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Northern Virginia Health Care Info for Adults

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MEDICAID HEALTH INSURANCE

Medicaid is a state health insurance program.

To get Medicaid:

    • You must live in Virginia.
    • You must be:
      • A parent or family member caring for a child; or
      • Pregnant; or
      • 65 or older, blind, or disabled.
    • You must have a low income.For example, for an adult who is
Number of people in your family Your income each month must be less than:*
1 $287
2 $387
3 $487
4 or more For each additional person, add $100
to the number just above

Attention: This chart applies to a parent or family member caring for a child. If your income is a little higher than the numbers above, you should still apply.

* These are the numbers for 2013. They will go up a small amount each year.

      • Your income can be higher if:
        • You have income from a job.
        • You pay for childcare.
        • You are a pregnant adult (for example, $3,255 a month for a family of three in 2013).
      • Your income can also be higher if you are an adult who is 65 or older, blind, or disabled. For example:
        • If your income is less than $766 a month in 2013 and you are single.
        • If you have Medicare and a low income.
        • If you get SSI (you should also get Medicaid).

You must be a U.S. citizen or meet certain immigration requirements to get Medicaid.

If you are not a citizen, see “How to get care if you are not a U.S. citizen” on the last page of this brochure.

Most people with Medicaid get their care through a managed care plan. Medicaid pays for:

      • Prescriptions.
      • Doctor visits, including specialists.
      • Hospital stays.
      • Mental health services.
      • Some other health care services.

Medicaid may even pay for medical care you got in the three months before you apply. You may have to pay a small amount for some services.

To apply for Medicaid:

Call the Virginia Department of Social Services at 800-552-3431. Ask how to apply and what information you will need. Or visit Virginia’s Medical Assistance Programs.

To keep getting Medicaid:

The Department of Social Services will send you a form. Fill out the form and return it right away so your health insurance does not get cut off.

OTHER PROGRAMS TO HELP YOU PAY FOR CARE

If you are disabled, if you are 65 or older, or if you need a kidney transplant or dialysis:

  • You can get Medicare if you or your spouse gets a Social Security check. If you are getting Social Security because of your disability, you may have to wait to get Medicare. You can also get Medicare if you have end stage renal disease or Lou Gehrig’s disease (ALS).
  • Medicare pays most of the bills for doctor and hospital care. Medicare also pays for prescription drugs and some nursing home care. You have to pay for part of the care you get.
  • You can apply for Medicare at your local Social Security office. Or call 800-772-1213.
  • If you have a low income, Medicaid may help you pay some of your Medicare costs. Medicaid has two programs that can pay the monthly Medicare premium that is taken out of your Social Security check and possibly other Medicare costs, too. These programs are called QMB and SLMB. Call the Department of Social Services at 800-552-3431 and ask how to apply or visit Virginia’s Medical Assistance Programs.

If you are pregnant:

  • The FAMIS MOMS program provides prenatal care.
  • You must have a low income (for example, $3,255 a month for a family of three in 2013).
  • You must be a U.S. citizen or meet certain immigration requirements.
  • Call 866-873-2647. Or call your local Department of Social Services.

If you have HIV or AIDS:

  • You may be able to get free HIV medicines from the Virginia AIDS Drug Assistance Program (ADAP). You must have a low income. Visit: Drug Assistance Program

Consider buying private health insurance:

  • This can cost a lot.
  • When you apply, you will have to answer questions about your health. You may need a physical exam.
  • Private insurance may turn you down because of a health problem you had before you applied. This is called a pre-existing condition. Even if you are accepted, the insurance may not cover your pre-existing condition. Make sure to ask if the insurance will pay for all the services you need.
  • If you have a pre-existing condition and have not had insurance for 6 months, you may qualify for the Pre-Existing Condition Insurance Plan. Call 866-717-5826 or visit www.pcip.gov.
  • To find out about health insurance companies and plans, call the Virginia Bureau of Insurance at 1-800-552-7945.

HOW TO GET CARE IF YOU ARE NOT A U.S. CITIZEN

You do not have to be a U.S. citizen to get health care and health insurance in Virginia. Applying will not hurt your immigration status.

If you meet the other requirements for getting Medicaid, you probably can get benefits if:

  • you have been a Legal Permanent Resident for five years and you and your spouse have worked enough in this country, or
  • you are a refugee, or
  • you are an asylee.

Some other immigrants can also get Medicaid. Call the Department of Social Services at 800-552-3431 or visit Virginia’s Medical Assistance Programs. Or call Legal Services at 703-778-6800.

Some immigrants can get other programs:

  • Call the FAMIS MOMS program if you are pregnant, at 866-873-2647. Or call your local Department of Social Services or your local Department of Health.

If you cannot get other insurance, find out about Emergency Medicaid:

  • Emergency Medicaid covers the birth of your child and most medical emergencies. Call the Department of Social Services at 800-552-3431 or visit Virginia’s Medical Assistance Programs
  • Your immigration status does not matter.
  • You must live in Virginia and meet all other Medicaid requirements.

HELPFUL PHONE NUMBERS

For free and low-cost health clinics:

For legal help:

  • Call Legal Services of Northern Virginia at 703-778-6800.
  • If you do not qualify for legal aid help, call the Virginia Lawyer Referral Service at 800-552-7977. The lawyers they refer you to may charge a fee. Tell them that you have a low income or ask for a reduced fee.

For help with Medicare and other programs for seniors:

  • Call the Virginia Insurance Counseling and Assistance Program (VICAP) at 800-552-3402.

If you or a family member has HIV/AIDS:

  • Call Legal Services of Northern Virginia’s HIV Unit at 703-778-6800.
  • Call Whitman-Walker Health Legal Services at 202-939-7627.

If you have a disability:

  • Call the Virginia Office for Protection & Advocacy at 800-552-3962.

For help dealing with the health care system:

  • Call the Patient Advocate Foundation’s Virginia Cares Uninsured Program at 800-532-5274.