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. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, DC Health Link’s enrollment window is open until the end of 2021.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households that qualify for them. Every household that pays more than 8.5 percent of its household income now qualifies for federal tax credits to help it afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
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?
- Open enrollment has been extended through the end of the year because of the coronavirus pandemic.
- If you enroll under the District’s special enrollment period (SEP), your health coverage can be applied retroactively to the beginning of the calendar month during which you enrolled.
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 email@example.com 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. – 6 p.m. If you’re hearing-impaired, dial 711 for assistance.
- In person: Due to the COVID-19 pandemic, DC Health Link has set up virtual enrollment via Zoom, called the One Touch Enrollment, in which certified assistors offer free one-on-one enrollment support. Schedule an appointment online. Language translators and legal counsel are also available.
You can also call customer service at 855-532-5465 and request over-the-phone help from a certified assistor free of charge. 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 and 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 new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
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.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. This subsidy is currently available. If you’ve already received unemployment benefits this year while enrolled in a marketplace plan, you’ll be able to claim the additional subsidies when you file your 2021 tax returns. This extra financial help will expire at the end of 2021.
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 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 and 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 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 will not qualify for tax credits if you opt out of your employer’s plan unless your premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage in order for you to qualify for lower premiums the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you should be receiving a temporary COBRA premium subsidy that covers 100 percent of your monthly premium cost. This premium assistance, made possible through the American Rescue Plan, runs through the end of September or the end of your last month of COBRA eligibility, whichever comes first.
If you’re on COBRA, you may want to sign up for a marketplace plan that starts as soon as your COBRA coverage ends. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker.
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.