Healthcare Options and Information
This page provides information on COBRA, Medicaid, Medicare, and Obamacare. We will continue to update this page with information on coverage options. If you have any questions, contact Local 25 at (202) 737-2225.
COBRA: During an extended layoff, COBRA allows you to continue the family or single healthcare coverage you normally have under your Union contract while you’re working. With COBRA you would pay the healthcare premiums your employer typically pays each month. Your employer is required to send you a COBRA notice that includes information on cost, and you can contact your Human Resources department if you’re interested in signing up.
District of Columbia Healthcare Options
+ DC Programs
DC’s healthcare coverage options depend mainly on income and citizenship/immigration status.
| Program | Description | Application |
|---|---|---|
| Medicaid (0-64) (MAGI Medicaid) | Free or reduced coverage for low-income DC residents. Medicaid in DC covers medical, dental, and vision care. Applicants must be citizens or eligible immigrants and fall below income thresholds. This includes children so it takes the place of CHIP. There are different income requirements for each category of eligible person (children, youth, adult, parents, etc.). There is no asset limit. | DC Health Link Online Medicaid Application |
| Medicaid (65+ or disabled)(Non-MAGI Medicaid) | Non-MAGI Medicaid refers to Medicaid for individuals who qualify for reasons other than income. These can include age, disability, foster care children, or recipients of other medical assistance programs. Recipients must be citizens or eligible immigrants and DC residents. | DC Combined Benefits Application |
| DC Health Link (Obamacare) | DC Health Link is DC’s marketplace for private insurance coverage. DC residents who are not eligible for other programs listed here will sign up for coverage through this. Applicants may still qualify for financial aid. | DC Health Link |
| Healthcare Alliance | Basic healthcare for adults (21+) who do not qualify for Medicaid due to citizenship status. District residents with income at or below 200% FPL (Federal Poverty Level), less than $4,000 (ind.) or $6,000 (family) in liquid assets, and no other health insurance may qualify for this. Coverage through the Alliance has no co-pays, premiums or other charges. Alliance coverage does not meet essential coverage standards. It covers medical and limited dental care and requires a 6 month renewal. | DC Combined Benefits Application |
| Immigrant Children's Program (ICP) | This program is for children (0-21) who do not qualify for Medicaid due to citizenship status. Children must also be DC residents, with income at or below 200% FPL (Federal Poverty Level), and ineligible for Medicaid. ICP meets essential coverage standards. | DC Combined Benefits Application |
| Cover All DC | Cover All DC is for DC residents who are looking for health coverage but may not qualify for DC Health Link private coverage due to citizenship status. People covered by Cover All DC do not receive financial support towards their medical costs. | You must apply through a community organization (see "Resources" section below) |
+ DC Eligibility
Determine which categories you fall into and your household size. Then compare your household income in the last 30 days to the amount in the corresponding box. Keep in mind that parents and children might have different eligibility levels.
