Are Alliance beneficiaries eligible for private plans through DC Health Link? Can they get premium tax credits and cost sharing reductions?
Current Alliance enrollees, who are lawfully present, may file an application for health coverage with assistance. These are individuals who are ineligible for Medicaid under what is called the "5-year bar" based on immigration status. The "5-year bar" applies to individuals, other than pregnant women and children, who have been legally residing in the United States for less than five years. During this period, by law, they are not eligible for several public benefits, including Medicaid.
If a household includes lawfully present persons, those persons can file an application and include undocumented persons on the application as non-applicants. The undocumented persons must be included for purposes of determining household size.
There are costs and benefits of Alliance coverage versus private plan coverage.
* Alliance coverage has no monthly premiums, co-payments, co-insurance, or deductibles. * Alliance does not covers as many health services as a private plan would. * Alliance has a limited provider network as compared to private plans. There is no coverage for doctors or services provided outside the District of Columbia. * Alliance coverage does not meet the individual mandate to have health coverage. If clients do not enroll in other coverage, but are lawfully present and make enough money to be required to file federal taxes, the federal government may impose a penalty through the tax code. * Because Alliance coverage does not meet the individual mandate, individuals that have Alliance as their only coverage would be eligible for premium tax credits and cost-sharing reductions if they plan to file federal income taxes (jointly if married). The premium tax credits will never cover the full cost of the private DCHL plan. Enrollees will have to pay a portion of the monthly premium along with any co-payments, deductibles, and co-insurance under the plan. These later amounts may be reduced because of cost-sharing reductions. * Enrolling in private coverage, including any DCHL plan, makes the customer ineligible for Alliance coverage. * If an Alliance beneficiary enrolls in a private DCHL plan, they must tell the Economic Security Administration (ESA) by calling (202) 727-5355.