The federal health law (also known as the Affordable Care Act) provides individuals and families new rights, benefits, and responsibilities. Many of these take effect in 2014.
An important goal of the law is ensuring that individuals and families have access to affordable, high-quality health coverage. It will also make it much easier for people to shop for health insurance coverage through what are called insurance marketplaces.
The District has established DC Health Link [PDF], a new marketplace designed to help people find, compare, and select the insurance policy that meets their needs and budget. This page provides a summary of the major parts of the law that will affect individuals and families who do not have job-based health insurance coverage. To stay informed, visit DCHealthLink.com.
Putting You in the Driver's Seat
The existing private health insurance market has not worked well for many people. You may have been denied coverage or charged a much higher premium if you had medical needs, or your health insurance did not cover treatment for your pre-existing medical condition. Insurance policies were allowed to place annual or lifetime caps on your benefits that may have left you without enough insurance coverage when you were sick. Women of child-bearing age were charged more than men. And some people paid more for coverage if they worked in construction and other high-risk jobs.
The new health care law has changed all of that.
- Insurance companies are not allowed to turn you down or charge you more because of a current or past medical condition like diabetes, heart disease, or cancer. And they must pay for care related to your condition.
- Insurance companies are not allowed to charge you more because you are a woman of child-bearing age or because of your occupation. And there are limits on how much more insurers can charge older people.
- Insurance companies are not allowed to cap your benefits annually or have lifetime dollar caps.
- Doctor visits
- Hospital stays
- Emergency room care
- Maternity and newborn care
- Prescription drugs
- Lab tests
- Preventive tests and services
- Rehabilitative and habilitative services and devices
- Chronic disease management
- Mental health care
- Substance use disorder services
- Dental care for children
- Vision care for children
Starting in January 2014, most people are required to have health insurance or pay a penalty. In 2014, the yearly penalty is $95 per person but it will rise to $695 by 2016.
To make coverage more affordable, many people will get help paying their premiums. If you qualify, the federal government will pay part of your premium based on your income and you will pay the rest. Some people will also get help with their cost-sharing expenses. If your income is low enough, you may qualify for Medicaid.
What Is DC Health Link?
When Can I Shop for Health Insurance?
Who Can Shop for Health Insurance at DC Health Link?
- You are uninsured;
- You buy your own health insurance;
- You work for a small business that buys coverage through DC Health Link; or
- You work part-time and don’t qualify for your employer’s benefits.
Will I Be Able to Get Help Shopping for Health Insurance?
What Insurance Companies are Planning to Participate?
- CareFirst BlueCross BlueShield
- Kaiser Permanente
How Will I Know if I'm Eligible for Help Paying My Premiums?
- You are a single adult with income between $22,980 and $45,960
- You are a married couple with combined income between $31,020 and $62,040
- You are a family of three with total income between $39,060 and $78,120
- You are a family of four with total income between $47,100 and $94,200