Just because you live in the Washington, DC area doesn’t mean you should struggle to find the health insurance that you and your family need. Being a resident of our nation’s capital gives you some unique options that people living in other states don’t necessarily have access to. But understanding all of those options – and making a choice between them – can be difficult. That’s why we’re here to help. Whether you want major medical, short-term health insurance, a health share plan, or more, our experts can guide you through the pros and cons of each so that you can make the best decision possible.
Major Medical Insurance in District of Columbia
The Patient Protection and Affordable Care Act passed back in 2010. It created the Health Insurance Marketplace, which is where all major medical health insurance is now sold – either through local, state exchanges or through the national Health Insurance Marketplace. And if you can’t or don’t want to purchase health insurance through your employer, then you can sign up for a policy each year during Open Enrollment.
Open Enrollment happens each year starting November 1st, and the deadline to enroll usually goes until December 15th – although it has been known to change from time to time. There are also special enrollment periods that will allow you to enroll at any point during the year if you experience a significant life change. More information on the qualifications for special enrollment periods can be found at HealthCare.gov. And if you want to enroll in ACA major medical coverage through the Health Insurance Marketplace, you as a DC resident will want to go to The DC Health Link website in order to fill out an application and check your status.
But what, exactly, is so special about the health insurance policies that are sold on these exchanges? Well, quite a few things, actually. For one, they are all guaranteed issue, which means that you won’t be rejected for coverage as long as your application is accepted and you are given permission to shop on the Health Insurance Marketplace. You also won’t be charged more for your monthly premiums, unless one of the following four factors somehow makes you a riskier investment for your insurance company. There are no extra charges or rejections for pre-existing conditions.
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
When you sign up for health insurance through the ACA, you’ll also be getting some of the most comprehensive coverage available. This is due to the 10 guaranteed Essential Health Benefits. These benefits are mandatory for all insurance policies that are sold through the Health Insurance Marketplace. Without them, companies cannot sell insurance products to consumers through the government. The benefits are deemed necessary for comprehensiveness, preventative care, and helping consumers maintain optimum health and wellness for the lowest total health care costs in the long run.
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Another good thing about ACA coverage is that most people will qualify for a subsidy based on their household size and income. You can see how this applies to you using the handy chart below. If you make somewhere between 138% and 400% of the federal poverty limit, you will receive a premium tax credit that is paid directly to your insurance provider which will greatly reduce your monthly premium. And if you make below 138% of this income threshold, you have other options, as well.
|Household Size||Annual Income (138% of FPL)|
Because the District of Columbia is not a state, but rather federal territory, they automatically adopted the Medicaid expansion funding back in 2014. This means that if you make less than 138% of the federal poverty limit, you are allowed to apply for Medicaid instead. If you want more information on qualification requirements, you should visit the Medicaid web page on the DC Health Link website and apply today. If you have questions, they also have helpful contact information so that you can get a hold of a real, live person and ask them questions.
Short Term Health Insurance in District of Columbia
Short-term health insurance works a little bit differently in the District of Columbia than it does in other states. This is true even though DC is a federal territory and, therefore, federal rules about short-term health insurance should apply. But here are the main differences between the federal rules, and what short-term health insurance is actually allowed to do in DC: for one, short-term health insurance isn’t allowed to base eligibility on medical history or pre-existing conditions. Secondly, short-term plans are only allowed for a maximum of three months and renewals are not allowed.
Aside from that, short-term health insurance has some other pros and cons that you should know about when comparing it to major medical coverage. If you cannot get a subsidy or qualify for Medicaid, your monthly premiums for short-term health insurance could be up to 33% less costly compared to an unsubsidized ACA plan. But you’ll only have it for three months, and you won’t get all 10 guaranteed Essential Health Benefits like you would through the ACA. You can negotiate for more benefits if your baseline policy doesn’t have enough, but you may not be able to purchase all of the benefits you wish. You’ll also have to deal with annual and lifetime caps on your benefits, and many short-term health insurance companies automatically come with a very high deductible you must pay before you get reimbursed. It’s up to you to take all of these facts under consideration and weigh the pros and cons of each before deciding upon a short-term health insurance policy.
