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Washington, DC Health Insurance Consumer Guide
This guide to health insurance in Washington, DC will help you understand the coverage options available to you and your family, and whether you might be eligible for financial assistance with your health coverage.
The District of Columbia runs its own health insurance exchange – DC Health Link. DC residents and business owners can use DC Health Link to shop for individual/family and small-group health plans offered by various private health insurance carriers.
DC Health Link’s individual and family plans are used by people who aren’t eligible for Medicare, Medicaid, or an affordable employer-sponsored health plan. The small-group health plans are used by businesses with up to 50 employees, as well as by members of Congress and their staff.1
Individual/family and small-group health insurance can only be obtained via the exchange (DC Health Link) in Washington, DC.2 In the rest of the country, off-exchange policies are available – albeit without any subsidies. But that’s not the case in DC.
And Washington, DC’s exchange is unique in terms of having more small-group enrollees than individual enrollees. In the rest of the country, small-group plans are either not available through the exchange, or account for a minority of total exchange enrollment.
Explore our other comprehensive guides to coverage in Washington, DC
Dental coverage in Washington, DC
Want to improve your smile and save money when you visit the dentist? Dental insurance might be a good addition to your medical coverage. Our guide will help you understand your dental coverage options in the District of Columbia.
DC’s Medicaid program
DC Medicaid is the District’s Medicaid program, which provides health coverage for low-income residents. Compared with the rest of the country, DC Medicaid has more generous eligibility rules for Medicaid expansion, allowing adults under 65 to enroll in Medicaid with income up to 215% of the poverty level, as opposed to 138% in other states.3 This results in fewer people being enrolled in individual market plans through DC Health Link, as they’re eligible for Medicaid instead.
Medicare enrollment in Washington, DC
Nearly 95,000 DC residents had Medicare coverage as of 2023.4 Our Washington, DC Medicare guide explains the various parts of Medicare, coverage options for Medicare Advantage and Part D, and the District’s rules regarding Medigap (Medicare Supplement) availability.
Short-term health insurance coverage in Washington, DC
There are no insurers that offer short-term health insurance in Washington, DC. The District enacted legislation that limits short-term plans to three months, prohibits renewals, and prevents short-term health insurance from excluding pre-existing conditions or basing eligibility on medical history. This essentially made short-term health insurance a non-starter in DC, and the plans are no longer available for purchase.
Frequently asked questions about health insurance in Washington, DC
Who can buy Marketplace health insurance in Washington, DC?
To be eligible to enroll in private individual/family health coverage through DC Health Link, you must:5
- Be lawfully present in the United States, and reside in Washington, DC
- Not be incarcerated
- Not be enrolled in Medicare
So most DC residents are able to 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.
In addition to those basic parameters, DC Health Link premium subsidy eligibility will depend on your household’s income and how that compares with the cost of the second-lowest-cost Silver plan in your area, which will depends on your age. (In most states, it also depends on your location, but DC is one rating area so there are not location-specific rate differences within the District.6)
When can I enroll in an ACA-compliant plan in Washington, DC?
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 just six state-run exchanges where pregnancy is considered a qualifying life event, making it easier for someone who is pregnant to obtain health coverage.
Some people can enroll year-round even without a specific qualifying life event. And enrollment in DC Medicaid is available year-round. (You can enroll at districtdirect.dc.gov.)
How do I enroll in a Marketplace plan in Washington, DC?
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.
How can I find affordable health insurance in Washington, DC?
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, simply because Medicaid eligibility extends to higher income levels in DC, meaning that many people qualify for Medicaid instead of premium subsidies for private plans. (For adults under age 65, the eligibility limit for Medicaid in DC is 215% of the poverty level, as opposed to 138% in most states.8)
In addition, the fact that there is no “off-exchange” enrollment option in DC also helps to reduce the percentage of exchange enrollees who are subsidy-eligible. (In other states, people who know they aren’t eligible for subsidies might opt for off-exchange coverage, whereas that’s not possible in DC.)
So only 19% of DC Health Link enrollees were receiving federal premium subsidies as of 2023, versus 91% of Marketplace enrollees nationwide.9
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 2023, versus 48% of Marketplace enrollees nationwide.9 Again, this is due in large part to the fact that people with income between 139% and 215% of the poverty level are eligible for Medicaid in DC, whereas they’re eligible for premium subsidies and CSR in other states.
Learn more about whether you might be eligible for Medicaid in Washington DC.
How many insurers offer Marketplace coverage in Washington, DC?
The following insurers offer 2023 individual/family plans via DC Health Link:10
- Group Hospitalization and Medical Services (CareFirst PPO)
- CareFirst Blue Choice (CareFirst HMO)
- Kaiser of the Mid-Atlantic States
Are Marketplace health insurance premiums increasing in Washington, DC?
The following average rate changes have been proposed by DC’s individual market insurers for 2024:11
Washington, DC’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company
|Group Hospitalization and Medical Services (CareFirst PPO)||9.9%|
|CareFirst Blue Choice (CareFirst HMO)||18.5%|
|Kaiser of the Mid-Atlantic States||12%|
Source: DC Department of Insurance, Securities, and Banking11
Average rate changes apply to full-price premiums, and most DC Health Link enrollees 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).12
How many people are insured through DC’s Marketplace?
What health insurance resources are available to DC residents?
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.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Footnotes
- “What are SHOP and DC Health Link?” Health Questions and Answers, U.S. Office of Personnel Management
- “Frequently Asked Questions” DC Health Benefit Exchange Authority
- “Medicaid, Children's Health Insurance Program, & Basic Health Program Eligibility Levels” Medicaid.gov, 2022
- "Medicare Monthly Enrollment" CMS.gov, April 2023
- ”A quick guide to the Health Insurance Marketplace” HealthCare.gov
- “Market Rating Reforms State Specific Geographic Rating Areas” CMS.gov, Accessed September 2023
- “Health Benefit Exchange Authority Executive Board Meeting Minutes” DC Health Benefit Exchange Authority, May 2019
- “Uninsured DC Residents Can Apply for Free Health Insurance” DC.gov, Accessed September 2023
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2023
- “Proposed 2023 Health Insurance Rate Filings” DC.gov, Accessed September 2023
- “Proposed 2024 Health Insurance Rate Filings” DC Department of Insurance, Securities, and Banking, Accessed September 2023
- “Effectuated enrollment: Early 2023 snapshot and full-year 2022 average.” CMS.gov, March 31, 2023
- “DC Health Benefit Exchange Authority Enrollment Summary” DC.gov, July 8, 2023
- “ASPE Issue Brief (2014)” ASPE, 2015
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022