Health Insurance In Washington D.C. For 2023


WRITTEN BY: Craig Sturgill

UPDATED: SEPTEMBER 12, 2022 | 1 MIN READ

There are many great options for affordable Washington D.C. health insurance. Residents have the option of enrolling in employer’s group coverage, signing up for a health plan with DC Health Link, or enrolling in Medicaid or Medicare. We are going to walk you through all the affordable options.

Washington D.C. Health Insurance Demographics

Washington D.C health insurance is determined based on demographics including average household income, age, and education level.

  • Average Household Income: The average household income is $133,587. The median household income is $90,842.
  • Median Age Range: The median age is 34.1 years of age. 
  • Education: Only 37% of residents have a bachelor’s degree or higher. 

What Type Of Marketplace Does Washington D.C. Have?

Health insurance in Washington D.C. has a district-run exchange with several carriers. Individual and small group markets are available through the DC Health Link, the state-run exchange.

How many people are insured through the Washington D.C. health insurance marketplace?

Open enrollment in 2022 had 15,989 residents enrolled in individual market plans through DC Health Link. It was 29% lower than enrollment in 2016, a decrease of 6% from the previous year.

Did Washington D.C. implement the ACA’s Medicaid expansion?

Washington D.C. did adopt the Medicaid expansion. This means more residents qualify for coverage under the Affordable Care Act. 

When can you purchase ACA insurance in Washington D.C.? 

Open enrollment takes place between November 1, 2022 to January 15, 2023. Outside of the enrollment period, you require a qualifying event to either change coverage or enroll in the program. 

Types of ACA Plans In Washington D.C.

There are multiple types of insurance plans available for Affordable Care Act plans in Washington D.C. The plans are divided into metal tiers, and each tier has different types of coverage. 

What carriers offer ACA insurance in Washington D.C.?

Many different insurers offer coverage in the exchange. Many plans are offered for small businesses instead of family, or individual plans. There is a large small business market because group plans can’t be purchased outside the exchange.

Three insurers offer family or individual plans:

  • Kaiser of the Mid-Atlantic States
  • Group Hospitalization and Medical Services
  • CareFirst BlueChoice

Small-group Insurers include:

  • Kaiser
  • Optimum Choice
  • Aetna Life
  • Aetna Health
  • UnitedHealthcare Insurance Company
  • CareFirst HMO
  • GHMSI/CareFirst PPO
  • UnitedHealthcare of Mid-Atlantic

How Much Does Health Insurance Cost In Washington D.C.?

The average cost of health insurance in Washington D.C. is $424 monthly. That’s a plan for a 40-year-old with Silver health insurance.

Cheapest Health Insurance By Metal Tier In Washington D.C.

Area plans are divided into metal tiers. Washington D.C. has four metal tiers. Below are the cheapest individual plan options for each one.

Metal TierCheapest PlanMonthly PremiumDeductibleMaximum Out-of-Pocket
BronzeKP DC Standard Bronze 6350/20%/HSA/Vision$350$6,350$6,900
SilverKP DC Silver Virtual Forward 4000$385$4,000$8,550
GoldKP DC Gold Virtual Forward 2000$420$2,000$5,000
PlatinumKP DC Standard Platinum$535$0$2,000

Are Subsidies Available In Washington D.C.?

DC Health Links offer subsidies, and subsidy-eligible residents receive 85% of their subsidy up-front monthly. However, most enrollees take up-front more than 85% of the subsidy.

Can You Purchase Off-Exchange Insurance Coverage In Washington D.C.?

No. Washington D.C. health insurance plans do not offer the option to select an off-exchange plan.

Can You Purchase Short-Term Insurance In Washington D.C.?

Washington D.C health insurance plans offer short-term insurance plans, but only for up to three months. After that, renewals are not allowed, and if you have a pre-existing condition, you don’t qualify.

Health Coverage Options For Low-Income People In Washington D.C.

There are a couple of health insurance options for low-income people. Both Medicare and Medicaid are available. 

What Medicare Options Are Available In Washington D.C.?

Medicare is health insurance for people over 65 or older, or those with a disability. You may have to pay part of the premium, but it’s still cheaper than private insurance.

Medicaid In Washington D.C.

Medicaid is available in Washington D.C. for low-income people. You must fall below 138% of the federal poverty level to qualify. It’s free health insurance as long as you qualify.

Cheapest Health Plans In Washington D.C.

We have compared plans at each metal level and found the most affordable individual and family health insurance plans in Washington D.C. Below are the cheapest options for plans with low premiums, and out-of-pocket costs.

Cheapest health plan in Washington D.C. with low out-of-pocket maximums 

If you have high medical expenses, then gold plans are the best option. The premium is low, and you end up reaching the maximum quickly. After that, your insurer covers your costs. The cheapest individual health plan premium is with KP DC Gold Virtual Forward 2000 at $372 monthly, with an out-of-pocket cost of roughly $7,500.

Cheapest health plan in Washington D.C. with high out-of-pocket maximums 

The cheapest policies are in the Bronze tier and are best for those in good health with low medical expenses. They have low premiums and high out-of-pocket costs. The cheapest plan is the KP DC Standard Bronze 6350 at $417 monthly with an out-of-pocket max of $8,250.

Cheapest health plan in Washington D.C. with an HSA option

Health Savings Accounts are great options for those with low medical costs. They are pre-tax contributions that are essentially savings accounts you only use if you have medical costs. 

Cheapest HMO/PPO/POS health insurance plans in Washington D.C. 

There is various health insurance in Washington D.C, including HMO and PPO. The cheapest HMO is with BlueChoice HMO Standard Bronze at $7,500. The cheapest PPO is BluePreferred PPO Standard Bronze, also $7,500.

FAQs

What’s the average cost of health insurance in D.C.?

The average cost of health insurance in Washington D.C. is $424 monthly.

Do D.C. residents get free health insurance?

If you qualify for Medicaid, you get free health insurance. Your income must fall below 138% of the federal poverty line. 

What’s the maximum income to qualify for Medicaid in D.C.?

For an individual, the maximum household income is $18,075. For a family of four, the maximum household income is $36,908.

Does Washington D.C. have good healthcare?

Hospitals in Washington D.C have received a low rating for quality and safety for healthcare.

What is the penalty for not having health insurance in D.C.?

The penalty amount is either 2.5% of the gross family household income or $695 per individual and $347.50 per child; you’ll pay whichever amount is greater. qualifying health coverage in Washington D.C. typically means having health insurance that covers at least 60% of the cost of covered health care benefits, including doctor visits, hospitalizations, and prescription drugs.

How To Find Health Insurance In Washington D.C.

Washington D.C. health insurance is more affordable than you might think. And if all the available plans are too expensive, there are government programs available that can help reduce the cost of coverage. To get started finding the right plan for you, get a quote online today.