Healthy DC Plan for Providers
(Doctors, Hospitals, Community Health Centers, Pharmacists, and others that provide patient care)
The Healthy DC Plan is quality health coverage for DC residents who qualify. There are no monthly payments and no costs when you get care. All plans cover doctor visits, urgent care visits, hospital stays, prescription drugs, mental health care, and more.
Healthy DC Plan began on January 1, 2026. Residents who lost Medicaid on December 31, 2025 because Medicaid eligibility changed, and who qualified for Healthy DC Plan, were automatically enrolled in Healthy DC Plan without a gap in coverage.
Which insurance companies are offering Healthy DC Plan?
There are three insurance companies offering Healthy DC Plan:
- AmeriHealth Caritas District of Columbia Healthy DC Plan
- CareFirst BlueCross BlueShield Healthy DC Plan
- MedStar Family Choice Healthy DC Plan
Where can I check enrollment for Healthy DC Plan members?
You can access the provider portals for the three insurance companies offering Healthy DC Plan below.
AmeriHealth Caritas District of Columbia Provider Portal (login required)
CareFirst BlueCross BlueShield Provider Portal (login required)
MedStar Family Choice Provider Portal (login required)
Where can I check benefits, provider networks, and prescription drug coverage for Healthy DC Plan members?
All three insurance plans cover the same services. The major differences are provider networks and prescription drug coverage. Use our Healthy DC Plan Match Tool for more information on coverage and prescription medication. You can also visit the insurance company provider websites:
Will patients get a Healthy DC Plan insurance card?
Healthy DC Plan enrollees will get an insurance card from their Healthy DC Plan. All Healthy DC Plan enrollees will have a new Healthy DC Plan insurance card and Healthy DC Plan member ID number, even those who are enrolled with the same insurance company they were previously enrolled with in Medicaid.
Each enrolled person in the family will receive their own insurance card in the mail. If a patient does not have their new insurance card yet, they can login to the health insurance company’s enrollee portal for an electronic insurance card.
For DC residents losing Medicaid because Medicaid eligibility changed on December 31, 2025, how did automatic enrollment into Healthy DC Plan work?
For DC residents who lost Medicaid December 31, 2025, we automatically enrolled individuals into a Healthy DC Plan with the same company they had with Medicaid. If their Medicaid was with Wellpoint DC, we automatically enrolled them into a Healthy DC Plan with CareFirst BlueCross BlueShield.
Summary of Automatic Enrollment
| Medicaid Plan | Healthy DC Plan |
|---|---|
| AmeriHealth Caritas DC Medicaid MCO | AmeriHealth Caritas District of Columbia Healthy DC Plan |
| MedStar Family Choice Medicaid MCO | MedStar Family Choice Healthy DC Plan |
| Wellpoint DC Medicaid MCO | CareFirst BlueCross BlueShield Healthy DC Plan |
Are there out-of-pocket costs for Healthy DC Plan?
No. Healthy DC Plan does not have monthly payments (also called premiums) or out-of-pocket costs for covered services. When residents get care from participating doctors and hospitals, and community health centers, there is no out-of-pocket cost.
What does Healthy DC Plan cover?
The Healthy DC Plan covers essential health care services including:
- Primary care doctor visits
- Specialist doctor visits
- Urgent care visits
- Hospitalizations and emergency care
- Laboratory services
- Prescription drugs
- Mental health, behavioral health, and substance use disorder services
- Preventive care
Are there services I get with Medicaid that are not covered by Healthy DC Plan?
Yes. Healthy DC Plan does NOT cover:
- Adult dental
- Adult routine vision services, such as eye exams, and glasses or contact lenses.
- Eye care needed to diagnose and treat disease is covered (e.g., are to treat eye infections, conjunctivitis, dry eye, diabetic eye disease, or glaucoma). See each plan’s Evidence of Coverage for more information.
- Non-emergency transportation
- Community behavioral supports, such as housing support
There are other differences between Healthy DC Plan and Medicaid. For more information about covered services and non-covered services, review the plan’s summary of coverage (SOC).
Coverage Details
For more information on covered services, download and review each plan's Summary of Coverage (SOC) and Evidence of Coverage (EOC).
Who is eligible for Healthy DC Plan?
Starting January 1, 2026, DC residents are eligible for Healthy DC Plan if they are:
- 21-64 years old;
- US Citizen or lawfully present;
- Not eligible for Medicaid;
- Not eligible for employer or other coverage; and
- Have an annual income between 138% and 200% of the Federal Poverty Level. For more information, see the Income Eligibility for Healthy DC Plan table below.
Income Eligibility for Healthy DC Plan
| Household Size* | You qualify if your annual income is:** |
|---|---|
| 1-person household, annual income | $22,025 - $31,920 |
| 2-person household, annual income | $29,863 - $43,280 |
| 3-person household, annual income | $37,702 - $54,640 |
| 4-person household, annual income | $45,540 - $66,000 |
*Contact us about eligibility for larger households.
**Special Eligibility for Lawfully Present Residents: If a lawfully present resident with an annual income below 138% of the federal poverty level is not eligible for Medicaid due to immigration status, the resident is eligible for Healthy DC Plan in 2026.
Need help?
HEALTHY DC PLAN CONTACT CENTER
(833) 432-7526 / TTY: 711
Mon-Fri 8am-6pm
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If you don’t find what you’re looking for, please fill out this contact form for more assistance from our team.
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