Washington, DC Health Insurance Marketplace Guide

To be eligible to enroll in private individual/family health coverage through DC Health Link, you must:¹⁰

• Be lawfully present in the United States, and reside in Washington, DC
• Not be incarcerated
• Not be enrolled in Medicare¹¹

So most DC residents can enroll in a health plan through the exchange. But eligibility for financial assistance involves some additional parameters. To qualify for income-based federal Advance Premium Tax Credits (APTC) or cost-sharing reductions (CSR), you must:

• Not be eligible to enroll in an affordable plan offered by an employer. If you have access to an employer’s plan and are wondering whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via DC Health Link.
• Not be eligible for DC Medicaid.
• Not be eligible for premium-free Medicare Part A.¹²
• If married, file a joint tax return with your spouse.¹³ (with very limited exceptions)¹⁴
• Not be able to be claimed by someone else as a tax dependent.¹³
• Starting in 2027, the only non-U.S. citizens eligible for Marketplace subsidies are lawful permanent residents (LPR), Cuban-Haitian entrants (CHE), and COFA migrants. All other immigration statuses are no longer be eligible for subsidies as of 2027.¹⁵

In addition to those basic parameters, DC Health Link premium subsidy eligibility will depend on your household’s income.

Open enrollment for 2027 health coverage starts on November 1, 2026 in DC, and continues through January 31, 2027.³ To have your plan in place by January 1, 2027, you’ll need to complete your enrollment by December 15, 2026 (enrollments completed later in the open enrollment period will have an effective date in February or March).¹⁶

A federal rule that would have shortened the open enrollment window was blocked by a judge and did not take effect in the fall of 2026.¹⁷

After the open enrollment period ends, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage.

DC Health Link is one of several state-based exchanges where pregnancy is considered a qualifying life event, making it easier for someone who is pregnant to obtain health coverage.

American Indians and Alaska Natives can enroll in coverage through DC Health Link year-round.

Medicaid enrollment is also available year-round, as is enrollment in DC’s new Basic Health Program, Healthy DC Plan.¹⁸

To enroll in an ACA Marketplace/exchange plan in the District of Columbia, you can:

• Visit DC Health Link – the District’s exchange – to compare the health plans that are available in your area, determine whether you’re eligible for financial assistance, and enroll in coverage during open enrollment or during a special enrollment period.
• Enroll in a DC Health Link plan with the help of an insurance agent or broker, Navigator, or a certified enrollment assister.

When you enroll in coverage through DC Health Link, you may find that you’re eligible for subsidies that can cover some of your monthly premiums and possibly also reduce your out-of-pocket costs for medical care.

These subsidies are not as common in DC as they are in other states. There are three main reasons for this:

• Subsidy eligibility is based on income, and median household income in DC is significantly higher than the rest of the country.¹⁹
• There is no option to enroll outside the exchange in DC.²⁰ In other states, people who know they aren’t eligible for subsidies might enroll off-exchange, but that’s not an option in DC.
• DC’s Basic Health Program (Healthy DC Plan) covers DC residents with household income up to 200% of the federal poverty level, whereas they would be eligible for Marketplace subsidies instead in most other states.¹⁸

As a result of the points detailed above, only 18% of DC Health Link enrollees were receiving federal premium subsidies as of 2026, versus 87% of Marketplace enrollees nationwide.²¹

Source: CMS.gov²¹

Premium subsidy eligibility depends on how your household income compares with the cost of the second-lowest-cost Silver plan in your area, which will depend on your age. (In most states, it also depends on your location, but DC is one rating area so there are no location-specific rate differences within the District.²²)

Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which will reduce the deductible and other out-of-pocket expenses for Silver-level plans. But only 3% of DC Health Link enrollees were receiving these subsidies as of 2026, versus 37% of Marketplace enrollees nationwide.²¹ Again, this is due in large part to the fact that people with income between 139% and 200% of the poverty level were eligible for DC’s Basic Health Program, whereas they were eligible for premium subsidies and CSR in other states.

The plans available through DC Health Link include both standardized and non-standardized plans. All of the plans comply with the ACA, but standardized plans also conform to additional District-specific rules that include pre-deductible coverage for various services.²³ Since 2024, outpatient mental health visits for children with standardized DC Health Link plans have only a $5 copay, with no deductible.²⁴

And starting with the 2026 plan year, standardized plans do not have cost-sharing for HIV treatment.²⁵

Learn more about whether you might be eligible for Medicaid in Washington DC.

DC Health Link offers individual/family health insurance from two insurers:

• CareFirst
• Kaiser of the Mid-Atlantic States

CareFirst has both HMO and PPO entities offering plans (the PPO entity is called Group Hospitalization and Medical Services), while Kaiser only offers HMO plans.²⁶

DC’s individual market insurers are implementing the following average rate changes for 2027 individual/family coverage, amounting to a weighted average rate increase of 9.9%, before any subsidies are applied:³

Source: DC Department of Insurance, Securities, and Banking, and DC SERFF²⁷

Average rate changes apply to full-price premiums, and most DC Health Link enrollees — more than 80% — do pay full price (as opposed to most other states, where the large majority of Marketplace enrollees receive subsidies and thus do not pay full price).²⁸

But for those who qualify for premium subsidies, the net rate change from one year to the next will depend on how much the subsidy amount changes, as well as how much their own plan’s rate changes.

And for 2026 and future years, subsidy amounts do not cover as much of the premium as they did in 2025 — and are available to fewer people — because Congress failed to extend the subsidy enhancements that had been in place since 2021.

For perspective, here’s a summary of how average full-price premiums have changed in DC’s individual/family health insurance market over the years:

• 2015: Average increase of 11%.²⁹
• 2016: Average increase of 4.3%.³⁰
• 2017: Average increase of 7.3%.³¹
• 2018: Average increase of 15.6%.³² (negligible CSR cost; not added to rates)
• 2019: Average increase of 13%.³³
• 2020: Average increase of 7.6%.³⁴
• 2021: Average increase of 0.2%.³⁵
• 2022: Average increase of 5%.³⁶
• 2023: Average increase of 13.6%.³⁷
• 2024: Average increase of 7.8%.³⁸
• 2025: Average increase of 4.7%.³⁹
• 2026: Average increase of 8.7%⁴⁰

For 2026 coverage, 16,053 people enrolled in individual/family health plans through DC Health Link during the open enrollment period.²¹

In most states, Marketplace enrollment has trended upward significantly in the last few years, but that has not been the case in the District of Columbia. But most states also saw a decline in Marketplace enrollment from 2025 to 2026, and that also was not the case in DC.

Source: 2014,⁴¹ 2015,⁴² 2016,⁴³ 2017,⁴⁴ 2018,⁴⁵ 2019,⁴⁶ 2020,⁴⁷ 2021,⁴⁸ 2022,⁴⁹ 2023,⁵⁰ 2024,⁵¹ 2025⁵² 2026²¹

In contrast to the rest of the U.S., the majority of DC Health Link’s enrollees have small group coverage. As of early 2026, DC Health Link’s enrollment included just over 16,000 people with individual/family coverage, and nearly 82,000 people with small-group coverage.⁷

DC Health Link
The District’s health insurance exchange (Marketplace) for small businesses, individuals, and families.

DC Department of Health Care Finance
Administers DC’s Medicaid program and various other social services programs in the state.

District of Columbia Department of Insurance, Securities & Banking
Licenses and regulates health insurance companies, brokers, and agents in the District. Provides assistance and information to consumers who have questions or complaints about regulated entities.

DC Department of Aging and Community Living
A resource for DC Medicare beneficiaries and their caregivers.