What's covered: All approved plans in the district must cover the same package of benefits, called essential health benefits. In the District of Columbia, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital
- Emergency services
- Hospital stays, including hospice
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment (Includes inpatient substance abuse services for 60 days)
- Prescription drugs, including generic and certain brand-name drugs
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In D.C., habilitative services include behavioral analysis for the treatment of autism in children. Habilitative services are also limited to those under 21.
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions. Includes nutrition counseling and therapy.
- Services for children, including dental and eye care
Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.
Financial Aid and Medicaid
You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:
Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.
You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.
Medicaid Expansion: Some states, along with D.C., expanded Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,500 for a family of four.
CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid.
Check with DC Health Link to see if you are eligible for these programs.
Trained navigators and assisters can teach you about the Marketplace and guide you through enrollment. They are supposed to be fair and impartial and cannot take money from insurance companies. Trained insurance agents also can help you with your choices. Here are several ways you can get help with your insurance decisions:
- Call Center: Call 855-532-5465 for information about your insurance options.
- Web Site: Find information about the District of Columbia’s Marketplace at DC Health Link. You can create an account, find information about different plans, and buy insurance.
- Other resources: Go toGet Help to find a licensed broker or an assister.
- Consumer Assistance Programs: These programs will help you understand your rights under the new law. They can help you with problems, complaints, and appeals. D.C.’s program is run through the District of Columbia Healthcare Finance’s Office of the Ombudsman.