Overview of Washington, DC’s Health Insurance Exchange
In 2010, the federal healthcare law—the Affordable Care Act—was passed, giving states the opportunity to build health insurance marketplaces called exchanges. DC Health Link is Washington, D.C.’s marketplace. It will allow D.C. residents to compare, select, and purchase insurance policies.
DC Health Link offers a total of 301 plans, including 34 for individuals and families. Three insurers are selling private insurance to individuals and families through DC Health Link: Aetna, CareFirst BlueCross BlueShield, and Kaiser Permanente. Those three providers plus UnitedHealthcare are in the small group market.
Plans became available on the site as of October 1, 2013. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014. People will be able to enroll online at http://www.dchealthlink.com. Enrollees can also talk to trained enrollment experts on the phone (through the DC Health Link call center) and/or in-person with the DC Health Link Assisters.
The DC web portal will allow consumers to compare plan options and use filters to narrow down those choices if they would like to do so—i.e., show me only HMOs, show me plans with a certain level of deductible, etc.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (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 services
- Preventive and wellness services and chronic disease management
- Pediatric services, 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), and Platinum (90 percent). Lower percentage plans will have lower premiums, but higher out-of-pocket costs. The cost of your healthcare depends on many factors. The primary factors are income and what type of plan you want to purchase. Additionally, depending on your income level, you may qualify for Medicaid, tax credits, or a subsidy to help offset the costs of coverage.
Parents living at or below 216 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), other adults living at or 210 percent of the FPL, and pregnant women living at or below 319 percent of the FPL will qualify for Medicaid in Washington D.C., based on eligibility standards that take effect January 1, 2014.
Tax credits are based on the Silver Plan, which has the second lowest cost, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to Silver. The Affordable Care Act (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.
Many people will want to how much of a subsidy they qualify for, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan. For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income. This comes out to $2,926 annually, or $244 monthly. The challenge is to compare the cost of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Here is a table comparing the costs of DC Health Link’s different plans. For a 40-year-old non-smoker, the Silver Plans range from $254.61 per month from Kaiser Permanente to $318.92 per month from Aetna. The average premium for a Silver Plan is $281.75 per month.