The District of Columbia offers the full range of health insurance options to its 670,000 residents1: employer-provided plans; Affordable Care Act (ACA) individual and family plans purchased through the District’s Health Insurance Exchange (also called a Marketplace); and government-assisted plans such as Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
Over half the District’s residents get their coverage through their work. One in four receives it through Medicaid and one in 12 through Medicare, though ACA (aka Obamacare) plans cover only about one in every 15 residents.2
In 2014, D.C. expanded Medicaid coverage after the ACA was passed. You can get Medicaid coverage through the expansion if you’re not eligible for other Medicaid programs or Original Medicare (Medicare Part A and Part B) and you earn equal to or below 210% of the federal poverty level (FPL).3 By October 2019, the expansion covered an additional 110,000 District residents.4 Obamacare and the District’s Medicaid expansion helped drop the rate of uninsured people from 6.3% in 2013 to 3.6% in 2019.5
Here you’ll find an overview of D.C.’s health insurance landscape and get help navigating your options to find the plan that’s right for you.
WHAT YOU NEED TO KNOW:
The Open Enrollment Period to sign up, renew or change your health insurance plan in the District of Columbia is November 1 to January 31.
You can enroll online for an Affordable Care Act (ACA) plan only through the District’s DC Health Link. Your application for an ACA plan will also automatically let you know if you qualify for other coverage or help paying your monthly premium.
The average monthly premium for a 2021 ACA plan for a 40-year-old ranges from $337 to $431, but your income may qualify you for help with premiums and out-of-pocket costs.
When Is the District of Columbia’s Open Enrollment Period?
Each year, the Open Enrollment Period (OEP) in Washington, D.C. to sign up for an Obamacare plan runs from November 1 to January 31.
Your coverage will start based on when you select your plan.6 For example, if you choose a plan by December 15, 2020, your coverage will start on January 1, 2021. And if you select a plan by January 15 or 31, 2021, your coverage would kick in on February 1 or March 1, 2021, respectively. The OEP is the period to enroll, change or update your plan.
If you miss the OEP, you won’t be able to apply until next year’s enrollment period. However, you can sign up for an ACA plan at any time of the year if you’re eligible for a Special Enrollment Period due to a “qualifying life event” such as the birth of a child or a job loss.
In 2014, 11,000 people in the District of Columbia enrolled on the ACA exchange. That number peaked at 23,000 in 2016 and dropped steadily, to 17,500 in 2020.7
More Time to Enroll
D.C. residents have until the coronavirus pandemic to enroll in a health plan. D.C. Health Link announced a Special Enrollment Period in September 2020 that would continue until the end of the coronavirus pandemic period.
How Do I Enroll in the District of Columbia’s Health Insurance Exchange?
Every ACA plan must provide 10 essential health benefits, which includes coverage for preexisting conditions, inpatient hospital care and prescription drugs. Although the District of Columbia is not a state, it has set up the DC Health Link as its exchange to provide ACA-compliant individual health policies to its residents.8
By providing some details about yourself on the DC Health Link website, you can compare affordable health plans and purchase coverage. The site also lets you apply for Medicaid and other government support for your healthcare needs.
Besides establishing its own ACA exchange to buy health insurance, the District has expanded Medicaid beyond what most states have done, severely restricted short-term health insurance policies, and put in place an individual mandate. This means that every D.C. resident must have qualifying health coverage. If you don’t have insurance or get an exemption, you will have to pay a penalty as part of the taxes you file for D.C. The mandate took effect in 2019.9
How Much Does Exchange Health Insurance Cost in the District of Columbia?
First, it’s important to know that as a D.C. resident, you can only buy an individual Obamacare plan through the DC Health Link exchange, not directly from insurance companies.
The individual plans offered on the exchange are broken down by levels of cost-sharing, meaning how much you pay and how much the insurance company contributes toward your covered healthcare expenses. There are three levels of plans, each named after a metal: gold, silver and bronze. The more valuable the metal, the more coverage you have on a given plan.
Although premiums spiked in 2020, from 2019 to 2021 they rose only slightly: Qualified bronze, silver and gold plans increased by only 6.65%, 1.05% and 1.17%, respectively.
Here are the average monthly costs for a 40-year-old District resident for bronze, silver and gold plans sold through the local exchange.10
Average Premiums for District of Columbia Marketplace Plans (for a 40-year-old person)
|Lowest-Cost Bronze Plan||$316||$345||$337|
|Lowest-Cost Silver Plan||$380||$404||$384|
|Lowest-Cost Gold Plan||$426||$450||$431|
Remember that these are the costs before any savings you might be eligible for based on your family size and household income. Your monthly premium could be much less if you qualify for tax credits or cost-sharing subsidies for a qualified plan you buy from DC Health Link.
Subsidies are calculated based on a DC Health Link silver “benchmark” plan — the second-lowest-cost silver premium for a 40-year-old. From 2019 to 2021, the District’s average benchmark premium has grown from $393 to $415, an increase of 5.6%.11
Which Companies Offer Individual Health Insurance Plans in D.C.?
In 2021, two health insurance companies sell individual ACA-compliant HMO and PPO health policies to District of Columbia residents through the exchange:12
- CareFirst Blue Cross Blue Shield
- Kaiser Permanente
The same 25 plans are available as were offered in 2020.
What Are My Coverage Options in D.C. If I’m Low-Income?
