Healthy DC Plan for District Residents Who Lost Medicaid Coverage
The Healthy DC Plan is quality health coverage for DC residents who qualify. If you lost Medicaid because Medicaid eligibility changed on December 31, 2025 and you qualify for Healthy DC Plan, we automatically enrolled you into a Healthy DC Plan beginning January 1, 2026.
If you lost Medicaid after January 1, 2026, you are eligible for a special enrollment period. You need to select a plan for your new coverage to begin.
How do I enroll if I lost Medicaid on December 31, 2025?
Individuals who lost their Medicaid coverage on December 31, 2025 due to eligibility changes were automatically enrolled into a Healthy DC Plan if they were eligible. If your Medicaid was with AmeriHealth Caritas DC or with MedStar Family Choice, we automatically enrolled you into a Healthy DC Plan with the same company you had your Medicaid coverage with. Although your benefits and some providers may be different, the company providing your new coverage is the same.
If your Medicaid was with Wellpoint DC, we automatically enrolled you into a Healthy DC Plan with CareFirst BlueCross BlueShield. Your insurance company will mail you your new insurance card. Each enrolled person in the family will receive their own insurance card. When you go to the doctor, make sure you bring your new insurance card. If you need to go to the doctor and do not have your new card yet, you can call your insurance company to get your plan details.
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 |
How do I enroll if I lost Medicaid after January 1, 2026?
Individuals who lost or are losing Medicaid coverage after January 1, 2026, are eligible for a special enrollment period. You must log in to or create an account with DC Health Link and select a plan for your new coverage to begin. In your account, select ‘Loss of Medicaid coverage’ under ‘Have life changes?’ on the right-hand side of the screen.
To learn more about your plan options, use the DC Health Link Plan Match tool. You can also book an appointment to get free expert help from a DC Health Link Assister.
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 you get care from participating doctors and hospitals, and community health centers, there is no out-of-pocket cost to you.
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 your plan’s summary of coverage (SOC). Use our Healthy DC Plan Match Tool for more information on coverage and prescription medication.
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?
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.
Important information about pregnancy: If you become pregnant, you will no longer be eligible for Healthy DC Plan. Medicaid will cover you, including delivery and 12 months of post-partum care.
Keeping your Healthy DC Plan
It is very important to keep your information updated in order to keep your Healthy DC Plan coverage. You must report any changes to your income, address, tax filing status, and immigration status.
Need help?
HEALTHY DC PLAN CONTACT CENTER
(833) 432-7526 / TTY: 711
Mon-Fri 8am-6pm
CONTACT FORM
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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