualified Medicare Beneficiary (QMB), and has an income limit (see chart below).

Qualifications for Medicare:

  • All folks 65 and over who are citizens qualify for Medicare. For non-citizens there are more complicated rules around how long someone has been in the US and what documentation they’ve had.
  • All folks receiving Social Security Disability (SSDI) automatically have Medicare, and have both A and B unless they rejected B. They cannot reject A, so they always have that.

How to Apply for Medicare:

  • Folks can call SSA at 1-800-772-1213. It’s generally recommended that they apply in-person, because of proof documents that they need to bring. However, it’s possible that SSA is devising alternate means given the current pandemic, so folks should call to ask.

Medicaid

  • DC Medicaid covers all medical services for free, no-holds-barred. All folks receiving Supplemental Income (SSI) automatically have Medicaid, and will have all costs fully covered. Folks under 65 who are (1) not receiving SSDI and (2) citizens OR have had an Legal Permanent Resident card (LPR card, “green card”) for at least five years can qualify for Medicaid based on the incomes in the below chart. All columns without color are Medicaid, and are split into three groups. “Childless Adult” means someone between 21 and 64 with no dependents.
  • NOTE: Folks who qualify for Medicaid and apply now can hold onto their bills and submit them to Medicaid for reimbursement once approved.
  • To apply, folks should call DC Healthlink at 855-532-5465. They’re open M-F 8am-6pm.

DC Healthcare Alliance/Immigrant Children Program (ICP)

  • This is the only free healthcare option for folks who aren’t citizens, or either don’t have an LPR card or haven’t had one for five years. It should cover ER visits, but to apply people need to go in-person to an ESA location, which isn’t recommended. However, folks over 65 automatically get waived out of that requirement, as well as folks who are able to get a doctor to write them a note waiving the in-person requirement. They can then fax their application in.

Note on this chart: these are 2019 numbers, I’ll update once I have the 2020 numbers. 2020 is slightly higher with the inflation index.

Size of Family Unit

200% FPG Per Month

210% FPG

Per Month

216% FPG

Per Month

300% FPG

Per Month

319% FPG Per Month

500% FPG Per Month

DC Healthcare Alliance

Childless Adult (21-64 years old)

Medicaid

Parent/Caregiver/

Children 19 + 20 years old Medicaid

QMB for Medicare Beneficiaries

Pregnant Folks/Children 18 and under Medicaid

ADAP

1

2,082

2,186

2,248

3,123

3,320

5,204

2

2,818

2,959

3,044

4,228

4,495

7,046

3

3,555

3,733

3,839

5,333

5,670

8,888

4

4,292

4,506

4,635

6,438

6,845

10,729

5

5,028

5,280

5,431

7,543

8,020

12,571

6

5,765

6,053

6,226

8,648

9,195

14,413

7

6,502

6,827

7,022

9,753

10,370

16,254

8

7,238

7,600

7,817

10,858

11,545

18,096

For additional family members, add:

737

773

796

1,105

1,175

1,842