D.C. has minimized cost as a barrier to medical care through required standardized plan designs, according to a recent 50-state study by the Georgetown University Center on Health Insurance Reforms and Urban Institute.
The study, funded by the Robert Wood Johnson Foundation, found that the District and six states lowered cost-sharing for specific health services and drugs with standardized benefit plans sold through the Affordable Care Act’s state-based health insurance marketplaces.
DC Health Link, the District’s online health insurance marketplace, offers standardized plans so that consumers can make “apples-to-apples” health insurance plan comparisons knowing that every standard plan within the same metal tier has the same cost-sharing amounts and benefits. These plan designs focus on ensuring that people can access certain medical services without deductibles and with low out-of-pocket costs.
Standardized plans have been available through DC Health Link’s individual marketplace for several years. The standardized plan designs were developed in 2014 and 2015 and first offered through DC Health Link in 2016.
The plans cover pre-deductible services with zero to moderate co-payment amounts for doctor’s visits for non-preventative primary care and specialty care, mental health and substance abuse, urgent care and generic prescription drugs.
“From day one, DC Health Link has offered robust coverage choices,” said Dr. Leighton Ku, chair of the DCHBX Standard Plans Advisory Working Group. “Policies such as standardized benefit design help simplify consumer decision-making and create a more transparent and competitive shopping experience for District residents, while improving access to medical care.”