| Household Size | Children (0-18) | Youth (19-20) | Pregnant People | Childless Adults (21-64) | Parents & Caretakers (18-64) | Healthcare Alliance (21+) & ICP (0-21) | Non-MAGI Medicaid |
|---|---|---|---|---|---|---|---|
| 1 | $3,392.03 | $2,296.80 | $3,190.00 | $2,233.00 | $2,296.80 | $2,126.67 | $1,063.33 |
| 2 | $4,582,97 | $3,103.20 | $4,310.00 | $3,017.00 | $3,103.20 | $2,873.33 | $1,436.67 |
| 3 | $5,773.90 | $3,909.60 | $5,430.00 | $3,801.00 | $3,909.60 | $3,620.00 | $1,810.00 |
| 4 | $6,964.83 | $4,716.00 | $6,550.00 | $4,585.00 | $4,716.00 | $4,366.67 | $2,183.33 |
| 5 | $8,155.77 | $5,522.40 | $7,670.00 | $5,369.00 | $5,522.40 | $5,113.33 | $2,556.67 |
| 6 | $9,346.70 | $6,328.80 | $8,790.00 | $6,153.00 | $6,328.80 | $5,860.00 | $2,930.00 |
| 7 | $10,537.63 | $7,135.20 | $9,910.00 | $6,937.00 | $7,135.20 | $6,606.67 | $3,303.33 |
| 8 | $11,728.57 | $7,941.60 | $11,030.00 | $7,721.00 | $7,941.60 | $7,353.33 | $3,676.67 |
Maryland Healthcare Options
+ Maryland Programs
| Program | Description | Application |
|---|---|---|
| Medicaid | Medicaid makes health insurance coverage available at no cost to low-income households and individuals. Maryland Medicaid does not cover dental care. Medicaid is administered by Managed Care Organizations (MCOs) that offer care networks. Note that Kaiser Permanente administers acts as an MCO in Baltimore City and Anne Arundel, Baltimore, Calvert, Charles, Harford, Howard, Montgomery and Prince George’s counties, allowing you to continue your care through Kaiser. | Maryland Health Connection Application |
| Medicaid for Seniors | Medicaid is available to seniors (65+) based on income, assets, and care type. | myDHR Application (under maintenance until 7/6/2020) |
| MCHP | Maryland’s Children Health Program (MCHP) provides healthcare at no cost to low-income children (0-19). | Maryland Health Connection Application |
| MCHP Premium | Maryland’s Children Health Program (MCHP) Premium provides healthcare at no cost to children (0-19) who come from households with incomes too high to qualify for MCHP but too low to afford many of the private insurance options (up to 300% FPL(Federal Poverty Level)). It does require a small monthly premium of $57 (Tier 1) or $71 (Tier 2). | Maryland Health Connection Application |
| Maryland Health Connection (Obamacare) | Maryland’s health insurance marketplace offers Qualified Health Plans (that meet the ACA standards) and the ability to browse private insurance options. | Maryland Health Connection Application |
+ Maryland Eligibility
To be eligible for all Maryland programs, you must be a Maryland resident, a citizen or eligible immigrant, and meet the income guidelines below. Determine which categories you fall into and your household size. Then compare your household income in the last 30 days to the amount in the corresponding box. Keep in mind that parents and children might have different eligibility levels.
| Household Size | Adults (21-64) | Children (0-21)(MCHP) | MCHP Premium Tier One | MCHP Premium Tier Two | Pregnant People |
|---|---|---|---|---|---|
| 1 | $1,468 | $2,245 | $2,809 | $3,426 | N/A |
| 2 | $1,938 | $3,032 | $3,794 | $4,627 | $3,794 |
| 3 | $2,498 | $3,819 | $4,778 | $5,828 | $4,778 |
| 4 | $3,014 | $4,608 | $5,766 | $7,032 | $5,766 |
| 5 | $3,529 | $5,395 | $6,750 | $8,234 | $6,750 |
| 6 | $4,043 | $6,182 | $7,735 | $9,435 | $7,735 |
| 7 | $4,560 | $6,971 | $8,723 | $10,639 | $8,723 |
| 8 | $5,074 | $7,758 | $9,707 | $11,840 | $9,707 |
Maryland Medicaid for Seniors (65+) is broken into three types: (1) Institution/Nursing Home Medicaid, (2) Medicaid Waivers/Home and Community Based Services, and (3) Regular Medicaid.
Each of these types has different requirements based on the applicants. There are three categories of applicant:
- SINGLE: single spplicant
- MARRIED (both): Married applicants, both people are applying
- MARRIED (one): Applicant is married, one person in the couple is applying
Each of the categories has different requirements regarding income limits, asset limits, and the level of care they require.
