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Washington DC Health Insurance
Health insurance is an indispensable alternative when it comes to insuring your financial future. Protecting your family against the occurrence of illness or injury is difficult; however a suitable health policy can relieve your financial burden caused by these events. When it comes to purchasing health coverage, your top priority should be evaluation of all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, have to bear the brunt of the lack of proper health insurance. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.
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 | Yes |
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 | None |
Guaranteed Issue Options | None |
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 | 2-50 |
Employee Qualifications | Proof of Employment |
Guaranteed Issue | Yes |
Premium Rating Factors | No Rating Restrictions |
Rate Adjustment Factors | None |
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 | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 3 months |
Extension of Benefits Period - Disabled | 3 months |
Maximum Premium Increase | 102 to 150%% |
State Legislation Reference |
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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 |
Website | http://doh.dc.gov/doh/cwp/view,a,1371,q,575879,dohNav_GID,1807.asp |
Phone Number | 888- 557-1116 |
Apply Online | Yes |
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 | Yes |
Cost | None |
Medicaid
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 | Mediciad |
Website | |
Phone Number | 202-724-5506 |
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 |
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 HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com 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. Statehealthfacts.org 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.
