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District of Columbia health insurance

Three carriers are offering 2019 individual coverage through DC marketplace. Open enrollment continues through January 31, 2019.

Health insurance in Washington, DC

DC’s health insurance marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

How hard is the District of Columbia fighting to preserve the Affordable Care Act’s provisions? Compare to other state efforts.

In Washington, DC, coverage in the individual and small-group health insurance markets is available only through the state-run exchange: DC Health Link. There is not an off-exchange option.

The federal government reduced the duration of individual market open enrollment to just over six weeks, starting in 2017.  But DC was one of three exchanges  that opted to keep the duration of open enrollment at three months. Open enrollment in DC began November 1 and will continue until January 31, 2019.

  • Enrollments through Dec. 15 will have a Jan. 1 effective date.
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.
  • Enrollments between Jan. 16 and Jan. 31 will have a March 1 effective date.

Three insurers are offering individual-market plans in DC for 2019: Group Hospitalization and Medical Services, CareFirst Blue Choice, and Kaiser of the Mid-Atlantic States. The average rate increase proposed by the three for 2019 was 15.5 percent, but the final approved rate hike on average was 13 percent instead.

SHOP enrollment in DC

As of December 5, 2017, enrollment in small-business plans through DC’s exchange stood at 75,633, by far the highest SHOP enrollment in the country. (DC doesn’t have an off-exchange option, so small businesses that want coverage must enroll through DC Health Link. In addition, members of Congress and their staffers must enroll through DC Health Link’s SHOP exchange in order to get their employer contribution to their health insurance premiums).

DC enrollment in qualified health plans

Approximately 10,700 individuals selected a qualified health plan through DC Health Link during the first Obamacare open enrollment period. Forty-five percent of the people who signed up for private health plans through the District’s exchange that year were ages 18 to 34 – the highest percentage in the U.S. Nationwide, 28 percent of enrollees belonged to this age group.

In the District of Columbia, there is no off-exchange enrollment for individuals or small businesses. In September 2015, a new Plan Match tool was launched to help DC consumers compare plans and select 2016 coverage.

DC Health Link’s 2016 open enrollment period saw 22,912 individuals select private qualified health plans through the exchange. During the 2017 open enrollment period,23,779 people enrolled in individual market plans through the exchange.

During the open enrollment period for 2018 coverage , 22,717 people in DC enrolled in individual market coverage through DC Health Link. Fifty-five percent of all enrollees for 2018 were 34 or younger, which is a demographic that helps to stabilize the risk pools.

Enrollment in small-group plans through DC Health Link reached 76,574 – dramatically higher than small-business exchange enrollment in other states.

Read more about DC’s marketplace.

Medicaid in Washington, DC

The District of Columbia is one of 32 states that expanded Medicaid coverage under the ACA. The state decided early on to participate in the expansion ahead of schedule, beginning enrollment in 2011.

Between fall 2013 (before the ACA expansion) and July 2018, enrollment in Medicaid/CHIP in DC increased by 23,053 people, a 9.8 percent increase.

Read more about Medicaid expansion in DC.

Short-term health insurance in DC

The District of Columbia has enacted enacted emergency legislation that limits the duration of short-term health plans to three months and prohibits renewals.

In addition, legislation signed into law on December 10 also prevents short-term plans from excluding pre-existing conditions or basing eligibility on medical history. Permanent legislation to limit short-term plans is under consideration; would take effect after the emergency legislation expires in March.

Read more about short-term health insurance in DC.

How has Obamacare helped DC?

According to the Kaiser Family Foundation, about 50,000 District of Columbia nonelderly residents were uninsured in January 2014. About 27,500 of these residents were estimated to qualify for Medicaid or the Children’s Health Insurance Program, with many of them newly qualified under the ACA’s more generous eligibility criteria.

An additional 5,000 of uninsured, nonelderly residents qualified for the ACA’s premium tax subsidies to help them purchase medical insurance through the marketplace.

At 3.7 percent, the District of Columbia’s uninsured rate was tied with Wisconsin for the third lowest in the nation, according to the National Center for Health Statistics’ National Health Interview Survey 2015, which was released in May 2016.

District of Columbia and the Affordable Care Act

While a delegate represents the District of Columbia in the U.S. House of Representative, that delegate does not vote on proposed bills. The District of Columbia is not represented in the U.S. Senate. Accordingly, the District of Columbia is not “on record” for the 2010 House and Senate votes establishing the Affordable Care Act.

The District of Columbia City Council established a state-run health insurance marketplace under the ACA. The legislation establishing the District of Columbia Health Benefit Exchange Authority was signed into law by Mayor Vincent Gray (D) in January 2012. The bill was also subject to review by the U.S. Congress. This is the typical process for legislation in the District of Columbia, and Congress rarely rejects laws passed by the District of Columbia.

The District of Columbia’s marketplace is named DC Health Link, and it is the only place that individual and small group markets can purchase major medical health insurance plans in DC. The District also accepted Medicaid expansion, and total enrollment in DC’s Medicaid program grew by more than 50,000 people from late 2013 through May 2017.

Medicare enrollment in DC

In 2015, there were 88,421 DC residents enrolled in Medicare in the District of Columbia, about 13 percent of the District’s total population. Nationally, about 17 percent of the total population is enrolled in Medicare. The District spent about $9,490 per enrollee in 2014, about 6 percent more than the national average.

In the District of Columbia, Medicare enrollees can select a Medicare Advantage plan instead of Original Medicare as a way to receive additional benefits. Of District Medicare enrollees, 13 percent select Medicare Advantage, a number much smaller than the 31 percent who do so nationwide. Medicare Part D provides 45 percent of District Medicare enrollees with stand-alone Rx benefits.

Washington DC health insurance resources

Healthcare legislation in DC