| Care Requirements | SINGLE: Income Limit | SINGLE: Asset Limit | SINGLE: Level of Care Required | MARRIED (both): Income Limit | MARRIED (both): Asset Limit | MARRIED (both): Level of Care Required | MARRIED (one): Income Limit | MARRIED (one): Asset Limit | MARRIED (one): Level of Care Required |
|---|---|---|---|---|---|---|---|---|---|
| Institutional/Nursing Home Medicaid | Cannot exceed cost of nursing home care | $2,000 | Nursing Home | Cannot exceed cost of nursing home care | $3,000 | Nursing Home | Cannot exceed cost of nursing home care | Applicant: $2,000 Non-Applicant: $128,640 | Nursing Home |
| Medicaid Waivers/ Home and Community Based Services | $2,349/month | $2,000 | Nursing Home | Each spouse is allowed up to $2,349/month | $3,000 | Nursing Home | $2,349/month for applicant | Applicant: $2,000 Non-Applicant: $128,640 | Nursing Home |
| Regular Medicaid/ Aged, Blind, and Disabled | $350/month | $2,500 | None | $392/month | $3,000 | None | $392/month | Applicant: $3,000 | None |
Virginia Healthcare Options
+ Virginia Programs
| Program | Description | Application |
|---|---|---|
| Medicaid | Virginia’s Medicaid program provides comprehensive coverage with no co-pays. This is available for adults, pregnant people, and elderly, blind, and disabled Virginians but the eligibility levels are different based on the category. Medicaid is administered by Managed Care Organizations (MCOs) that offer care networks. Note that Virginia Premier and Kaiser Permanente have partnered to administer a Medicaid program that offers care through any Kaiser Permanente medical center. Medicaid for children (0-19) is also called FAMIS Plus in Virginia. | Common Help Application |
| FAMIS | FAMIS covers medical care for children (0-19) whose household income does not exceed 200% FPL (Federal Povery Level). This is higher than the income restriction for FAMIS Plus. FAMIS coverage may include $2 or $5 co-pays. | Common Help Application |
| Plan First | Free family planning service for qualifying Virginians that provides yearly services that include STI testing, contraceptive prescriptions, and counseling. | Common Help Application |
| FAMIS MOMS | Similar to FAMIS, FAMIS MOMS is Virginia’s state coverage program for pregnant people with incomes slightly above the Medicaid threshold. It also requires no premiums or copays for pregnancy related services. | Common Help Application |
| Federal Health Insurance Marketplace (Obamacare) | Virginia does not have a state marketplace for private insurance so residents have to sign up through the federal marketplace. Applicants will also have to apply for a Special Enrollment Period in order to enroll outside of the typical enrollment window. | Healthcare.gov |
+ Virginia Eligibility
Determine which categories you fall into and your household size. Then compare your household income in the last 30 days to the amount in the corresponding box. Keep in mind that parents and children might have different eligibility levels.
| Household Size | Medicaid: Adults (19-64) |
Medicaid Children: (FAMIS Plus) (0-19) |
Elderly (65+), Blind, Disabled Individuals | FAMIS (0-19), FAMIS MOMS, Plan First |
|---|---|---|---|---|
| 1 | $1,469 | $1,575 | $851 | $2,181 |
| 2 | $1,983 | $2,127 | $1,150 | $2,964 |
| 3 | $2,499 | $2,680 | N/A | $3,711 |
| 4 | $3,014 | $3,233 | N/A | $4,477 |
| 5 | $3,529 | $3,785 | N/A | $5,242 |
| 6 | $4,044 | $4,337 | N/A | $6,007 |
| 7 | $4,560 | $4,890 | N/A | $6,773 |
| 8 | $5,074 | $5,442 | N/A | $7,538 |
Medicaid Frequently Asked Questions
+ How do I calculate my income?
Medicaid eligibility is based on your income in the last 30 days.
You should include in your calculation:
- Unemployment benefits
- Disaster or severance pay from your employer
- Income from retirement accounts
- Income from other members of your household
- Any wages or tips you earn from secondary jobs
You should NOT include:
- $600/week federal unemployment benefit
- $1,200 one-time stimulus payment
+ Am I eligible if I am not a citizen? What is an eligible immigrant?
Medicaid is only available to citizens and eligible immigrants. Generally these eligible immigrants or “qualified non-citizens” include:
- Lawful Permanent Residents or Green Card Holders (after 5 years)
- Asylees
- Refugees
The District of Columbia provides healthcare options similar to Medicaid through the Immigrant Children's Program and the DC Healthcare Alliance for DC residents who do not qualify for Medicaid due to their immigration status.