ACA Marketplace Plans (Obamacare)
With an income of up to four times the federal poverty level (FPL), you may qualify for help from the federal government to help pay your premiums. In 2020, only one in 20 people who enrolled in ACA plans in D.C. received the subsidies, called Advanced Premium Tax Credits (APTC).13 These monthly subsidies averaged $368.14
Here are some examples of cost savings with subsidies:
- A 28-year-old in Brentwood who earns $30,000 a year could get a 2021 silver plan for $195 per month after subsidies.15 The same policy would cost $317 per month without the premium tax credits, which cover 39% of the cost.
- A family of three in Cleveland Park with an income of $50,000 a year could pay $317 per month after subsidies for a 2021 silver plan.16 This policy would cost them $904 per month without the premium tax credits, covering 65% of the cost.
If you buy a silver plan on the D.C. exchange and meet some other requirements such as income, you may also qualify for cost-sharing reductions (CSRs).17 These reduce your out-of-pocket costs for expenses like doctor’s visits and prescriptions even more. In 2019, 2% of enrollees in the District of Columbia’s exchange plans received CSRs.18
By going through the DC Health Link application process, you’ll also find out if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or other income-based discounts, too. You can use the 2021 Health Plan Comparison Tool to compare the costs of plans available to you.
Medicaid is a joint federal-state program that provides healthcare coverage at little or no cost for eligible District of Columbia residents, including low-income and disabled adults, children and families.
Childless adults, parents/caretaker relatives, children up to 21 and pregnant women can also check on their eligibility by applying for Medicaid.19 The types of services you’re eligible for will vary with your age, family structure and needs.
D.C.’s generous Medicaid expansion program20 covers nonelderly adults up to at least 210% of the FPL — much more than in most states.21 The District’s Medically Needy program provides Medicaid coverage for specific groups whose income is over the Medicaid limit but who have high medical expenses.22
You can enroll in Medicaid at any time during the year. As of June 2020, more than one-third of D.C. residents were enrolled in Medicaid or CHIP.23 Enrollment has increased by 6% since the Affordable Care Act was put in place.24
To qualify for Medicaid, recipients must meet income eligibility requirements as a percentage of the FPL. The percentages vary for different groups:25
- Parents: 216%
- Childless adults: 210%
- Pregnant women: 319%
- Children: 319% (age 0-18); 216% (age 19-20)
- Seniors: 100%
- People with disabilities: 100%
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) was set up to cover children whose parents earn too much to qualify them for Medicaid but aren’t covered on another health plan.
For children to qualify for CHIP in the District of Columbia, the maximum family income for a child from birth to age 1 is 206% to 324% of the FPL for its family size. For ages one to five, it’s 146% to 324%; and for ages six to 18, it’s 112% to 324%. (The 2020 FPL for a family of three is $21,720.)26
Help is available by calling the DC Health Families Helpline at (800) 620-7802.27
How Do I Apply for District of Columbia Health Coverage Assistance?
What About Medicare Plans for D.C. Seniors and People with Disabilities?
Medicare is a federal health insurance program that primarily covers people age 65 and older, younger people who are disabled and dialysis patients. Your income doesn’t affect whether or not you’re eligible for Medicare.
As of October 2020, nearly 95,000 D.C. residents had Medicare Part A (hospital insurance) and Part B (medical insurance).29 And more than three-quarters of Medicare enrollees gpt their Part A and Part B coverage through the federal government’s Original Medicare program. The rest get these benefits through private Medicare Advantage (Part C) plans.30 Part C plans roll in other benefits, including Part D prescription drug coverage, in most cases.
If you get your Part A and Part B coverage through Original Medicare, you may also want to buy an individual Part D prescription drug plan from a private insurer. In October 2020, more than 38,000 D.C. residents had a standalone Part D plan.31
Original Medicare only covers about 80% of approved costs. If you choose coverage through Original Medicare, you can add a Medicare Supplement Insurance plan (called a Medigap policy) to pick up expenses that Medicare doesn’t include.
Like many U.S. states, 10 standardized Medigap plans are available in the District of Columbia to help pay some to all of your uncovered, out-of-pocket costs. These include copayments, coinsurance and deductibles.
The federal government sets the benefits for each standardized plan, so each type of plan’s basic benefits are the same no matter where you buy it. But since an insurance company can charge what it wants for its policies, premiums can vary depending on the insurer you buy it from.
State Health Insurance Assistance Programs (SHIP) get funding from the federal government to provide free local health coverage counseling to people with Medicare. The District’s Health Insurance Counseling Project (HICP) can be reached by calling (202) 727-8370.
A Medicare Savings Program (MSP) can help you with various Medicare payments if you meet the District’s income and asset limits. Contact your local SHIP office for specific guidelines and information. The help in paying for Medicare premiums, coinsurance, deductibles and prescription drugs will come from Medicaid, but this doesn’t mean you’d be entitled to D.C. Medicaid benefits.
Can I Buy Short-Term Health Insurance in the District of Columbia?
Short-term health insurance is an affordable solution if you find yourself in transition, such as between long-term insurance plans or jobs, and needing coverage. However, a D.C. law passed in January 201933 limits the length of temporary health insurance plans to three months and you can’t renew them. An insurance company must also wait nine months before selling another short-term health insurance policy to anyone who previously bought a temporary policy.
These plans aren’t easy to find, either. That’s because the District’s law requires insurance companies to cover any preexisting medical or behavioral health conditions treated within the previous 12 months and companies can’t reject applications because the applicant is too great a risk to insure.