Washington, D.C. Health Insurance

From historic landmarks to vibrant neighborhoods and cultural institutions, the District of Columbia remains a dynamic place to live — and understanding your health insurance options here is key to protecting your health and finances.

As of 2025, the uninsured rate in the District reflects steady progress in access and enrollment, thanks in part to strong public programs and ACA expansion. If you’re currently without coverage, here’s what you need to know about getting insured in D.C.

Health Insurance Options in the District of Columbia

D.C. offers a variety of health insurance options tailored to your age, income, employment status, and family size. Here are the most common types of coverage available:

Employer-Sponsored Insurance

Many District residents receive health insurance through their employers. If your workplace offers this benefit, it is often the most affordable and convenient option.

ACA Marketplace Plans

The Affordable Care Act (ACA) makes it possible for individuals and families to purchase health insurance through DC Health Link, the District’s official health insurance exchange. These plans cover essential health benefits, include no-cost preventive care, and protect those with preexisting conditions.

If you don’t have access to job-based coverage, you may qualify for subsidies that reduce your monthly premiums. You can use the ACA Subsidy Calculator to estimate your savings.

Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.

ACA Plan Types

ACA marketplace plans come in four metal tiers, which reflect different levels of coverage and cost-sharing:

• Bronze: Lower premiums, higher out-of-pocket costs — suited for those with minimal healthcare needs.
• Silver: Balanced premiums and out-of-pocket costs; may qualify for cost-sharing reductions (CSRs).
• Gold: Higher monthly premiums, lower costs when you need care — ideal for frequent healthcare users.
• Platinum (if available): Highest premiums but lowest costs at the point of service.

Short-Term Plans

Short-term medical (STM) plans offer temporary health coverage and can be a practical solution for individuals who are between jobs, recently lost employer coverage, waiting for ACA or Medicare eligibility, or need affordable protection during a coverage gap. 

These plans are available in this state and follow federal rules, but they are not regulated by the ACA. That means they can deny coverage based on pre-existing conditions and typically do not include comprehensive benefits like maternity, mental health, or preventive care.

While short-term medical plans are not a substitute for long-term health insurance, they may be ideal in situations where you’re temporarily uninsured—such as after job loss or before new coverage begins—and want short-term protection from unexpected medical events.

STM Plan Enrollment 

Unlike ACA-compliant plans, you can enroll in short-term health plans year-round.

Quick Coverage Start: Many short-term plans can begin as soon as the next day after your application is approved.

Medicaid

The District’s Medicaid program offers free or low-cost health insurance to eligible low-income individuals and families. It includes services such as preventive care, doctor visits, hospital stays, prescription drugs, and mental health services.

Medicaid has been expanded in the District to cover more residents, including adults who wouldn’t qualify under traditional eligibility rules.

Children’s Health Insurance Program (CHIP)

Known locally as DC Healthy Families, this program provides affordable insurance for children and pregnant women whose family income is too high to qualify for Medicaid. It covers doctor visits, immunizations, prescriptions, dental and vision care, and more.

Student Health Insurance

Students attending college in D.C. have several options:

• Remain on a parent’s plan until age 26
• Enroll in a school-sponsored health plan
• Apply for coverage through the ACA Marketplace

Depending on your income and circumstances, you may also qualify for Medicaid, CHIP, or other affordable coverage options, making student health insurance in D.C. flexible and accessible.

Medicare

D.C. residents aged 65 and older — and younger people with certain disabilities — can get Medicare coverage, including:

• Medicare Advantage (Part C)
  • Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
• Prescription Drug Plans (Part D)
  • Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
• Medicare Supplement (Medigap)
  • Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.

COBRA Coverage

Recently lost job-based insurance? COBRA allows you to temporarily continue your former employer’s coverage. This option is typically available for a limited time and may be more expensive than other options.

Enrollment Periods in the District of Columbia

Open Enrollment for 2026 Coverage:
November 1, 2025 – January 31, 2026
During this time, all eligible residents can apply for, renew, or change their ACA marketplace health plans.

Special Enrollment Period:
You may qualify outside of open enrollment if you experience a qualifying life event (QLE), such as:

• Loss of coverage
• Marriage or divorce
• Birth or adoption of a child
• Relocation
• Major change in income

Generally, you have 60 days from the event to enroll.

Health Insurance Providers in D.C.

As of 2025, the following insurers typically offer individual and family plans through DC Health Link:

• CareFirst Blue Cross Blue Shield
• Kaiser Permanente

Plan availability may vary depending on where you live in the District. Check DC Health Link to compare options in your area.

Understanding Health Insurance Costs

Here are common health insurance cost terms to help guide your decision-making:

• Premium: Your monthly payment to maintain coverage.
• Deductible: What you pay before insurance starts covering services.
• Copayment: A set fee for a doctor visit or service.
• Coinsurance: Your share of costs after meeting your deductible.
• Out-of-Pocket Maximum: The most you’ll pay in a year for covered services.
• In-Network vs. Out-of-Network: Using in-network providers keeps your costs lower.

Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.

Bottom Line

Health insurance in the District of Columbia comes with diverse options — from employer plans and ACA marketplace coverage to government programs like Medicaid and Medicare. By understanding your choices and enrollment windows, you can find a plan that fits your healthcare needs and budget.

Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.