Best Health Insurance in Washington D.C.
Best Overall for Health Insurance in Washington D.C.
Kaiser Permanente is the best health insurance provider in Washington D.C., earning a MoneyGeek score of 88 out of 100. This company offers affordable rates, low MOOP costs and above-average claims processing. Our findings are based on Silver health plans in Washington D.C., including 25 HMOs and five PPO plans.
Claims denial rate of 0%
Lower average MOOP than its competitors
Cheaper average rate than its competitors
Only offers HMO plans
Kaiser Permanente is MoneyGeek’s winner for Washington D.C.’s best overall health insurance provider. Although it only offers HMO plans, the least flexible of all health plans, it features cheap rates averaging $450 per month. On top of being more affordable, Kaiser Permanente also has a lower average MOOP cost of $7,988 — almost a thousand dollars less than its competitors. We also found that while most other providers deny around 2% to 49% of claims, Kaiser Permanente has an excellent claims denial rate of 0%. It accepts all valid claims and pays for all legitimate coverage requests.
MoneyGeek recommends Kaiser Permanente’s KP DC Silver 3300/30%/HSA/Vision, costing roughly $428 per month with a MOOP of $6,650.
Best Health Insurance in Washington D.C. for Low Out-of-Pocket Costs
Kaiser Permanente is the best health insurance company in Washington D.C. for consumers looking for low out-of-pocket costs. It received a MoneyGeek score of 58 out of 100 for its affordable monthly premiums and excellent claims management. Our analysis focused on Gold and Platinum plans in Washington D.C., covering 45 HMOs and 15 PPO plans.
Low MOOP cost
Accepts a high percentage of claims
Has the most affordable rates
Limited to HMO plans
Consumers in the market for health insurance with low maximum out-of-pocket costs may fare best with our winner, Kaiser Permanente. It offers 25 Gold HMO plans and five Platinum HMO plans, averaging $556 per month — the lowest rate for higher metal tier plans in Washington, D.C. Kaiser Permanente’s Platinum plan costs almost the same as its competitors' Gold plans and $93 to $130 less than other Platinum plans. This means that with Kaiser Permanente, you may benefit from lower premiums while enjoying broader coverage. Another upside is that the company also upholds most insurance claims. Most other providers in the U.S. deny around 17% of policyholders’ coverage requests. However, this insurer’s average MOOP cost of $5,283 for higher metal tier plans is around $1,683 more than its competitor’s rate.
MoneyGeek recommends Kaiser Permanente’s KP DC Gold 1600/25%/HSA/Vision. It costs approximately $495 per month and comes with a MOOP of $5,000.
Best Cheap Health Insurance in Washington D.C.
Kaiser Permanente is Washington D.C.’s best cheap health insurance provider, receiving an impressive MoneyGeek score of 94 out of 100. Its Silver plans cost approximately $450 per month, around $60 cheaper than its competitors. Our study included 25 HMOs and five PPO plans.
We determined the winner for this category by focusing on the affordability of premiums above all else. But there’s typically a trade-off between monthly premiums and MOOP cost — cheaper plans tend to have higher MOOPs.
If you're focused soley on cost, MoneyGeek also determined the cheapest health insurance in Washington, D.C..
Exceptional claims management
Limited plan offerings
MoneyGeek recommends Kaiser Permanente as the best cheap health insurance provider in Washington D.C.. Its Silver plans are competitively priced at an average monthly premium of $450 and a $7,988 MOOP cost. This means you could spend less on your health needs each month, and your insurer should pay its share of costs earlier when you receive medical care. With this insurer, you can choose from 20 Silver plans. You'll benefit from Kaiser Permanente's strong reputation for efficient claims processing, and it rarely denies coverage. With other health insurance providers, approximately 17.3% of in-network claims for Silver plans are denied. But with Kaiser Permanente’s exceptional claims management record, policyholders can have peace of mind knowing their coverage requests will be given prompt attention, so you shouldn't have to dip into your savings or get into crippling debt when settling your medical bills.
If you’re looking for the most affordable health plan, we suggest purchasing Kaiser Permanente’s KP DC Silver 3300/30%/HSA/Vision. It costs approximately $428 per month with a MOOP of $6,650.
Best Health Insurance for Young Adults in Washington D.C.
With a MoneyGeek score of 58 out of 100, Kaiser Permanente is the best health insurance provider for young adults in Washington D.C.. Our analysis focused on companies offering Bronze or Catastrophic plans. These tend to have low monthly premiums but high MOOP costs, making them better suited to younger individuals with no significant health issues. You need to be under 30 or have a hardship exemption to qualify for a Catastrophic plan.
For this category, we studied 29 HMOs and 10 PPO plans available in the state.
