Residents of Washington, D.C., have many options when it comes to health coverage. You can sign up for a health plan via DC Health Link, enroll in your employer’s group coverage, use TRICARE or another military health plan, or enroll in Medicare or Medicaid if you meet the eligibility requirements.

Keep reading to learn more about your health insurance options in Washington, D.C.

What to know about insurance in Washington, D.C.

  • Marketplace plans: In Washington, D.C., you don’t have the option of purchasing a plan directly from an insurance company. If you don’t qualify for an employer’s health plan, you must use the DC Health Link marketplace to buy a plan.
  • Open enrollment: Washington, D.C.’s open enrollment period runs from November 1 to January 31.
  • Special enrollment: In most cases, you can’t sign up for coverage or make changes to your existing coverage outside the annual open enrollment period. However, if you have a qualifying life event, such as losing your job, the death of a spouse, or birth of a child, you qualify for a special enrollment period.
  • Health insurance exchange: Washington, D.C., operates its own health insurance exchange: DC Health Link. This means you won’t use the federal Health Insurance Marketplace to shop for coverage.
  • Coverage types: In 2019, 54.9% of the insured population of Washington, D.C., had health coverage through an employer. Another 1.3% had military coverage, 6.5% had nongroup coverage, and 33.7% were enrolled in Medicare and Medicaid. Approximately 3.6% of the population of Washington, D.C., had no health insurance coverage.

How do I enroll in Washington, D.C.'s, health insurance marketplace?

To enroll in a health plan, visit DCHealthLink.com and click the “Get Started” button under “Individual & Family.” Then, click “Shop & Enroll” to start the application process. If you want to check your eligibility for lower monthly premiums, you’ll need to answer questions about your household size, availability of employer coverage, and household income. When you click “Get Your Estimated Savings”, the site will tell you if you qualify for reduced premiums or Medicaid coverage based on your income.

Once you answer the initial questions, you’ll need to create a DC Health Link account to finish your application. After you enter the required information, you’ll be able to see the plans available to you. DC Health Link has several standardized plans to make it easier to compare costs and coverage options. These standard plans cover many services, such as primary care visits and generic drugs, before you’ve met your deductible. As a result, your out-of-pocket costs may be lower than they would be with a nonstandard plan. You can click on each plan’s Summary of Benefits and Coverage to determine how much you can expect to pay for each type of covered service.

Once you pick a plan, you’ll be able to complete the enrollment process.

How do I enroll in Washington, D.C., individual and family insurance?

If you don’t have group coverage and don’t qualify for Medicare or Medicaid, you’ll need to purchase individual or family coverage via DC Health Link. As an individual, your most important concerns are the cost of the plan and the coverage it provides for your specific health needs. If you need a family plan, you also need to consider whether one of your family members needs access to specialty care or a provider who isn’t in-network with many insurance companies.

Insurance for individuals in Washington, D.C.

Although there are many health plans from which to choose, picking a plan is a little easier if you’re only looking for individual coverage. You don’t need to worry about meeting a family deductible or choosing a plan that covers the needs of several people.

Cost is typically one of the most important considerations when buying health coverage. Not only do you need to think about the monthly premium, but you also have to compare plans based on their deductibles and other out-of-pocket costs. If you have a severely limited budget, you may need to pick the plan with the lowest premium even if it has a high deductible and high out-of-pocket limit. If you can afford it, a plan with a higher premium may be a better choice if you know you’ll need regular health care services.

Access to care is also an important consideration. Your health insurance won’t do you much good if you can’t use it to see your preferred health care providers. Compare each plan carefully to determine if your primary care provider (PCP) and any specialists you see are considered in-network. If you prefer one hospital over the others in your area, you should also check to see if your preferred hospital is an in-network facility.

There are different types of plans you can choose from:

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Washington, D.C.

When shopping for family coverage, consider the age of each person in your household and any special health needs they may have. For example, if you’re a person of child-bearing age, you may want to compare plans to see which one offers the best coverage for prenatal and maternity care.

Another distinction between individual and family coverage is that family plans often have an individual deductible and a family deductible. This means that each individual on the plan must meet their deductible before the insurance company starts paying for any of the services they receive. In some cases, it’s possible to meet the family deductible before meeting each individual deductible.

How much does health insurance cost in Washington, D.C.?

As with many areas of the country, the type of health insurance plan you choose determines what your overall costs will be. Your options include bronze, silver, and gold plans. From 2018 to 2020, the average costs of all of these plans rose slightly every year. However, in 2021, average costs dipped slightly.

Average premiums in Washington, D.C.  2018 2019 2020 2021
Most affordable Bronze plan $271 $316 $345 $337
Most affordable Silver plan $317 $380 $404 $384
Most affordable Gold plan $385 $426 $450 $431

  • Bronze plans usually have the lowest premiums, making them the most affordable on a monthly basis; however, it’s important to consider other out-of-pocket costs. Since 2018, the average cost of the most affordable Bronze plan has increased from $271 to $337. Bronze plans tend to have high deductibles and high coinsurance requirements, which can make them less affordable than other options if you need regular medical care.
  • Silver plans offer a good mix of coverage and affordability. Although the monthly premiums tend to be higher than the premiums for Bronze plans, Silver plans usually have lower deductibles and out-of-pocket maximums. If you see a doctor regularly, it may cost less overall to purchase a Silver plan and take advantage of the lower out-of-pocket costs associated with each service. The cost of the most affordable Silver plan has increased from $317 in 2018 to $384 in 2021.
  • Gold plans give you a high level of coverage, and they have a monthly premium to match. If you have ongoing health needs, purchasing a Gold plan may reduce your overall costs because you’ll have a much lower deductible and lower copays for each office visit. The coinsurance requirement is also lower, so you’ll pay a lower percentage for hospital care than you would if you signed up for a Bronze or Silver plan. The average cost of the most affordable Gold plan has increased over the past four years, rising from $385 in 2018 to $431 in 2021.

