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Get Covered. Stay Covered.

DC'S INDIVIDUAL RESPONSIBILITY REQUIREMENT

A DC law begins in 2019 that requires residents to have qualifying health coverage, get an exemption, or pay a penalty on their DC taxes.

All DC Residents Must:

Have health insurance

Get Covered, Stay Covered

Find a plan, see if you qualify for cost savings, and learn about what kind of coverage is required.

Pay a penalty on their taxes

Pay a tax penalty

Find out about the penalty for not having qualifying health coverage or an exemption.

GET COVERED

Find medical coverage that meets your needs and budget. See if you also qualify for a tax credit or Medicaid.

STAY COVERED

Health coverage that provides a broad range of health services like doctor visits, hospitalization, emergency services and prescription drug coverage meets DC's individual responsibility requirement. For every month that you have any of the following coverage, you do not need to have an exemption or pay a penalty on your taxes.

If you have a questions about a plan type not listed below, contact the insurance company and ask whether it meets the federal requirement for minimum essential coverage. If it does, it likely meets DC's individual responsibility requirement.

Employer-sponsored coverage

  • Comprehensive employer-provided plans
  • COBRA coverage
  • Retiree coverage
  • Expatriate employee coverage

Individual & family coverage

  • All plans purchased through DC Health Link
  • Coverage you get through a parent's plan
  • Health plans purchased directly from an insurance company if the plan provides a comprehensive range of benefits
  • Most student health plans (check with your school to see if the plan counts as qualifying health coverage)
  • All plans purchased through healthcare.gov or another state health insurance marketplace

Government-sponsored coverage:

  • Medicare and Medicare Advantage
  • DC Medicaid
  • DC Healthcare Alliance
  • TRICARE
    • Check with the US Department of Defense if there are limitations on your coverage that would make it not qualify as minimum essential coverage.
  • US Veterans Affairs coverage
  • Peace Corps coverage
  • Refugee medical assistance
  • Immigrant Children's Health Insurance Program

Plans that don’t meet the requirement:

  • Limited benefit plans - for example, indemnity, hospital-only, vision-only, or dental-only. The coverage still does not count if a few categories of health services are covered, but overall most essential health services are not.
  • Short-term, limited-duration plans
  • Multiple employer welfare arrangements like an association health plan, unless the plan provided coverage in DC on December 15, 2017 or complies with federal laws in place for such plans on that date.

PAY A TAX PENALTY IF YOU GO WITHOUT COVERAGE

Find out about the penalty for not having qualifying health coverage or an exemption.

QUALIFY FOR AN EXEMPTION

All DC residents must have health coverage or pay a tax penalty for the months that they do not have coverage. Some people qualify for an exemption from the tax penalty. You can claim most exemptions on your tax return.

Find an Exemption

Answer a few questions to see if you may qualify for an exemption. We'll tell you how to apply for or claim each one that applies to you.

Types of Exemptions

Exemptions you claim on your tax return

You qualify to claim an exemption on your tax return if any of the situations listed below applied to you during the months you didn't have health coverage:

  • Income low enough that you aren't required to file a DC tax return (even if you choose to file). Tax filing thresholds increase a bit each year. The tax filing thresholds for 2018 were:
    • Single: $12,000
    • Married filing jointly: $24,000
  • Generally, if your income is low, which means you are likely eligible for Medicaid. Learn more
  • Did not have coverage for less than 3 consecutive months during the year
  • Not a resident of the District of Columbia for the months you were not covered
  • Enrolled in DC Healthcare Alliance coverage
  • US citizen who lived abroad during the tax year or was not lawfully present (i.e., not a US citizen, not a US national, or not an alien lawfully present in the US)
  • Membership in a health care sharing ministry
  • Member of a religious sect that is conscientiously opposed to accepting health benefits, including Social Security and Medicare
  • Did not have coverage based on a sincerely-held religious belief
  • Member of a federally-recognized Indian tribe
  • Incarceration (serving a jail or prison sentence)

Exemptions you must apply for through DC Health Link

There are two types of exemptions that require you to submit an application to and gain approval from DC Health Link: Hardship and affordability.

Hardship Exemptions

If you were not able to obtain coverage due to financial or personal circumstances, including unexpected events that prevented you from obtaining coverage, you may qualify for a hardship exemption. You may qualify if, during the year, you:

  • were homeless.
  • were evicted in the past 6 months or were facing eviction or foreclosure.
  • received a shut-off notice from a utility company.
  • experienced domestic violence.
  • experienced the death of a family member.
  • experienced a fire, flood, or other natural human-caused disaster that cause substantial damage to your property.
  • filed for bankruptcy in the last 6 months.
  • had medical expenses you couldn't pay in the last 24 months.
  • were pregnant and had an annual household income at or below 324% of the Federal Poverty Level.
  • experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
  • expected to claim a child as a tax dependent who's been denied coverage in Medicaid, and another person is required by court order to give medical support to the child.
  • you successfully appealed an eligibility decision by DC Health Link.

Affordable Coverage Exemptions

Coverage is considered unaffordable if you would have to pay more than about 8 percent of income for the lowest cost plan available to you.

Important: To qualify for an affordability exemption, you must complete two applications – an Application for Coverage with Financial Assistance and an Affordability Exemption Application.

Other Reasons to Get an Exemption

  • Using an Exemption to purchase a Catastrophic Plan

    Usually catastrophic health plans are only available to people under 30. If you are determined eligible for either a hardship exemption or an affordability exemption, you’re eligible to enroll in a catastrophic health plan, even if you are over 30. Catastrophic health plans are designed to protect you from only worst-case situations like a serious illness or accident.

  • Using an Exemption to get a Special Enrollment Period

    If you’re found eligible for a hardship or affordability exemption, the exemption may be for the entire year or only part of the year. If it is for part of the year, once it expires you may be eligible for a special enrollment period. A special enrollment period allows you (and your family) to enroll in insurance through DC Health Link outside the open enrollment period.

Apply for a hardship or affordability exemption

Most exemptions from the District's individual responsibility requirement can be claimed on your tax return. You only need to submit an exemption application to DC Health Link and be approved for affordability and hardship exemptions. Learn more about exemption types.

If you're not sure what kind of exemption you need, use our exemption tool to quickly determine if you may qualify, and if you do, what you need to do next to get an exemption approved.

How to submit an exemption application to DC Health Link

Send your signed application to:

Email Address

info@dchealthlink.com

Mailing Address

DC Health Benefit Exchange Authority
Exemption Processing Unit
1225 Eye Street, NW
Suite 400
Washington, DC 20005

Important: Depending on the type of exemption you're requesting, you may need to include copies of supporting documents with your application. (Do not send originals).

PAY A TAX PENALTY

A DC law begins in 2019 that requires residents to have qualifying health coverage, get an exemption, or pay a penalty on their DC taxes. The penalty is based on the number of months an individual or family goes without health coverage. For someone who goes without coverage for a full year, the penalty is:

$695 for each adult and $347.50 for each child, up to $2,085 per family

2.5% of family income that is over the federal tax filing threshold, whichever is greater *

Here's an example for a family of 4 with a household income of $98,000
$695
$695
$347.50
$347.50

Total: $2,085

2.5% of $74,000

($98,000 - $24,000 = $74,000)

Total: $1,850

GET AN EXEMPTION

Find out if you qualify for an exemption if you don't have qualifying health coverage.

* The tax penalty for not having coverage in DC will never be higher than the average premium for a bronze level health plan available through DC Health Link.