Christian Health Plans/Health Share Plans in District of Columbia
If you want something like short-term health insurance, but you need it for longer than 3 months, then you might want to take a look at a Christian health plan. These are also referred to as health share plans. They work like insurance, and if the individual mandate were still the law of the land, they would exempt you from a tax penalty that you would otherwise have to pay for not purchasing qualifying coverage. But there are some specific things about Christian health plans that make them unique to other types of coverage.
But let’s start by talking about what Christian health plans have in common with short-term health insurance so that you have a better idea of the context:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- Their monthly payments can be up to 33% less expensive than unsubsidized ACA health insurance premiums
There aren’t term limits with a Christian health plan the way there are with short-term health insurance in DC; however, there are membership guidelines you must follow in order to stay in good standing and receive your benefits from the plan. Usually, the guidelines insist that you declare a specific (and usually Christian) faith, attend a specific church a certain number of times a year, and you may even have to change the way you use alcohol and tobacco products to improve your health and lower your health care costs. These religious organizations aren’t regulated by the federal government, so if you do happen to get into a situation where there is a dispute over your benefits, you won’t have any legal recourse. You will have to hope that you can settle the dispute with your plan provider. Your plan provider will also use different language with regard to the payment structure of your plan. There are no monthly premiums like there are with regular insurance; there are “monthly share amounts” that you have to pay in order to continue receiving benefits. Similarly, there are no co-pays, deductibles, or co-insurance payments; however, there are “unshared amounts” and “personal responsibility amounts” that you will be expected to pay, which basically serve the same purpose.
Fixed Indemnity Plans in District of Columbia
Fixed indemnity insurance is a good tool to have in your healthcare toolbox – depending on what you intend to use it for, that is. If you want to use it as a supplement to the coverage you already have, then you’re on the right track. But if you’re trying to use it as a replacement for major medical coverage, that might not be the best idea. This is because fixed indemnity plans only pay a fixed amount per claim – not a fixed percentage of the total cost, the way major medical does. If you go to the doctor and it costs you $300, a fixed indemnity plan my pay out $80 whereas major medical will pay out 80% of the total bill. And this applies to each claim, whether your indemnity plan pays out on a per day, per week, per month, per incident, or per visit basis.
There may also be medical underwriting involved with a fixed indemnity plan, which means that you won’t have any protection against your premiums rising or being rejected for coverage if you have pre-existing conditions. There are also annual and lifetime benefit caps to worry about, but no limit whatsoever on your out-of-pocket costs. Still, there are some advantages to a fixed indemnity plan, especially if you use it to supplement a high-deductible insurance plan that you already have. Your fixed indemnity benefits can help lower your total costs out-of-pocket and get you closer to reaching your deductible faster. Depending on the indemnity plan you choose, you could get hospital, doctor visit, and even dental benefits. Best of all, fixed indemnity plans aren’t limited to specific medical networks the way certain HMO or PPO major medical plans are.
Discount Cards in District of Columbia
Another good way to help supplement your out-of-pocket costs is with a medical discount card. Ideally, if you find a good medical discount card provider, they will charge you a modest membership fee on a monthly or annual basis. Then they will send you a card that you can use when checking out at pharmacies, doctor’s offices, or other providers to give you an immediate discount on goods and services. As long as you are saving more money in discounts than you are paying for your membership fee, this is a pretty good deal that could save you a decent amount of money on the medical expenses you were going to pay for anyway.
But medical discount cards are not insurance, and they don’t even come close to replacing major medical coverage. Even worse still is that not all medical discount card companies operate in an ethical manner. Some may try to lie and say that the card is an adequate insurance replacement, even though it isn’t. Others may claim to have large provider networks and offer generous discounts that they don’t actually offer. If you see a deal that looks too good to be true, call around and make sure that the providers they say they work with are actually with them, and ask questions about the discounts they offer. If everything checks out, then you can feel confident knowing you’re going to get a good deal on your medical discount card.