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Health Care Reform:

Health Insurance & Affordable Care Act

DC Health Link

Plans and Costs continued...

A single 27-year-old could choose a silver-level plan (which pays about 70% of medical costs) that ranges from $178 a month to $238 a month. For a 40-year-old, silver-level plans range from $238 to $319 a month. The cost of a silver-level plan For a 55-year-old can range from $424 to $567 a month.

Who Can Sell Insurance in the Marketplace: Three companies are offering individual plans through DC Health Link. They are Aetna, CareFirst BlueCross BlueShield, and Kaiser Permanente.

Benefits

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:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays, including hospice  
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment (Includes inpatient substance abuse services for 60 days)
  6. Prescription drugs, including generic and certain brand-name drugs
  7. 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.
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions. Includes nutrition counseling and therapy.
  10. Services for children, including dental  and eye care

Some services not included: infertility treatments, long-term care, and weight loss surgery. But insurers can cover these services if they want.

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.

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