In 2010, the federal healthcare law — the Affordable Care Act (ACA) — was passed, giving states the opportunity to build health insurance marketplaces called exchanges. DC Health Link is Washington, D.C.’s marketplace. It helps D.C. residents to compare, select, and buy insurance policies.
DC Health Link offers hundreds of plans for individuals, families, and small businesses. Four insurance companies are authorized to sell private health insurance through DC Health Link:
- CareFirst from BlueCross BlueShield
- Kaiser Permanente
- United Healthcare
Beginning in 2014, according to the ACA, all plans must offer the following important services:
- doctor’s visits
- emergency services
- in-patient hospital stays
- maternity and newborn care
- mental health and substance abuse rehab services, including behavioral health treatment
- prescription drug coverage
- rehabilitative and habilitative services (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy. DC Health Link’s definition of habilitative services also includes applied behavioral analysis for autism spectrum disorders.)
- laboratory and diagnostic services
- preventive and wellness services
- chronic disease management
- well-child visits, including oral and vision care
There are four basic plans available with varying levels of coverage:
- Bronze (60 percent of expenses paid by plan)
- Silver (70 percent)
- Gold (80 percent)
- Platinum (90 percent)
Lower percentage plans will have lower premiums (monthly payments), but higher out-of-pocket costs. The cost of your healthcare depends on many factors. The main factors are income and what type of plan you want to buy.
The DC Health Link website lets you compare plan options and use filters to narrow down those choices. For example, you can sort by plan type asking only to see HMOs, or only plans with a certain level of deductible.
Use their calculator to figure out how much a certain plan will cost you, and if you qualify for Medicaid.
Many people will want to know how much government assistance they qualify for, but the real question is, how much will you pay? To do this, you need to figure out the maximum healthcare percentage for your income. This is the maximum amount you are expected to pay for health insurance based on your income. Once you figure out what that is, then you can determine what you'll have to pay for whatever plan you choose. For example, if your income is $32,500 a year (278 percent of the federal poverty level for a single adult), the most you’ll have to pay for health insurance is 9 percent of your income. This comes out to $2,315 yearly, or $193 monthly.
The challenge is to compare the cost of the Bronze, Silver, Gold, and Platinum plans, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of how much assistance you qualify for and how much you should expect to spend on health insurance.
Depending on your income level, you may qualify for Medicaid, tax credits, or a subsidy to help offset the costs of coverage.
Eligibility standards for Medicaid took effect on January 1, 2014. These are based on income relative to the federal poverty level (FPL). The current FPL is $11,770 a year in wages for one person and $24,250 a year in wages for a family of four. The following people qualify for Medicaid in Washington, D.C.:
- parents living at or below 216 percent of the FPL
- other adults living at or below 210 percent of the FPL
- pregnant women living at or below 319 percent of the FPL
Tax credits are based on the Silver plan, which has the second lowest cost, so people can easily figure out what their extra out-of-pocket costs will be if they choose a higher or lower plan compared to Silver. The ACA was designed so the Silver plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
To buy a health insurance plan in the exchange, you need to do it during the open enrollment period. Open enrollment for 2016 starts on November 1, 2015, and continues through January 31, 2016. If you want your insurance coverage to start on January 1, 2016, you have to enroll by December 15, 2015. Your coverage will start March 1, 2016, if you enroll between December 15 and the deadline of January 31.
If you miss the deadline, you’ll need to wait for the next open enrollment period, unless you qualify for a special enrollment period. Reasons for special enrollment include loss of job, loss of coverage, and relocation to D.C. You have 60 days after one of these life events occurs to enroll.
To learn more about DC Health Link, please visit http://www.dchealthlink.com, email firstname.lastname@example.org, or call 1-855-532-LINK (5465). You can also meet in-person with a DC Health Link Assister.