Health Insurance in District of Columbia

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Washington D.C. is the 10th healthiest state to live in and obtain health coverage, according to the America’s Health 2008 Rankings. The state has shown remarkable improvement in its healthcare system since last two years; it was on 12th and 15th position in 2007 and 2006 respectively. Several factors contributed to the positive change in Washington D.C.’s health care system including reduced prevalence of smoking and low percentage of poverty among children. The state of Washington D.C., with more than five hundred seventy thousand people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Washington D.C. who meet specific eligibility requirements of age and income.

The Washington D.C. Department of Insurance, Securities and Banking manage and supervise all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s moderate public health funding, approximately 10.6% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 38.2% of Washington D.C.’s uninsured residents come under the above 200% FPL category.

Buying health coverage is not so simple. Nevertheless, through a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are ideal for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Washington D.C. These regulations apply to all insurance companies offering individual or family health insurance in Washington D.C.:

Medical Underwriting
Pre-Existing Condition Exclusion Period
No Limit
Look Back Period
No Limit
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women, breast cancer screening, reconstruction surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as primary care providers,
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Washington D.C. These regulations apply to all insurance companies offering small group health insurance in Washington D.C.:

Small Group Size
Employee Qualifications
Proof of Employment
Guaranteed Issue
Premium Rating Factors
No Rating Restrictions
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Washington D.C. For employer groups of more than 20 employees, refer to the federal COBRA guidelines.

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
3 months
Extension of Benefits Period – Disabled
3 months
Maximum Premium Increase
102 to 150%%
State Legislation Reference

Additional Notes
Must apply within 45 days of losing coverage
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Washington D.C. to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Washington D.C. does not offer health insurance coverage through state high risk pool program for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Washington D.C. provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
DC Healthy Families Insurance Program
Phone Number
888- 557-1116
Apply Online
Age Limits
Under 19
Insurance Carrier
Amerigroup Corporation, DC Chartered Health Plan, Health Right
Length of Coverage
12 months
Residency Requirements
DC residents, U.S. citizens
Other Eligibility Requirements
Income Levels for eligible families should be equal to or below 300% of FPL
Pre-Existing Condition Exclusions

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Washington D.C.

Governing Agency
Phone Number
Residency Requirements
DC residents, U.S. citizens
Federal Poverty Line Income Limits
Children Ages 0-19 and Pregnant Women may have an income up to 300% of the FPL
Aged, Blind and Disabled: 100% FPL
SSI Recipients: 74% FPL
Medically Needy Individual: 53% FPL
Medically Needy Couple: 41% FPL
Additional Resources

DC Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Washington D.C.’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
DC: At a Glance
Provides exclusive health data of Washington D.C. is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.