When you enroll in coverage through DC Health Link, you may find that you’re eligible for subsidies that can cover some of your monthly premiums and possibly also reduce your out-of-pocket costs for medical care.
These subsidies are not as common in DC as they are in other states. There are three main reasons for this:
Subsidy eligibility is based on income, and median household income in DC is significantly higher than the rest of the country.16 There is no option to enroll outside the exchange in DC.6 In other states, people who know they aren’t eligible for subsidies might enroll off-exchange, but that’s not an option in DC. Medicaid (and the new Basic Health Program that became ailable as of 2026) covers more low-income people in DC, whereas they would be eligible for Marketplace subsidies instead in most other states.Regarding that third point, there were some changes for 2026, but subsidy eligibility still starts at a higher income level in DC, as the state debuted a new Basic Health Program (Healthy DC Plan) starting with the 2026 plan year.15
Prior to 2026, DC Medicaid was ailable to adults under age 65 if their household income didn’t exceed 215% of the federal poverty level (as opposed to 138% in other states that he expanded Medicaid). But starting with the 2026 plan year, Medicaid eligibility extends to 138% of the poverty level in DC. Healthy DC Plan eligibility starts above that level and extends to 200% of the poverty level.15
As a result of the points detailed above, only 28% of DC Health Link enrollees were receiving federal premium subsidies as of 2025, versus 93% of Marketplace enrollees nationwide.17
Source: CMS.gov18
Premium subsidy eligibility will depend on how your household income compares with the cost of the second-lowest-cost Silver plan in your area, which will depend on your age. (In most states, it also depends on your location, but DC is one rating area so there are no location-specific rate differences within the District.19)
Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which will reduce the deductible and other out-of-pocket expenses for Silver-level plans. But only 3% of DC Health Link enrollees were receiving these subsidies as of 2025, versus 53% of Marketplace enrollees nationwide.17 Again, this is due in large part to the fact that people with income between 139% and 215% of the poverty level were eligible for Medicaid in DC, whereas they were eligible for premium subsidies and CSR in other states.
(As noted above, Medicaid expansion in DC extends only to 138% of the federal poverty level as of 2026, matching most other states. But DC debuted a new Basic Health Program as of 2026, which offers coverage up to 200% of the federal poverty level. So it continues to be the case that relatively few people qualify for CSR benefits in DC, as they are instead eligible for Medicaid or the Healthy DC Plan.)
The plans ailable through DC Health Link include both standardized and non-standardized plans. All of the plans comply with the ACA, but standardized plans also conform to additional District-specific rules that include pre-deductible coverage for various services.20 Since 2024, outpatient mental health visits for children with standardized DC Health Link plans he only a $5 copay, with no deductible.21
And starting with the 2026 plan year, standardized plans do not he cost-sharing for HIV treatment.22
Learn more about whether you might be eligible for Medicaid in Washington DC.