Public Benefits and Insurance Navigation Services
Our team is here to talk with you about your health insurance options and any problems you are having with insurance or the cost of your care. The PBIN team serves as certified DC Health Link Assisters, providing critical consumer outreach and enrollment assistance to uninsured and under-insured DC residents. Given our patient population and geographic locations, the PBIN team also counsels clients from Maryland and Virginia and receives calls from other areas for assistance and advice.
We can help with:
- health insurance eligibility screening, including wrap around programs to reduce costs;
- enrollment and renewal assistance;
- health insurance literacy counseling (how to use coverage, understand out of pocket costs, reduce costs); and
- troubleshooting eligibility, coverage, cost of care issues.
We serve as a DC Health Link enrollment center to help you find an insurance plan that meets your needs and help you navigate any insurance issues.
We're Here to Help
Whitman-Walker Insurance Navigators can help eligible patients enroll in health insurance programs and get information on ways to keep healthcare costs low, including:
- Medicaid
- Medicare
- Qualified Health Plans (DC Health Link, Maryland Health Connections, and Virginia heathcare.gov)
- Subsidies (premium tax credits and cost sharing reductions)
- AIDS Drug Assistance Program (ADAP) and AIDS Insurance Assistance Program (AIAP)
- Qualified Medicare Beneficiaries (QMB)
- Sliding Fee Schedule
In addition to helping you find the best health insurance options, we can assist people in fixing coverage problems, denials when they happen, and recertifying/renewing your coverage, as needed.
We are here to help you and want you to know how best to get the help you need!
Please call our Insurance Helpline for whatever help you need. We have limited on-site appointments and do not recommend walking in – you are better served by calling the Helpline and leaving a message if you don’t reach someone.
Insurance Help Line – 202-745-6151 (Monday – Friday from 9 am – 5 pm)
Virtual Appointments: A Virtual (Phone) Appointment is when PBIN sets a time they will call you to complete your application or renewal for insurance, ADAP, and/or Sliding Fee. We have options for sending PBIN supporting documents by email, sending a picture of the documents by text, or, if neither of these work for you, PBIN will schedule a time to drop off the documents in person.
You need supporting documents to apply or renew insurance: We cannot complete applications or renewals without these documents. If you are uninsured or recently lost insurance and need to apply, call the Insurance Helpline for an appointment by phone and have the following ready:
- Proof of Identity: Driver’s license/ID/Passport
- Proof of Residency: Rent/mortgage/utility statement or utility bill (gas/electric)
- Proof of Income (most recent month): Pay stubs totaling 1 month of income or SSI/SSDI/TANF award letter
- Immigration Documents (if applicable): Passport, Green Card/LPR, Approval of Asylum
If you do not have these documents, let PBIN know so they can help you figure out the next steps.
AIDS Drug Assistance Program (ADAP)
The AIDS Drug Assistance Program (ADAP) provides HIV-related prescription drugs to underinsured and uninsured individuals living with HIV/AIDS and can help pay insurance premiums. Our Public Benefits and Insurance Navigation team can help you to figure out if you qualify for ADAP.
Coverage Dispute
If your health insurance plan denied a service, medication or equipment, you may be able to appeal. Our Insurance Navigators and Legal team can assist you to determine how to handle the dispute. If you’d like to talk with someone about insurance, please call the Insurance Help Line at 202.745.6151.
DC Health Link
Whitman-Walker Health’s team of Public Benefits and Insurance Navigators are also certified DC Health Link Assisters. DC Health Link is DC’s online health insurance exchange. Created by the Affordable Care Act, DC Health Link allows you to compare and shop for health insurance plans that fit your needs and budget.
Insurance Navigation
Insurance Navigation is a service to help you find the right insurance plan for your care needs, remove barriers to payer issues, and identify health-harming legal needs.
As certified DC Health Link Assisters, our Insurance Navigators are available to help any DC residents with their health insurance options regardless of whether they are current Whitman-Walker Health patients or not. After helping you enroll, our Insurance Navigators/DC Health Link Assisters can help you understand how to keep your insurance by helping you address coverage problems and denials when they happen and re-certify as needed.
Medicaid
Medicaid is the healthcare program that pays for medical and behavioral health services (and in DC, dental services) for people who meet certain eligibility criteria. Eligible individuals are people who are low income and are US citizens or meet certain immigration requirements in addition to state residency.
Medicare
Medicare is a healthcare program that pays for medical and behavioral health services for people who meet certain eligibility criteria.
Eligible individuals are people who are 65 years or older with Social Security work credits and people who have received Social Security Disability Insurance benefits for 24 months.
Medicaire Part D
Medicare Part D is the part of Medicare for prescription drug coverage. People enrolled in Medicare must also enroll in a separate Medicare Part D prescription drug plan to have prescription drug coverage. Our Legal team can assist you to review your plan options and choose the best plan for your prescription needs. If you’d like to talk with someone about insurance, please call the Insurance Help Line at 202.745.6151.
Open Enrollment
Open enrollment occurs at certain times of the year, allowing you to enroll in specific health insurance. Marketplace coverage – DC Health Link, Maryland Health Connection, and Virginia Healthcare.gov – all have different open enrollment periods. In addition, Medicare Advantage and Medicare Part D also have open enrollment periods.
Qualified Medicare Beneficiaries (QMB)
The Qualified Medicare Beneficiary program (QMB) reduces cost sharing for lower income Medicare beneficiaries. If you’d like to talk with someone about insurance, please call the Insurance Help Line at 202.745.6151.
Sliding Fee Schedule
As a federally qualified health center (FQHC), we have a sliding fee schedule of discounts available for patients who are uninsured and under 200% of the federal poverty level based on their family size. Our Insurance Navigators can also work with you to help find insurance options and reduce your out of pocket costs.
To get help from the Public Benefits and Insurance Navigation team, please call our Insurance Helpline at 202.745.6151.”
