What is Medicaid?
Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
What is Medicare?
Medicare is a federal health insurance program for people who are age 65 or older, disabled persons, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.
What is the Alliance?
Alliance is a plan for District of Columbia residents for those without insurance – those who often need help the most. The D.C.Healthcare Alliance (Safety Net) plan provides accessible and comprehensive health care benefits from qualified UnitedHealthcare providers and specialists in an area near you. To qualify for the plan you must live in the District of Columbia, have no health insurance and meet certain income requirements. Alliance is free to those who meet the requirements of the program.
What documents will I need when I apply for Medicaid?
When you apply for Medicaid, you must fill out an application form. You will also need to have various documents:
- Information about household members (name, date of birth and Social Security number)
- Rent or mortgage information
- Expenses (utilities, daycare, etc.)
- Vehicle information
- Bank statements
- Income (pay stubs)
- Proof of disability or medical records showing a lasting medical condition
- Recent medical bills
- Proof of citizenship
- Additional information as requested
How do I choose a Primary Care Provider (PCP)?
You may choose any plan provider to be your PCP. Plan Providers are listed in the provider directory or you may call Customer Service for assistance in finding a plan provider.
How can I switch to another PCP?
You may change your PCP for any reason, at any time. Customer Service will help make sure that the PCP you want to switch to is a participating provider with ABD. They will also check to be sure the PCP you want to switch to is accepting new patients.
What if my doctor or other provider leaves your plan?
Sometimes a PCP, specialist, clinic, hospital or other plan provider you are using might leave the Plan. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services.
How is a "medical emergency" defined?
A "medical emergency" is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse.
What if I have a medical emergency?
If you think you are having an emergency, call 911 or go to the emergency room of a network provider. Alliance members do not have coverage for any service that you get from an out of network provider, including emergency services. You will be responsible for the charges for the out of network services.
How to get urgently needed care?
If, while temporarily outside the Plan's service area, you require urgently needed care, then you may get this care from any provider. The plan is obligated to cover all urgently needed care at agreed upon rates that apply to care received within the Plan network. Alliance members do not have coverage for any service that you get from an out of network provider, including emergency services. You will be responsible for the charges for the out of network services.
What if I use non-plan providers to receive services that are "covered"?
Except in limited cases such as emergency care, urgently needed care when our network is not available, or out of service area dialysis, you must obtain covered services from network providers for the services to be covered. If you get non-emergency care from non-network providers without prior authorization, you must pay the entire cost yourself.
