Frequently asked questions about health insurance
coverage options in the District of Columbia
In Washington, DC, coverage in the individual and small-group health insurance markets is available only through the DC-run health insurance marketplace: DC Health Link.
There is not an off-exchange option in DC. So you cannot buy a health plan outside of the exchange, directly from a health insurance company. None of the other states require all individual and/or small-group medical plans to be purchased on-exchange, but nationwide, financial assistance with premiums and cost-sharing is only available on-exchange.
Read about the history of DC’s health insurance marketplace.
The federal government reduced the duration of the individual market open enrollment to just over six weeks, starting in 2017. But DC was one of three exchanges that opted to permanently extend open enrollment. Each year, DC Health Link’s open enrollment period continues through January 31, instead of ending in mid-December the way it does in states that use HealthCare.gov. So the enrollment window in DC is twice as long as the open enrollment period that applies in states that use HealthCare.gov.
But due to the COVID pandemic, DC Health Link has been allowing uninsured residents to enroll outside of open enrollment, and that will continue through the end of the public health emergency period in the District.
Uninsured DC residents can enroll in medical coverage through DC Health Link using this special enrollment period, and it also applies to uninsured residents who are employed by businesses that use the DC Health Link small business exchange. As long as the employee is eligible for coverage, they can enroll anytime during the COVID-related special enrollment period, even if it’s not during their employer’s normal annual enrollment period.
For enrollments completed during the COVID-related enrollment period in DC, residents can select an effective date of the first of the month they enroll (ie, a retroactive effective date) or the first of the following month. Maryland also allows for retroactive effective dates during the COVID-related enrollment window (depending on the enrollment date) but this is a fairly unusual provision; most states are simply offering effective dates of the first of the month following enrollment.
Washington, DC’s marketplace insurers offering individual/family plans include:
- Group Hospitalization and Medical Services (CareFirst PPO)
- CareFirst Blue Choice (CareFirst HMO)
- Kaiser of the Mid-Atlantic States.
The District of Columbia’s small-group insurers include:
- CareFirst HMO
- GHMSI/CareFirst PPO
- Aetna HMO
- Aetna PPO
- Optimum Choice (a UnitedHealthcare HMO)
- UnitedHealthcare of the Mid-Atlantic (HMO)
- UnitedHealthcare Insurance Company (PPO)
For 2021 health coverage, DC insurance regulators approved an overall average rate increase of 0.2% for individual market plans, and an overall average rate decrease of 0.5% for small-group plans. In both cases, the overall average approved rates were lower than insurers initially proposed.
16,947 people enrolled in individual market plans through DC Health Link during the open enrollment period for 2021 coverage (that’s from the official CMS report; DC Health Link reported a higher number of enrollments).
As of August 2020, there were 80,471 people with employer-sponsored plans through DC Health Link’s small business (SHOP) exchange. Members of Congress and their staffers have coverage through DC Health Link’s SHOP exchange, as do all small businesses with group health coverage in the District, as there are no off-exchange options available.
The District of Columbia’s uninsured rate stood at 6.7% in 2013, which was well below the national average. By 2018, the uninsured rate in DC had dropped to 3.2%; only Massachusetts had a lower uninsured rate (DC’s uninsured rate climbed a little in 2019, to 3.5%, but it was still second only to Massachusetts). The ACA has been instrumental in the reduction of the uninsured rate, along with various reforms that the District has made.
All of the people who are enrolled in individual/family and small group health plans in DC have coverage for the ACA’s essential health benefits without annual or lifetime caps on the benefits.
Premium subsidies are much less common in DC than other areas (only 7% of DC Health Link enrollees were receiving subsidies as of early 2021, versus 85% of exchange enrollees nationwide; this has undoubtedly increased in 2021 due to the American Rescue Plan’s expansion of premium subsidies).
The District’s low number of enrollees receiving premium subsidies is due in large part to the District’s generous Medicaid eligibility, which extends coverage well above the levels used in most other states, along with the District’s relative affluence and the fact that everyone who buys individual/family coverage does so through the exchange (in other states, people who don’t qualify for premium subsidies might simply shop outside the exchange, but residents from DC’s most affluent communities shop in the exchange, just like anyone else in the District).
So in DC, many of the people who would get premium subsidies elsewhere are instead eligible for free Medicaid. And for those above the Medicaid eligibility levels, premium subsidies are available just as they would be in other states, but most people enrolling in private plans through the exchange in DC earn too much money to qualify for subsidies (note that many of them may now qualify for subsidies since the “subsidy cliff” has been eliminated for 2021 and 2022).
The District of Columbia, along with 36 states, has expanded Medicaid coverage under the ACA (Oklahoma will expand Medicaid as of July 2021; Missouri plans to do so as well, although funding is still uncertain).
DC decided early on to participate in the Medicaid expansion ahead of schedule, beginning enrollment in 2011 (in most other early-adopter states, it began in 2014). Additionally, DC’s Medicaid eligibility guidelines are among the nation’s most generous, with Medicaid coverage for adults extending to at least 210% of the poverty level (versus 138% in most states).
So people who are covered by Medicaid in DC might find that that they have to transition to a private plan in the exchange if they move to another state. They would qualify for premium subsidies, but the amount they spend in out-of-pocket costs and premiums would be higher in another state.
Read more about Medicaid coverage expansion in Washington, DC.
The District of Columbia has enacted legislation that limits the duration of short-term health insurance plans to three months and prohibits renewals. In addition, DC law prevents short-term health insurance coverage from excluding pre-existing conditions or basing eligibility on medical history. As of 2021, there are no insurers offering short-term health plans in DC.
Read more about short-term health insurance in Washington, DC.
By December 2020, there were 93,975 DC residents with Medicare enrollment. Although nationwide Medicare enrollment has been steadily climbing (up by almost a million people from August 2019 to July 2020), it has been declining in recent months in DC. And only about 13 percent of DC’s population is enrolled in Medicare, versus about 19 percent nationwide.
In DC, 17% of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability, while the other 83% are eligible due to age (ie, being at least 65 years old).
There are no longer any Medicare Cost plans available in DC, although these plans were available prior to 2019.
- District of Columbia Department of Health
- DC Health Link (individual and small business health insurance exchange)
- Department of Health Care Finance – DC Community Resources (a wide range of resources and guidance related to healthcare, family/women/children’s resources, etc.)
- DC Department of Insurance, Securities, and Banking (health insurance rate review, regulation of health plans, and broker/agent licensing and oversight)
- Washington DC Medicaid (health benefits for individuals and families in DC with modest incomes)
- Medicare Rights Center (a nationwide service, including a website and call center, that can provide information and assistance regarding all aspects of Medicare coverage and programs).
- DC Department of Aging and Community Living