Washington, D.C.  Health Insurance Marketplace

Category: State Guides Originally Posted: December 11, 2014 by HealthCare.com Staff Last modified: July 24, 2015

With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.

The following guide offers a glimpse at the various types of ACA-compliant health insurance in the District of Columbia, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.

Health and healthcare in Washington, D.C.

The District of Columbia did not receive an overall rank in United Health Foundation’s 2014 America’s Health Rankings.1 However, its strengths were noted as a low prevalence of obesity, a low percentage of uninsured population, and high immunization coverage among children and adolescents. Challenges listed included a low high school graduation rate, a high percentage of children in poverty, and a low prevalence of low birthweight.

Washington, D.C. individual and family health insurance

The District of Columbia operates its own Obamacare health insurance exchange. DC Health Link offers health insurance plans for individuals and families, as well as small business employers and employees.

Those who buy health insurance through DC Health Link may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.

District of Columbia residents may also buy health insurance in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit the Washington, D.C.’s Health Insurance Marketplace to apply for health insurance coverage.

The U.S. Department of Health and Human Services reported that 10,714 individuals in Washington D.C. selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Washington, D.C. enrolled in a marketplace plan was 18,465 during the open enrollment period.3

The District of Columbia’s health insurance exchange: dchealthlink.com
The District of Columbia department of insurance: disb.dc.gov

Washington, D.C. small group health insurance plans

In the District of Columbia, small businesses with 50 or fewer employees may purchase small group health insurance plans through DC Health Link and in the private marketplace on websites as such as HealthCare.com. Small businesses that use DC Health Link and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.

Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the District of Columbia’s exchange.

Washington, D.C. state COBRA variations for small groups

The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.

In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.

Basic details for District of Columbia’s small group COBRA continuation, which is known as the D.C. mini-COBRA law, are as follows4:

Mini-COBRA option Yes
Eligible group sizes All sizes unless eligible for COBRA continuation coverage
Maximum continuation period – standard 3 months
Maximum premium Increase 102 percent
State legislation reference D.C. Code § 32-732

Washington, D.C. high-risk pools

It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5

The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.

Washington, D.C. Medicaid

Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6

Effective Jan. 1, 2014, the District of Columbia expanded its Medicaid program to low-income adults.7 Medicaid/CHIP open enrollment takes place year-round.

The information below is specific to DC Medicaid, the District of Columbia’s Medicaid program:

Medicaid expansion No
Governing agency Centers for Medicare & Medicaid
Administrator District of Columbia Department of Health Care Finance
How to apply healthcare.gov / Additional application options: dhs.dc.gov/node/117482
Phone number 202-727-5355
More information dhcf.dc.gov/service/medicaid
Open-enrollment period Year-round in all states

Washington, D.C. CHIP

The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.

The information below is specific to DC Healthy Families, the District of Columbia’s health insurance program for low-income children and their parents and guardians:

Program name DC Healthy Families
Website dhcf.dc.gov/service/dc-healthy-families
How to apply healthcare.gov / Additional application options: dhs.dc.gov/node/117482
Phone number 202-639-4030 / TTY 202-639-4041
Eligibility8 Working families who live in the District of Columbia, do not have health insurance; income levels apply

1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org

2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.

3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.

4 D.C. Code § 32–732. Continuation of Coverage. Aug. 12, 2014. http://dccode.org/simple/sections/32-732.html.

5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.

6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.

7 Centers for Medicare & Medicaid Services. “District of Columbia.” Medicaid.gov. N.D. http://www.medicaid.gov/medicaid-chip-program-information/by-state/District-of-Columbia.html.

8 District of Columbia Department of Health Care Finance. “DC Healthy Families.” http://dhcf.dc.gov/service/dc-healthy-families.