Washington, DC Health Insurance Consumer Guide

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)

In Washington, DC, the open enrollment period begins November 1 and continues through January 31,⁷ which is a couple weeks longer than the enrollment window in most states.

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.)

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.

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.

Source: CMS.gov¹⁰

Learn more about whether you might be eligible for Medicaid in Washington DC.

The following insurers offer 2023 individual/family plans via DC Health Link:¹¹

• Group Hospitalization and Medical Services (CareFirst PPO)
• CareFirst Blue Choice (CareFirst HMO)
• Kaiser of the Mid-Atlantic States

The following average rate changes have been proposed by DC’s individual market insurers for 2024:¹²

Source: DC Department of Insurance, Securities, and Banking¹²

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).¹³

As of 2023, DC Health Link’s enrollment included nearly 14,000 people with individual/family coverage, and more than 87,000 people with small-group coverage.¹⁴ 

Source: 2014,¹⁵ 2015,¹⁶ 2016,¹⁷ 2017,¹⁸ 2018,¹⁹ 2019,²⁰ 2020,²¹ 2021,²² 2022,²³ 2023,⁹ 2024²⁴

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.