Shop and Save with Standard Plans

standard plans

Many DC Health Link Individual & Family plans are designed to make shopping easier and health care more affordable. These plans are called standard plans.

Standard plans help you in 2 ways:

Covering Services Before You Meet Your Deductible

Deductibles can be a struggle. DC Health Link’s standard plans make it easier to get essential medical care when you need it. Standard plans cover essential in-network services without you having to meet the deductible first. These services include:

  • Primary care
  • Specialist visits
  • Generic drugs
  • Urgent care
  • Outpatient mental and behavior health
  • Outpatient substance abuse treatment
  • Type 2 diabetes treatment including:
    • Unlimited Primary Care visits
    • 1 dilated retinal exam per year
    • 1 diabetic foot exam per year
    • Unlimited nutritional counseling visits
    • 1 lipid panel test per year
    • 2 hemoglobin A1C test per year
    • 1 Microalbumin urine test or nephrology visit per year
    • 1 basic metabolic panel per year
    • 1 liver function test per year
    • A select list of diabetes supplies and medications, including insulin, within the diabetic agent drug class.

Please use our Plan Match tool to check which prescription drugs are covered with no cost-sharing for the treatment of type 2 diabetes.

If you need other services related to Type 2 Diabetes, they are covered but cost sharing applies. Check your plan documents for a complete list of services, items, and prescription medications covered.

New! Starting in 2024, standard plans will cover pediatric mental health visits with $5 copays.

sbc box
To see what services a standard plan covers before the deductible, look at the plan’s Summary of Benefits and Coverage. In the “What You Will Pay Plan Provider” column, you don’t have to meet the deductible first for a service if it says “deductible does not apply.” For example, a standard plan with a $3,500 deductible might list the cost for an in-network primary care provider as “$40/visit, deductible does not apply.” This means that your cost to see a primary care provider for this plan would be $40, even if you haven’t met your deductible.

Important EXCEPTION: There is one exception. If you choose a high deductible health plan eligible for a Health Savings Account (HSA), you’ll still need to meet the deductible first because of Internal Revenue Service rules. If you enroll in a Standard HSA plan, you will NOT have pre-deductible coverage. You will first have to meet your deductible.

Save Time Shopping

Each health insurance company in DC Health Link’s Individual & Family market offers a standard plan at each metal level. These plans have the same out-of-pocket costs for an in-network provider. For example, a primary care visit will have a $40 copay for any silver standard plan, whether you choose CareFirst BlueCross BlueShield or Kaiser Permanente. The major differences between standard plans at the same metal level are monthly premiums and provider networks. Comparing standard plans side-by-side makes it faster and easier to find the right plan that meets your needs and budget.