Maryland and Virginia Medicaid programs and other services are accessible to citizens and immigrants in the categories above. If you have questions about your eligibilty or or your family is of mixed immigration status, we encourage you to reach out to one of the organizations listed below to figure out what programs you may be eligible for.
+ Will this affect an application to change my immigration status?
Virginia assures that receiving health insurance through FAMIS or FAMIS Plus (Medicaid for Children) will NOT cause an immigrant family to be labeled a public charge. Being labeled a public charge would make it harder for families or individuals to become lawful permanent residents in the future.
However, for questions on how applying for other health insurance programs in Virgina, DC, or Maryland would affect applicants who are seeking to change their immigration status, we encourage you to speak to you lawyer or other immigration advisers.
+ How do I calculate my assets?
Beyond your income you may have additional things of value. Asset calculations for Medicaid and other healthcare programs generally do not include your car or your primary house. They will consider possessions including additional homes, bonds, stocks, and life insurance policies among other things.
The value of these things together cannot exceed the asset limits for the program.
Medicaid Resources
+ State Resources
Each state provides a tool to help you identify what programs you may be eligible for. None of them provide conclusive answers but they are a good place to start:
These tools will ask you to input your expected yearly income. Do your best to provide an estimate based on your expected work and the income sources listed in the section: "How do I calculate my income?"
+ Community Organizations
The organizations listed below can help members identify what benefits and programs they may be eligible for. They will also be able to help members complete applications or direct them to resources that will help fill out applications for coverage.
Maryland & DC Resources: These organizations can provide basic help to members living in DC, Maryland, and Virginia. However, they only provide more in-depth assistance to members living in DC and MD.
Whitman Walker: 202- 745-6151
Mary’s Center: 202- 420-7091
La Clinica del Pueblo: 202- 462-4788
Community of Hope: 202-407-7747
Virginia Resources: This organization, sponsored by the state of Virginia can provide in-depth assistance to members living in Virginia.
CoverVA: 1-855-242-8282
Medicare
+ Information on Applying
Medicare is the federal health insurance program for people 65+ and for people younger than 65 with certain disabilities or diseases. In order to be eligible for Medicare, you must be eligible for Social Security and have worked about 10 years while paying Medicare taxes (which are usually deducted from your paycheck).
Kaiser Permanente offers Medicare Advantage plans in DC, Maryland, and Virginia. Note that the plans may vary by county. Medicare Advantage plans are administered by private companies that bundle Medicare and additional services together in one plan.
For members newly applying for Medicare Part B, keep in mind that once you return to work, you can suspend part B and go back to the employer sponsored coverage.
Additionally, if you are eligible, apply for Medicaid in addition to Medicare.
Kaiser is working with our Union to reach out to members and help them navigate the Medicare application process and maintain coverage under Kaiser.
Below is a basic overview of the process for enrolling in Kaiser's Medicare Advantage program.
If you have questions, you can reach out to the Kaiser Medicare line at 1-866-973-4588 (English) or 1-866-973-4587 (Spanish).
| Group | Process to Obtain Medicare |
|---|---|
| Group 1: Individuals over 65 without Part A or Part B | (1) Enroll in Medicare Parts A and B. A. Part A Premium: If you paid Medicare taxes for 40+ quarters (10 years), Part A is free and you should have been automatically registered. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. B. Part B Payments: $144/month and may be subject to adjustment (2) Submit a Medicare Advantage application to Kaiser. For July 1st, Kaiser needs it postmarked, emailed (fillable PDF) or online by 6/30. |
| Group 2: Medicare Eligible Individuals with Part A but not Part B | (1) Enroll in Medicare Part B through Social Security. That process generally takes 2-4 weeks. Due to COVID, only paper applications are accepted. All members will need a letter that shows the dates that they had coverage. Part B is $144 a month and but may be subject to adjustment. (2) Then apply for Kaiser Medicare Advantage plan. For July 1st, Kaiser needs it postmarked, emailed (fillable PDF) or online by 6/30. |
| Group 3: Medicare Eligible Individuals with Part A & Part B |
(1) Submit a Medicare Advantage application to Kaiser. For July 1st, Kaiser needs it postmarked, emailed (fillable PDF) or online by 6/30. |