Frequently asked questions about health insurance coverage options in the District of Columbia
In Washington, DC, coverage in the individual/family 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.
Each year, DC Health Link’s open enrollment period runs from November 1 through January 31, which gives DC residents more time to enroll than people in most states have (open enrollment ends in most states on January 15). DC residents can enroll in coverage outside of open enrollment if they have a qualifying life event.
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. (The federal public health emergency ends May 11, 2023.)
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.
In DC, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (DC Health Link).
Nationwide, most exchange enrollees receive premium subsidies, but that’s not the case in DC: Less than 20% of the people who enrolled in private plans through DC Health Link qualified for subsidies in 2023. But that’s because DC has no off-exchange alternative (meaning that even people with incomes too high for subsidies can only enroll through the exchange), and because Medicaid eligibility for adults extends to much higher income levels in DC than it does in the rest of the country. The short story is that there is significant financial assistance available to obtain health insurance in DC if your income is in the low to mid-range.
Washington, DC’s marketplace insurers offering individual/family plans for 2023 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 2023, the weighted average rate change for DC health plans amounted to 13.6% for individual market plans, and 13.3% for small group plans.
The year before, for 2022 coverage, the overall average rate increase was about 5% for the individual market, and 3.5% for the small group market.
And 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.
14,768 people enrolled in individual market plans through DC Health Link during the open enrollment period for 2023 coverage.
Enrollment in DC’s marketplace decreased in 2022 and again in 2023, which was in contrast to nationwide record high enrollments in both years. But while enrollment grew sharply in states that use HealthCare.gov and especially in states that haven’t expanded Medicaid, it was not unusual to see decreases or flat enrollment in states that run their own exchanges and have expanded Medicaid.
Medicaid expansion is especially important in DC, because it extends to income levels up to 215% of the poverty level (for adults under age 65), as opposed to 138% in the rest of the country. So DC’s private plan enrollment decline has to be considered in conjunction with the fact that DC’s Medicaid eligibility limit is much higher than the rest of the country. And under the Families First Coronavirus Response Act, people with Medicaid could not be disenrolled from Medicaid between March 2020 and March 2023 (states received additional federal funding in trade for this).
As of January 2022, there were 83,935 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 in other areas. Less than 20% of DC Health Link enrollees were receiving subsidies as of early 2023, versus about 90% nationwide. But that was up from only 7% of DC Health Link enrollees who were receiving subsidies as of early 2021. The increase was due to the American Rescue Plan’s expansion of premium subsidies (this has been extended through 2025 by the Inflation Reduction Act).
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 — even with the temporary elimination of the “subsidy cliff.”
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 (but it can happen).
The District of Columbia, along with 40 states, has expanded Medicaid coverage under the ACA.
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 215% of the poverty level (versus 138% in most states).
So people who are covered by Medicaid in DC might find 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 on 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 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 were no insurers offering short-term health plans in DC, and that continues to be the case in 2023.
Read more about short-term health insurance in Washington, DC.
By late 2022, Medicare enrollment in DC stood at 94,739 residents. Only about 15% of DC’s population is enrolled in Medicare, versus about 19% nationwide.
In DC, 13% of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability, while the other 87% 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.
Learn more about Medicare coverage in the District of Columbia, including details about Medicare Advantage plans, Medicare Part D prescription drug plans, and Medigap plans.
- 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
Yes. The City Council in the District of Columbia approved an individual mandate, with a penalty modeled on the ACA’s penalty.
The penalty for not having coverage in 2023 is at least $700 for each adult and $350 for each child, up to $2,100 per family or 2.5% of family income that is over the federal tax filing threshold, whichever is greater *