District of Columbia: Health Insurance Coverage

Updated on: December 31st, 2020

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D.C. residents are now able to purchase quality health insurance plans available from Pivot Health. These plans, described below, offer District of Columbia individuals and families the ability to choose the benefit structure that best meets their insurance coverage needs and budget.

Short term health insurance – also known as short term medical, or temporary health insurance, this plan provides comprehensive benefits coverage for physician visits, in-hospital care, urgent care facility visits and much more. Thanks to no provider network restrictions, insureds with this plan may seek treatment from any doctor or hospital to access benefits. Pivot Health’s fast, user-friendly online application process means that you know within minutes of applying if you’ve been approved for coverage. Qualified applicants may choose any coverage start date – even within 24 hours after you apply.

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Availability of plans and policy duration vary by state

Supplemental insurance coverage – If you find yourself burdened by your major medical insurance plan’s high deductibles or costly coinsurance rates, supplemental insurance coverage may provide you the financial support you need. The cash benefits provided by a supplemental coverage plan help you pay out-of-pocket medical expenses, such as insurance deductibles, copayments or coinsurance. The cash payments provide you the flexibility to decide how to use them – you may use the cash for any expenses you incur due to a serious illness or accident. Designed to cover the gaps in your primary major medical coverage – whether you have an individual plan or employer-sponsored coverage – a supplemental insurance plan helps you protect your financial security from costly expenses related to medical care.

With your Pivot Health plan coverage, you also receive many additional non-insurance benefits, including:

Unlimited access to discounted telehealth doctor consultations. Your time is precious – why spend unnecessary time in a waiting room? Instead, connect directly with a doctor at whatever time of day it works for you – telehealth is available 24/7. And it saves money compared to a standard office or urgent care facility visit.

Savings on eye care and eyewear. With discounts of 15 percent to 40 percent on eye exams, eyeglass lenses, frames for eyeglasses and contact lenses, it’s easy and affordable to maintain good eye health.

Significant discounts on prescription drugs. It’s easier to pay for prescription medications with savings of up to 75 percent on prescription drugs at thousands of pharmacies across the nation.

Health Exchange Operations in the District of Columbia

In the District of Columbia, coverage in the individual and small group markets is available only on the health insurance exchange, called D.C. Health Link. The exchange is overseen by the District Health Benefit Exchange Authority board (DCHBX).

A recent study conducted for the DCHBX concluded that more than 25,500 D.C. residents who were uninsured in 2015 gained access to health insurance coverage in 2016 through D.C. Health Link. Overall, D.C. now boasts an uninsured resident rate somewhere between 3.7 and 4 percent, which is among the lowest in the nation.

Premium price adjustments for 2017 varied widely among exchange insurers, with an average increase of 7.27 percent for individuals and .36 percent for small group plans. Some plan premiums rose by just under 2 percent. However, CareFirst HMO consumers saw their premiums skyrocket by 23 percent. The rise was attributed to pricing changes, higher medical costs, and the insurer’s elimination of low-premium health savings account insurance plans. Exchange enrollees with CareFirst’s Health Savings Account-eligible plans were required to select new plans for 2017; otherwise, they were automatically moved into plans with premium increases of up to 75 percent.

Despite the uncertainty surrounding the future of the Affordable Care Act (ACA), District officials are continuing to move forward under a “business as usual” approach. In fact, D.C. Health Link has announced revised exchange plan offerings for 2018, including requiring exchange health insurers to provide bronze-level plans that are compatible with HSAs. This move is intended to help counter frustration expressed by individuals whose HSA-compatible plans were eliminated in 2017, forcing them into higher-premium plans.

There is no off-exchange insurance plan option in the District of Columbia, which limits plan choice. D.C. residents seeking other health insurance options that may better meet their coverage needs and budget may wish to consider Pivot Health’s insurance options.

  • Pivot Health’s short term medical insurance enables insureds to purchase comprehensive coverage at a fraction of the cost of major medical insurance coverage – with no provider network restrictions.
  • Pivot Health’s supplemental health insurance provides D.C. residents the opportunity to select insurance designed to provide financial protection against the coverage gaps of high deductible major medical insurance plans. This supplemental insurance – also called “gap” coverage – helps insureds pay for high deductibles, out-of-pocket costs, coinsurance, copayments, and other costs that they typically incur before their high deductible major medical plans begin to pay benefits.

