People in Washington DC have plenty of options when it comes to health care. According to the Commonwealth Fund, DC has the 20th best health system in the country. That study looks at access, affordability, treatment, hospital use and cost, healthy lives, and equity.
Health insurance options in Washington DC
There are several ways for DC residents to access health care in the district.
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Washington DC residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 53% | ||
| Individual or family | 7% | ||
| Medicaid | 28% | ||
| Medicare | 8% | ||
| Uninsured | 3% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Three percent of DC residents are uninsured, far below the national average. That’s great for policyholders, as a high rate of uninsured people raises rates for insured people.
Washington DC health insurance companies
Residents have two options for health care providers in their area. These companies offer both individual and family plans in DC:
- Aetna
- CareFirst
- Kaiser Permanente
- UnitedHealthcare
Washington DC health insurance costs and rate factors
DC residents spend an average of $11,944 per year on health care, more than the rest of the country. What determines your rates in DC? Prices vary person to person, but depend mostly on these factors:
Plan type
It’s pretty simple: better coverage costs more. And your coverage levels depend on your plan type. Marketplace plans come in metal tiers: bronze, silver, and gold.
So, how much does health insurance in DC cost? These are the average monthly prices for each plan type for a middle-aged DC resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $345 | $404 | $450 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a bronze plan cost about 30 percent less than premiums for a gold plan. Gold plans cover 80 percent of medical costs, whereas bronze plans only cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available in the marketplace. Catastrophic plans have low monthly premiums and a yearly deductible of $8,150. Because of that yearly deductible, it may save you money to invest in a bronze or silver plan for when you need to use your insurance.
Body mass index
According to the CDC, a high body mass leads to many serious health risks. Insurance companies analyze your BMI when pricing your policy. A high BMI means high health insurance premiums.
In 2019, DC had a 24 percent obesity rate, the lowest in the country! Of the DC residents who used QuoteWizard to compare health insurance plans, 22 percent had a BMI in the obese range.
Tobacco use
Smokers pay more for health care because of the high risks from tobacco use. About 15 percent of DC residents are smokers.
Age
Health insurance for an older person costs up to three times more compared to a younger person. DC residents who used QuoteWizard to shop for health insurance are, on average, 37 years old.
Location
Your location plays an important role in your premiums. Every state (including DC) has its own set of health care laws, regulations, and companies. Your policy options and prices depend quite a bit on where you live.
Health insurance companies use a community-rating system. That means your rates are partly based on the combined claims that everyone files. If your region files a high number of claims, your prices could go through the roof.
So, living in a health-conscious area can help lower your premiums. According to America’s Health Rankings, DC had the largest decrease in premature death from 2012 to 2017. And the American Fitness Index ranked DC as the third healthiest state in the country.
Washington DC health care insurance laws
The Affordable Care Act limits what factors insurance companies can consider when pricing your policy.
- Pre-existing conditions: Thanks to the ACA, insurance companies can’t charge more to people with pre-existing conditions. People with pre-existing conditions used to pay more for health insurance.
- Gender: The ACA also mandates that insurance companies cannot charge men and women different premiums for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to analyze your previous medical conditions and your insurance history to determine your prices. Now, insurance companies can’t use these factors to price your policy.
There’s a limit to how much you can pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
DC law requires health insurance companies to offer at least some coverage for the following services:
- Emergency medical services
- Minimum post-delivery stay
- Clinical trials
- Diabetes coverage
- Hormone replacement therapy
- Drug abuse, alcohol abuse, and mental illness
- Certain cancer screenings
There are additional services that providers must cover. Find the full list on cms.gov.
Medicare and Medicaid in Washington DC
Medicare and Medicaid are both government-funded health care programs in the US. Medicare aids seniors, whereas Medicaid helps low-income families and children.
Medicare
DC residents 65 and older qualify for Medicare. There are several different coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Low-income families and children may qualify for Medicaid. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Washington, D.C. Department of Insurance, Securities, and Banking
- Website:
- Homepage
- Insurance Commissioner:
- Stephen C. Taylor
- Insurance Hotline:
- (202) 727 – 8000
- Office Hours:
- Monday - Friday
8:15 am to 4:45 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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