En español | Most Washington, D.C. residents are eligible to buy health insurance through DC Health Link, the District of Columbia’s Affordable Care Act (ACA) marketplace, during open enrollment starting in the fall.
However, if you or someone in your household needs coverage due to the COVID-19 pandemic, a special enrollment period continues through the end of the pandemic.
Residents who experience a qualifying life event, such as a marriage, divorce, the birth of a child, a move or lost health insurance, may be eligible to buy or change coverage outside the open enrollment period.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its income qualifies for federal tax credits to help afford health insurance. These enhanced subsidies are available through 2025.
Before the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
Who is eligible?
- Most District of Columbia residents, including non-U.S. citizens with work or student visas, are eligible to buy health insurance through DC Health Link, regardless of whether they are currently insured.
- You may also qualify for Medicaid, which offers free or low-cost coverage to low-income people and families and to those who live in skilled nursing facilities or have certain disabilities. Pregnant women and children under age 21 are also eligible for Medicaid coverage. Emergency Medicaid is available for low-income individuals who are ineligible for standard Medicaid due to citizenship and/or immigration status. This program covers health care costs for those who’ve experienced a medical emergency as determined by a doctor.
- You may also be eligible for other subsidized plans via the DC Healthcare Alliance, a program designed for low-income District residents and immigrants who have no other health insurance and are ineligible for either Medicaid or Medicare. Cover All DC offers plans to people whose income makes them ineligible for coverage under the DC Healthcare Alliance (for example, your income may be too high), DC Health Link plans and Medicaid or Medicare.
When can I enroll?
- DC Health Link's annual open enrollment period for 2023 health insurance coverage ended on Jan. 31, 2023. It reopens in the fall for 2024 health insurance coverage.
- But if you or a member of your household needs coverage due to the COVID-19 pandemic, you can enroll via the District's special enrollment period.
- You can enroll outside of the open enrollment period if you experience a qualifying life event, but you have only 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
How do I sign up?
You apply for coverage and choose your plan at the same time. You must make your premium payment by the due date indicated on the invoice provided by your insurance company. To apply and enroll:
- Online: Go to the DC Health Link website and click on the plan category that applies to you (Individual and Family, Small Business or Employee). You will have to create an account to begin the enrollment process. You can email firstname.lastname@example.org if you have questions about getting started.
- By phone: Call the DC Health Link customer service center at 855-532-5465, Monday through Friday, 8 a.m. to 6 p.m. If you are hard of hearing, dial 711 for assistance.
- In person: A list of city enrollment centers is posted on the DC Health Link website. Call ahead to confirm operating hours, get directions and find out whether language translators and legal services are available.
You can also call customer service at 855-532-5465 and request over-the-phone help from a certified assistor for free. These impartial experts can help you and your family understand your options, walk you through the enrollment process and determine your eligibility for financial assistance.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your household income and the age and disability status of you and your family. If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income. All DC Health Link plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management
- Pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family. All DC Health Link plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have seen average annual savings of more than $950.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
DC Health Link plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and they cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of care costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and they cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
- Catastrophic plans, designed to cover excessive bills due to a medical emergency, are available for applicants up to age 29. Those older than 30 may be eligible for this kind of plan under the District’s hardship or affordability exemption. Applications are available online.
DC Health Link’s comparison tool allows you to estimate costs and benefits of various plans and check whether you might qualify for financial assistance.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to DC Health Link. But you may need to wait until open enrollment, and you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage.
If you lose your COBRA coverage, you may be able to sign up for a DC Health Link plan during a 60-day special enrollment window. Try to apply and select your plan through DC Health Link before your COBRA coverage ends to make sure there's no gap in coverage.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the next open enrollment period, unless you experience a qualifying life event.
Will I need to get a new doctor?
That depends. Major insurance providers, including CareFirst BlueCross BlueShield and Kaiser Permanente, offer DC Health Link plans, but not all doctors accept them. You can talk to your primary care physician or use the District’s online doctor directory to see whether a certain doctor or practice will accept a particular marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status.
This guide was updated on Feb. 3, 2023, with new information about open enrollment.