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District of Columbia Health Insurance

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District of Columbia Health Insurance

When researching your health insurance options in the District of Columbia, there are several things you'll want to think about. If your employer does not offer benefits, are you healthy enough to obtain health insurance on the individual market? If so, Health Plan One can be of service to you in quoting plans appropriate for your needs and price range. Are you self-employed and employing between 2-50 employees? Health Plan One can also assist small business owners in obtaining small group coverage. Do you have any serious medical conditions, disabilities, or are you below an income level which could qualify you for free or low-cost health care programs offered by the government? You may be eligible in DC for Medicaid, Healthy Families, DC Health Care Alliance, or the Prescription Drug Coverage Program. Eligibility requirements for each of these options are available on this page.

Click here to learn about Washington DC Medicare plans.

What Every DC Resident Should Know About Health Insurance

The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer, the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not subject to medical underwriting, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.

Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through Health Plan One. Simply visit our Short-Term information page for your free quotes. It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.

What If I'm Between Jobs?

As previously mentioned, it is important not to have a break in coverage of more than 63 days. As a result, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government, you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs, to invest in an individual/family insurance policy they find through Health Plan One.

With individual coverage, you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in DC so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs.

Even if you are not between jobs, a plan on the individual market through Health Plan One could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in DC each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.

If you're healthy and are between jobs, are unhappy with the health insurance offered by your employer, or are not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.

If you're not healthy, there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.

Small Group Plans

If you own a small business, you can apply for a small group plan. You must have 2 or more eligible employees who each work at least 30 hours per week. Small groups which meet these requirements may apply, but know that groups are subject to medical underwriting. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling.

Health Plan One can help you by quoting plans for both sole proprietors and small groups. Simply call our toll-free number at (877) 567-5267.

DC Medicaid Program

The Medicaid program is meant to help low-income residents maintain a basic level of medical care coverage. The program pays for medical services for residents of the District who meet income requirements and several other qualifications. If your income is over the limit allowable to be eligible for full Medicaid coverage, other factors may still qualify you for partial coverage, such as pregnancy. The program is free or very low-cost for enrollees. Services covered by DC Medicaid include doctor visits, hospitalization, eye care, ambulance rides, dental services, transplants, medical supplies, radiology, and many other services. For more information, see the program's home page at,a,3,Q,613280.asp For eligibility requirements and full program details, see this page:,A,1412,Q,609122,dhcfNav,|34820|.asp To apply, visit your local Income Maintenance Administration (IMA) Service Center. Call (202) 727-5355 to locate your nearest IMA Service Center.

DC Healthy Families (SCHIP)

DC Healthy Families is DC's version of the federal State Children's Health Insurance Program (SCHIP). The program is administered by the DC Department of Health Care Finance and provides free health insurance for DC residents and their children whose incomes are too high to qualify them for Medicaid. This free coverage is available to working families who live in DC, don't have health insurance, have incomes up to 200% of the Federal Poverty Level (or up to 300% if covering children only). The 3 health plans available within the program are the DC Chartered Health Plan, Health Right, and Unison Health Plan. These plans include services such as doctor visits, hospitalization, dental and vision care, and prescription coverage.

DC Health Care Alliance

The DC Healthcare Alliance offers a full range of health care services for DC residents who qualify. To be eligible your must live in the District, have no health insurance (including Medicare and Medicaid), and make below a certain income ceiling. Benefits include: inpatient hospital care, outpatient medical care (including preventive care), emergency services, urgent care services, prescription drugs, rehabilitative services, home health care, dental services, specialty care, and wellness programs.

DC Rx Prescription Drug Discount Card

One additional program available in DC to all residents is the DC Rx Prescription Drug Discount Card. This is a joint effort between the District and the National Association of Counties (NACo) to save residents money on prescription medications. Though the program does not offer comprehensive health or pharmacy coverage, it does offer discounts on all commonly prescribed drugs (brand name and generic) whether you have existing insurance coverage or not. This is useful even for those with insurance because any family member can use the card for prescriptions not covered by the family plan. The card is free and available to all regardless of age, income, or existing health insurance. The card is accepted at over 98% of all DC pharmacies, and there are no enrollment forms, annual fees, or limits on how many times you may use the card.

For a full list of programs offered in the District, see this page,A,1221,Q,460099.asp Also, check out the DC Department of Health Care Finance's website at

HIPAA Plans - DC's High Risk Pool Alternative

For information on HIPAA plans available in DC to those residents who are for medical reasons uninsurable on the private market, check out our HIPAA Insurance page.