The State of Health in the District of Columbia

The 2017 Commonwealth Fund’s Scorecard on State Health System Performance gave the District of Columbia an overall ranking of 20 out of 51 (the 50 states plus the District of Columbia). This is the most recent version of the organization’s scorecard of its comparison for states in the U.S. The Commonwealth Fund’s Scorecard rated D.C. in several areas, including:

  • Uninsured adults aged 19 to 64: 2nd ranking (5 percent in D.C., compared to U.S. average of 13 percent)
  • Adults who went without care because of cost in the previous year: 7th ranking (9 percent in D.C., compared to the U.S. average of 13 percent)
  • Individuals under age 65 with high out-of-pocket costs relative to annual household income: 1st ranking (10 percent, compared to U.S. average of 14 percent)
  • At-risk adults who did not have a routine doctor visit in the previous two years: 1st ranking (6 percent in D.C., compared to U.S. average of 13 percent)
  • Adults that did not visit a dentist in the previous year: 27th ranking (16 percent, the same as the U.S. average of 16 percent)
  • Adults with age- and gender-appropriate cancer screenings: 4th ranking (73 percent in D.C., compared to the U.S. average of 68 percent)
  • Hospitalized people who said the hospital staff managed pain well, were responsive to calls for help and who explained medications and their side effects: 51st ranking (58 percent, compared to U.S. average of 68 percent)
  • Breast cancer deaths per 100,000 females: 51st ranking (28.9 in D.C., compared to U.S. average of 20.6)
  • Colorectal cancer deaths per 100,000 people: 50th ranking (18.9 percent, compared to the U.S. average of 14.3 percent)
  • Suicide deaths per 100,000: 1st ranking (7.8 percent in D.C., compared to U.S. average of 13 percent)
  • Adults who report fair or poor health or activity limitations: 3rd ranking (21 percent, compared to the U.S. average of 26 percent)
  • Adults who smoke: 15th ranking (16 percent in D.C., compared to the U.S. average of 17 percent)
  • Adults who are obese: 2nd ranking (21 percent, compared to the U.S. average of 29 percent)
  • Children (ages 10-17) who are overweight or obese: 42nd ranking (35 percent in D.C., compared to U.S. average of 31 percent)
  • Percent of adults who have lost 6 or more teeth due to decay or disease: 2nd ranking (7 percent, compared to U.S. average of 10 percent)

The District of Columbia scored positively in these key health categories

  1. Children with medical and dental preventive care visits in the past year
  2. Children ages 19-35 months who received all recommended doses of seven key vaccines
  3. Home health patients who improved at walking or moving around
  4. Home health patients whose wounds improved or healed after an operation

2017 Health Insurance Plans in the District of Columbia

D.C.’s Department of Insurance, Securities and Banking reported that the following health insurance companies were offering individual health insurance plans on the D.C. Health Link exchange in 2017:

  • CareFirst HMO (CareFirst BlueChoice)
  • CareFirst PPO (GHMSI)
  • Kaiser Permanente HMO

Pivot Health offers in D.C.:

  • Short term health insurance
  • Supplemental health insurance

Medicaid Enrollment in the District of Columbia

The District of Columbia adopted Medicaid expansion under the terms of the ACA, beginning in 2011. By expanding Medicaid ahead of schedule, D.C. took advantage of an Affordable Care Act provision that provided federal matching funds to provide coverage for applicants with income up to 133 percent of the Federal Poverty Level (FPL).

The District has one of the most generous Medicaid programs in the country; about one in three D.C. residents is covered by Medicaid. That is approximately 260,000 District of Columbia Medicaid enrollees. Qualifying income eligibility levels for Medicaid coverage in D.C. are up to:

  • 319 percent of the FPL for children 0-18 and pregnant women
  • 216 percent of the FPL for parents with dependent children
  • 210 percent of the FLP for other, non-elderly adults

Because the District’s Medicaid eligibility guidelines are so generous, lower income applicants enroll in Medicaid, rather than participating in the D.C. Health Link exchange.

Your Health Care Coverage Choices

If you are a District of Columbia resident and do not have health insurance or do not wish to purchase an exchange plan on D.C. Health Link: Pivot Health’s short term health insurance offers you the choice of comprehensive medical coverage to meet your benefit and budget needs.

If you are a District of Columbia resident and have a high deductible health insurance plan: Pivot Health’s supplemental insurance can help relieve the burden of costly out-of-pocket expenses, such as deductibles, coinsurance, copayments and more.

Pivot Health: offering you choices and flexibility that pivot to meet your needs over time.

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