DC Health Insurance
Need to find health insurance quotes in D.C.?
You’ve come to the right place. Get instant quotes from leading providers in
the state of D.C. and find out how you can save on your coverage. Start your search by entering your zip code above or find out more about D.C. health insurance plans available in your area below.
Facts and Figures
- Number of
Primary Care Physicians
- Number of
Breakdown of Insureds
- Employer-sponsored health insurance 58%
- Private plans 7%
- Medicaid 24%
- Medicare 11%
State Health Report Card
The District of Columbia is not included in the ranking of states, as it is a unique governmental entity and is considerably more urban than the states.
DC Health Insurance Laws and Regulations
State laws require all District of Columbia health insurance plans sold to include a guaranteed renewability clause. With this, you are able to renew your health coverage each time you see it necessary as long as you’ve kept up with your monthly premiums and do not violate any terms of your contract. Therefor removing the need to search for a District of Columbia health insurance quote. Furthermore, health insurers are prohibited from terminating your coverage on the grounds that you have fallen ill.
All newborns and newly adopted children in D.C. are automatically covered under their parents’ existing health insurance policy, as long as the policy in question covers dependents. This can last for up to 31 days, giving parents enough time to look for a more permanent solution.
Health insurers in D.C. can exclude coverage for a pre-existing condition when writing up your new policy. This exclusion period can last for up to twelve months. Fortunately, the waiting period you’ve spent on one plan will be credited to another plan, should you wish to transfer.
Small businesses in the market for a District of Columbia health insurance quote with 2 to 50 employees are qualified to purchase group health plans being offered in other parts of the state. The cost of these plans may vary depending on the company, but prices cannot be based on age and health of the group members.
Group health policies may require certain conditions in order to maintain coverage. Most health insurers require a minimum percentage of participating employees and a minimum employer contribution to the members’ premiums. Failure to meet these requirements can be grounds of the group’s health plan cancellation. However, health insurers are prohibited from cancelling a group’s policy based on the members’ health status.
Self employed residents in D.C. are qualified to purchase group health policies even without any other employee on their payroll. They also have the option of buying individual health coverage, which gives the subscriber the power to deduct a portion of their premiums from their tax liability.
Heath Care Reform
Under the health care law, children under the age of 26 can choose to stay under their parent’s health plan as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In D.C., 3,943 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed 2,743 Medicare policyholders in D.C. to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 2,551 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plan when they hit the donut hole. An average of $621 per person or a total of $1,583,039 was saved in D.C.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 38 individuals in D.C. have benefited from this new law.
The new health care law requires all health insurers to allocate at least 80 percent of the premium payment on health care and related improvements. A rebate or premium discount shall be provided if the minimum is not met. All 146,000 private policyholders in D.C. will get greater value for their premium payments because of this 80/20 rule.
With the new law, insurance companies are now required to provide their subscribers with preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits with no deductible or co-pay. In 2011, more than 45,529 Medicare subscribers and 107,000 individuals with private policies received such services in D.C.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 208,000 residents in D.C. have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of D.C. received a total of $4.8 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In D.C., 45 community health centers received a total of $14 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. D.C. has already received a total of $23 million to support its policies, programs, and communities to help its residents lead healthier lives.
State Government Insurance Programs Offered
Pre-existing Condition Insurance Plan (PCIP)
The Pre-Existing Condition Insurance Plan is a federal high-risk pool created by the Health Care Reform and operated by U.S. Department of Health and Human Services. This program provides coverage for individuals with a pre-existing condition who may have a hard time finding private coverage.
Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs.
1. Must be a U.S. citizen or legal resident living in D.C.
2. Must be uninsured for at least six months.
3. Must have a qualified pre-existing health condition.
Medicaid offers coverage to needy individuals and families who cannot pay for their medical care. This program is funded by the federal and state government and applicants should meet certain financial and eligibility requirements.
Benefits for this program include physician services, laboratory services, radiology, hospitalization, emergency ambulance services, ambulatory surgical center, medically necessary transportation, dialysis services, medical supplies, durable medical equipment, eye care, dental services and related treatment, hospice services, nurse practitioner services, home and community based service (HCBS), transplants, and more.
1. Must be U.S. citizens or legal residents living in D.C. for at least five years.
2. Must not exceed income limits.
D.C. HealthCare Alliance offers District of Columbia health insurance for uninsured residents.
Services covered include inpatient and outpatient hospital care, home health care, emergency services, specialty care, urgent care services, rehabilitative services, wellness programs, dental services, and prescription drugs.
1. Enrollees must live in D.C.
2. Must be uninsured and ineligible for Medicare or Medicaid.
3. Must not exceed income limit of 200% of the federal poverty level (FPL) and assets must not exceed $4,000 for singles and $6,000 for couples.
D.C. Healthy Families
D.C. Healthy Families was created to provide free District of Columbia health insurance to uninsured children 19 years or younger and their parents or guardians.
The program offers comprehensive services including doctor visits, hospital stays, home health care, prescriptions, vision care and glasses, dental, immunizations (shots), emergency care, prenatal labor and delivery, family planning, mental health services, drug and alcohol treatment, durable medical equipment, and more.
1. Must be U.S. citizens or qualified residents living in D.C.
2. Must be uninsured.
3. Must not exceed income limits.
Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease.
Coverage has four parts:
Part A: provides inpatient care in hospitals and rehabilitative centers.
Part B: provides doctor and some preventive services and outpatient care.
Part C: provides Medicare benefits through Medicare Advantage.
Part D: provides prescription drug coverage.
1. Must be a U.S. citizen or permanent U.S. resident.
2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.