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.
Each year, DC Health Link’s open enrollment period continues through January 31. So the open enrollment period for 2023 coverage runs from November 1, 2022 through January 31, 2023 in DC.
The federal government reduced the duration of the individual market open enrollment to just over six weeks, starting in 2017 (although that has subsequently been extended by an additional month). But DC was one of three exchanges that opted to permanently extend open enrollment.
And 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.
Washington, DC’s marketplace insurers offering individual/family plans for 2022 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 2022 coverage, the approved rate increases were mostly lower than insurers had proposed (as is typically the case in DC). The overall average rate increase was about 5% for the individual market, and 3.5% for the small group market.
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.
15,989 people enrolled in individual market plans through DC Health Link during the open enrollment period for 2022 coverage. That was down about 6% from 2021, which was unusual for 2022; overall marketplace enrollment hit a record high nationwide in 2022, and DC was one of only a handful of areas with declining enrollment.
But the 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 (215% of the poverty level for adults under 65, as opposed to 138% in other states that have expanded Medicaid under the ACA). And under the Families First Coronavirus Response Act, people with Medicaid cannot be disenrolled during the COVID public health emergency period (states are also getting 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 15% of DC Health Link enrollees were receiving subsidies as of early 2022, versus about 89% 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 took effect mid-year in 2021, so the open enrollment period for 2022 coverage was the first time the enhanced subsidies were available during an open enrollment window).
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).
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, along with 38 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 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 were no insurers offering short-term health plans in DC, and that continues to be the case in 2022
Read more about short-term health insurance in Washington, DC.
By late 2021, there were 94,157 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 declined somewhat in 2020 in DC, and was almost unchanged from that level by the end of 2021. And only about 13% of DC’s population is enrolled in Medicare, versus about 19% nationwide.
In DC, 14% of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability, while the other 86% 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