Washington, D.C., the nation’s capital. It’s filled with dozens of national and historical landmarks, museums and people who need health insurance. Almost 70,000 D.C. residents do not have health insurance, which is essential to protecting the health of you and your family. To help guide you through the process of finding the right medical coverage to suit your needs, we at Health-Insurance.org have assembled the following information about health insurance in Washington, D.C.
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Individual Medical Coverage Options in Washington, D.C.
If you’re not covered under your employer’s health plan or your family’s policy, you may want to obtain medical coverage for yourself. The first choice you have to make is whether to take out a group or individual policy. Group policies, such as HMO and PPO networks, charge an annual premium plus a copay (usually around $20 or so) when you visit one of their doctors. These policies tend to be cheaper than individual policies, which have the benefit of being especially written for the person who buys it.
Insurance carriers in D.C. are permitted to turn you down if you have a health problem. However, if you get sick after your coverage has started, your policy cannot be canceled.
Washington, D.C. Family Health Insurance Regulations
Looking for a health plan for your family? Start by checking if your employer’s health plan will cover your family members as well. If not, decide whether you want to buy a group policy or an individual one. Group plans are fairly comprehensive and cost-effective, but if any of your family members have specific health issues, an individual policy can be written exclusively for your needs.
Washington, D.C. law mandates that group insurers provide coverage for all families who are eligible, even if they have health problems. To look for health problems, carriers can only search the past 6 months of your medical records. If any are found, your carrier can impose a (max. 12 month) exclusion period on your policy. In addition, if you take a family or medical leave of up to 16 weeks in length, your employer cannot cancel your benefits.
Living in DC and looking for a health plan? Request a quote today!
Pre-Existing Conditions and Washington, D.C. Health Insurance
If you have a preexisting health condition, such as diabetes, heart disease, or high cholesterol, you will face many more hurdles than healthy people when trying to obtain health coverage. For example, individual health plan carriers can turn you down, and both individual and group insurers can give you an exclusion period of up to 10 and 12 months, respectively, if you have a preexisting condition. But if you take the time to explore all your options, you should be able to find a good health care plan.
One good resource is CareFirst Blue Cross Blue Shield (BCBS). In Washington D.C., BCBS is required to offer you individual health insurance, and present you with at least two types of policies to choose from. If you are HIPAA-eligible and are purchasing a guaranteed-issue plan, CareFirst cannot give you an exclusion period. Your plan could be expensive, as the state does not set a ceiling on the rates you can be charged.
How to Get a New Health Plan in Washington, D.C.
If you’re new to D.C. or are transitioning between jobs, you’ll probably have to change your health policy. There are a few issues associated with this process, which we’ve listed for you below:
- If you want to purchase a plan from the carrier that provided your employee health coverage, speak to someone about exercising your COBRA, or state continuation rights.
- Employers in Washington, D.C. are not required to provide you coverage. If they do, they are allowed to give you awaiting period before permitting you to enroll in their group plan.
- Certain public employers, such as local government agencies and school districts, are not subject to the same regulations we have discussed above.
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