Health insurance in District of Columbia
This page was created to help consumers understand health insurance and coverage options in the District of Columbia. It includes an overview of the health insurance marketplace (exchange) in DC — run by the District and called DC Health Link — and the enrollment opportunities for people and businesses that use the exchange. We’ve also explained how Medicaid and Medicaid expansion work in DC, the District’s rules for short-term health insurance, and District-specific Medicare rules and enrollment numbers.
District of Columbia’s health insurance marketplace
How hard is the District of Columbia fighting to preserve the Affordable Care Act’s provisions? Compare to other state efforts.
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 in the US 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.
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.
As of early 2020, there were 15,247 people with individual coverage through DC Health Link, plus 79,809 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.
For 2021 health coverage, DC insurance regulators approved an overall average rate increase of 0.2 percent for individual market plans, and an overall average rate decrease of 0.5 percent for small group plans. In both cases, the overall average approved rates are lower than insurers initially proposed.
Read our overview of the DC health insurance marketplace.
District of Columbia open enrollment period and dates
Open enrollment in DC for 2021 health insurance coverage in the individual/family market (ie, plans that people buy for themselves) is scheduled to run from November 1, 2020 to January 31, 2021. This is twice as long as the open enrollment period that applies in states that use HealthCare.gov, and it’s a permanent extension in DC.
But due to the COVID pandemic, DC Health Link has been letting uninsured people enroll outside of open enrollment in 2020, and that will continue through January 31, 2021 as well (or longer, if the public health emergency declaration in DC is extended past that point). 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.
Medicaid expansion in District of Columbia
The District of Columbia, along with 36 states, has expanded Medicaid coverage under the ACA. The state decided early on to participate in the Medicaid expansion ahead of schedule, beginning enrollment in 2011. Additionally, DC’s Medicaid eligibility guidelines are among the nation’s most generous, with Medicaid coverage for adults extending to at least 210 percent of the poverty level (versus 138 percent 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 DC.
Short-term health insurance in District of Columbia
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.
Read more about short-term health insurance in DC.
How has Obamacare helped District of Columbia
The District of Columbia’s uninsured rate stood at 6.7 percent in 2013, which was well below the national average. By 2018, the uninsured rate in DC had dropped to 3.2 percent; only Massachusetts had a lower uninsured rate. 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 6 percent of DC Health Link enrollees were receiving subsidies as of 2020, versus 86 percent of exchange enrollees nationwide). But this 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.
District of Columbia and the Affordable Care Act
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.
Medicare coverage and enrollment in District of Columbia
By mid-2020, there were 94,045 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 percent of Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability, while the other 83 percent 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 health insurance resources
Health reform legislation in the District of Columbia
Scroll to the bottom of this page for a summary of recent healthcare reform legislation in DC.
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.