What kind of low-income health insurance is available in Washington, D.C.?

As a resident of Washington, D.C., you have access to Medicaid coverage if you meet certain income and asset requirements. Even if your family doesn’t qualify for Medicaid, you may qualify for health coverage through the DC Healthcare Alliance or DC Healthy Families.

Medicaid in Washington, D.C.

DC Medicaid pays for health services incurred by low-income residents and residents who have qualifying disabilities. You may be eligible for DC Medicaid if you meet any of the following requirements:

  • You have low income or very low income
  • You’re at least 65 years old
  • You’re blind or have some type of disability
  • Someone in your household has a disability
  • You’re responsible for a child under the age of 19

The Medicaid income limit depends on your household size. If you’re single and live alone, the annual limit is $17,131. For a household size of eight, the limit increases to $59,398. If you have more than eight people in your household, you can determine the annual income limit by adding $6,038 for each additional person. A household of nine, for example, would have an annual income limit of $65,436.

To apply for Medicaid, visit the DC Health Link website. Click “Get Started” under “Individual & Family” and then click the “Apply for Medicaid” button on the next page.

DC Healthcare Alliance

DC Healthcare Alliance offers health coverage to Washington, D.C., residents who don’t qualify for Medicaid. You may qualify for this type of coverage if you meet the following requirements:

  • You live in Washington, D.C.
  • You’re at least 21 years old
  • You have countable assets of no more than $4,000 (or $6,000 if you’re married)
  • You don’t have any other health insurance coverage
  • Your annual household income doesn’t exceed 200% of the federal poverty level (FPL)

If you qualify for DC Healthcare Alliance coverage, you’ll be assigned to one of three managed care organizations: CareFirst Community Health Plan, MedStar Family Choice, or AmeriHealth Caritas. You can enroll in one of these plans by visiting the DC Healthy Families website.

DC Healthy Families

DC Healthy Families offers free health insurance to Washington, D.C., residents who meet the eligibility requirements. The program covers people in the following groups:

  • Adults between the ages of 21 and 64 who don’t have any dependent children
  • Pregnant women
  • Children under the age of 21
  • Parents or caretakers of children 18 and younger

The income limits depend on which category you’re in. For adults without dependent children, the threshold is no more than 210% of the FPL, with 5% of your income disregarded when determining your eligibility. Therefore, the monthly income limit ranges from $2,307.67 for a single person to $7,300.37 for a household of six.

Pregnant women qualify with incomes at or below 319% of the FPL, and parents and caretakers qualify with incomes at or below 216% of the FPL. Children under the age of 21 qualify if they live in households at 319% of the FPL if they’re age 18 or younger and 216% of the FPL if they’re 19 or 20 years old. For each type of coverage, 5% of your income is disregarded when determining if you qualify for coverage.

What are Washington, D.C.'s, Medicare options for seniors and people with disabilities?

Washington, D.C. has options for older adults and younger people with qualifying disabilities.

  • Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D.
  • Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision.

If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Are there short-term health insurance plan options in Washington, D.C.?

Under Washington, D.C., law, a short-term health insurance contract must expire within three months of its effective date. You can’t renew the plan or purchase another short-term plan from a different insurance company to get around the time limit. Short-term plans don’t have to follow Affordable Care Act (ACA) requirements, so they may not offer the same level of coverage as a traditional health insurance plan.

As of 2021, Washington, D.C., has no insurance companies offering short-term coverage, so although this type of coverage is permitted, you can’t currently buy it.

Washington, D.C. Insurance FAQs

Does Washington, D.C., require health insurance?

Yes. You must have health insurance, or you’ll pay a tax penalty when you file your return. The individual responsibility requirement went into effect in 2019.

Do I have to use the Health Insurance Marketplace in Washington, D.C.?

Washington, D.C., has its own health insurance exchange, so you don’t have to use the federal Health Insurance Marketplace to compare plans or enroll.

What types of alternative health insurance plans (like cost sharing plans) are available in Washington, D.C.?

You may be able to get coverage through a health care sharing ministry (HCSM), a group of people who share similar beliefs and make monthly contributions. It’s important to understand that HCSMs aren’t regulated like major medical plans. Therefore, they may not cover all of your expenses. Some HCSMs even refuse to pay expenses arising from behavior that doesn’t mesh with the group’s beliefs. For example, a faith-based HCSM may refuse to cover birth control.

Do I need health insurance if I have an HSA/FSA?

Yes. You can only save $2,750 to $7,200 per year in an FSA or HSA depending on which type of account you have and whether you have an individual account or family account. A single hospital stay could easily cost much more than that.

Do I need short-term disability coverage in Washington, D.C., if I have health insurance?

Short-term disability coverage isn’t required, but it’s good to have even if you already have health insurance. Your health insurance only pays your medical expenses, but short-term disability coverage covers lost wages in the event you can’t work due to an illness or injury. The payments can be used to pay rent, buy groceries, and cover other costs.

Do I need long-term disability coverage in Washington, D.C., if I have health insurance?

Long-term disability coverage is helpful for the same reason you should consider having short-term disability coverage. Health insurance only covers medical expenses, but long-term disability replaces your lost wages, giving you money to pay your mortgage and cover other household expenses while you’re out of work.

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Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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