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Overview
The federal health law known as the Affordable Care Act provides individuals and families, regardless of income, new rights, benefits, and responsibilities when it comes to their health insurance.
An important goal of the law is ensuring that people have affordable, high-quality health coverage. It also makes it much easier for people to shop for private health coverage, to get lower monthly premiums for private insurance, and to apply for Medicaid.
The District of Columbia established DC Health Link to help people find, compare, and enroll in health coverage that meets their needs and budget. Below is a summary of the major parts of the law that affect individuals and families.
Putting You in the Driver's Seat
Before the Affordable Care Act, the private health insurance market did not work well for many people. You may have been unable to find affordable coverage, been denied coverage, charged a much higher premium if you had medical needs, or learned your health insurance did not cover treatment for your pre-existing medical condition.
Some insurance plans also had 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 Affordable Care Act changed all that.
Your Rights
- 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. 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. 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.
Your Benefits
All private health plans available through DC Health Link must cover essential health benefits that include:
- 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
There are no out-of-pocket costs for most preventive services like cancer screenings, immunizations, smoking cessation, and well-baby and well-child visits. For a list of preventive care that must be provided, visit healthcare.gov. Also, there can be no limits on the number of mental health or substance abuse treatment visits.
View the available health plans on DC Health Link.
Your Responsibilities
A DC law began in 2019 that requires residents to have qualifying health coverage, get an exemption, or pay a penalty on their DC taxes. This is called the individual responsibility requirement.