D.C. Health Insurance

Overview

If you live in D.C. and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for D.C.

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 202-715-7576 or go to the DC Health Link website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on D.C.'s new insurance marketplace, called DC Health Link. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on D.C.'s new insurance marketplace, called DC Health Link. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the DC Health Link website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on DC Health Link will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The DC Health Link website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 202-715-7576 or go to the DC Health Link website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of D.C.. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

Premiums on DC Health Link

The average premium rates listed below are the lowest that might be charged to a 27-year-old. You can use the amounts listed to gauge the relative cost of each tier. Higher tiers tend to cost more, but offer better health coverage.  Premium rates will vary depending on your age, where you live and whether the plan covers multiple members of your family or just one person.

Platinum
Average Premium: $288 per month
Gold
Average Premium: $240 per month
Silver
Average Premium: $201 per month
Bronze
Average Premium: $160 per month

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in D.C.’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Private Health Insurers in D.C.

Do I Have To Buy Health Insurance?

You may have heard that everyone in D.C. must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

D.C.'s Official Marketplace

DC Health Link is D.C.’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on DC Health Link, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the DC Health Link website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on DC Health Link

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a DC Health Link plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a DC Health Link plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

The three insurers participating in D.C.’s health exchange offer thirty-four plans for individuals to choose from, according to The Washington Post.

Aetna. This for-profit company is one of the largest U.S. health insurers and has a network that includes more than 1 million health care professionals and over 5,300 hospitals nationwide. Aetna offers preferred provider organization (PPO) and health maintenance organization (HMO) plans on the D.C. exchange, according to DC Health Link. Exchange plans are available in Catastrophic through Gold tiers. 

CareFirst Blue Cross Blue Shield. This nonprofit is the largest health insurer in the mid-Atlantic with approximately 3.4 million members, according to the company. CareFirst also has the largest provider network in the mid-Atlantic, with over 80 percent of the region’s providers in one or more of its networks. CareFirst is an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. Along with its subsidiaries, CareFirst serves residents of D.C., Maryland and parts of northern Virginia. CareFirst of Maryland and Group Hospitalization and Medical Services are both subsidiaries of the company. CareFirst offers preferred provider organization (PPO), health maintenance organization (HMO) and Point of Service (PoS) plans on the D.C. exchange, according to DC Health Link. Exchange plans are available in all tiers. 

Kaiser Permanente. Established in 1945, Kaiser is one of the largest U.S. nonprofit health insurers with over 9 million members, according to The Los Angeles Times. Kaiser offers health maintenance organization (HMO) and Point of Service (PoS) plans on the D.C. exchange, according to DC Health Link. Exchange plans are available in all tiers.

Platinum

Kaiser | HMO
Premium $248

CareFirst | HMO
Premium $276

CareFirst | PPO
Premium $341

Gold

CareFirst | HMO
Premium $206

Kaiser | HMO
Premium $209

CareFirst | PPO
Premium $273

Aetna | PPO
Premium $273

Silver

CareFirst | HMO
Premium $177

Kaiser | HMO
Premium $181

CareFirst | PPO
Premium $219

Aetna | PPO
Premium $227

Bronze

CareFirst | HMO
Premium $124

Kaiser | HMO
Premium $151

CareFirst | PPO
Premium $172

Aetna | PPO
Premium $195

Need More Help?

If you need help choosing a health insurance plan or filling out your application, D.C. has trained nongovernment groups to guide you through the process. Sometimes called “Navigators,” these groups can answer technical questions on insurance, Medicaid, and tax credits (subsidies on monthly premiums) . Navigators also specialize in assisting non-English speaking populations. For more information, contact the DC Health Link call center at 855-532-5465. The center is open Monday through Saturday from 8:00 a.m. to 12:00 a.m.

The Office of Health Care Ombudsman and Bill of Rights exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 202-727-8000 or emailed at disbcomplaints@dc.gov. Residents can file an insurance complaint online.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01