Exceptional claims management
Higher MOOP cost than its competitors
Kaiser Permanente is the best health insurance provider for young adults in Washington D.C.. A policy for the average 26-year-old Washington, D.C., resident costs roughly $281 monthly, $24 cheaper than its nearest competitor's rate. However, its MOOP is slightly higher at $8,550. Young adults in the District can choose from this insurer's 15 Bronze HMOs and two Catastrophic HMO plans. Another perk is Kaiser Permanente's low claims denial of 9.78%, making your valid coverage requests less likely to be denied. This is a huge plus considering other health insurance providers refuse around one-in-five claims from lower metal tier plans, which usually cater to young adults. For instance, we found that HealthCare.gov issuers denied claims for in-network services in 15.9% of Bronze plans and 19.7% of Catastrophic plans. But getting your valid claims denied likely won't be an issue with Kaiser Permanente.
Kaiser Permanente’s KP DC Standard Bronze 6350/20%/HSA/Vision is our top choice for young adults in Washington, D.C., which is priced at $295 per month for 26-year-olds and $266 per month for 18-year-olds and comes with a $6,900 MOOP.
We also recommend these plans from the same provider for young adults who don’t mind paying higher MOOP costs:
- KP DC Catastrophic 9100/0/Vision: $216 per month ($9,100 MOOP)
- KP DC Bronze 6500/65/Vision: $303 per month ($9,100 MOOP)
- KP DC Standard Bronze 7500/45/Vision: $311 per month ($9,100 MOOP)
Best Health Insurance by Plan Type in Washington D.C.
We found Kaiser Permanente has the best HMO plans, while Blue Cross Blue Shield is the only option in Washington, D.C., if you prefer a PPO plan. Health insurance providers typically offer different plan types that vary in coverage benefits, cost-sharing and flexibility.
MoneyGeek's study was limited to Silver plans, the middle-of-the-road option balancing monthly premiums and MOOP costs. Our recommendations are based on five HMOs and one PPO plan in Washington D.C..
Best for HMO: Kaiser Permanente
Kaiser Permanente is MoneyGeek’s top pick for the best HMO company in Washington D.C.. Its Silver plan averages $450 per month with $7,988 MOOP. These monthly premiums and MOOP costs are considerably lower than the rates that Kaiser Permanente's competitors offer. It also has a low claims denial rate, which means that policyholders rarely encounter difficulties getting their valid claims approved and paid. This frees policyholders from the stresses of facing unexpected expenses and a lengthy claims appeal process.
Buyers can choose from 20 Silver HMO plans from this insurer. Of the available plans, our top pick is Kaiser Permanente’s KP DC Silver 3300/30%/HSA/Vision, which earned a near-perfect MoneyGeek score of 99 out of 100 for offering the most optimal balance of cheap monthly premiums and low MOOP cost. It costs $428 monthly, only $2 more than Kaiser Permanente's most affordable Silver plan. In exchange, you could benefit from having a lower MOOP of $6,650.
Although HMO plans tend to be cheaper, you’re restricted to in-network providers and will need a referral to see a specialist.
MoneyGeek recommends Kaiser Permanente’s KP DC Silver 3300/30%/HSA/Vision, which costs approximately $428 per month and has a MOOP of $6,650.
Best for PPO: Blue Cross Blue Shield
Blue Cross Blue Shield is the only PPO plan provider we reviewed in Washington D.C., making it our outright winner for this category. On average, its Silver plans cost $542 per month with a MOOP of $8,850. If you’re considering this provider, note that it only carries five Silver PPO plans in Washington, D.C., and has a relatively high claims denial rate of 17.85%. That means one in every five claims gets denied.
Blue Cross Blue Shield is one of the country's largest health insurance providers, with one in three Americans relying on the company for affordable, safe, high-quality care. With Blue Cross Blue Shield as your insurer, finding a specialist won’t be a problem — BCBS has a network of 1.7 million doctors and hospitals across 50 states, Washington, D.C., and Puerto Rico.
PPO plans are generally more expensive than HMO plans. But they offer a more comprehensive network of physicians and health care facilities. You also won't need a referral to see a specialist.
We recommend Blue Cross Blue Shield’s BluePreferred Standard Silver $4,850, which costs approximately $542 per month and comes with a MOOP of $8,850.
How to Find the Best Health Insurance for You in Washington D.C.
Weigh your health care needs against your budget when choosing the best health insurance plan for you. The right choice provides the coverage you need with affordable monthly premiums and reasonable out-of-pocket expenses. Below are the two most important factors to examine when shopping for a health insurance plan.
Understand when a health insurance plan will cover you
Plans vary in coverage and benefits, so it’s wise to study whether a health insurance plan you’re considering has sufficient coverage and flexible services. HMO plans often have the cheapest monthly premiums, but they also have the most limited network and typically won’t cover out-of-network services. On the other hand, PPO plans have a wider network, and most won’t charge extra if you see an out-of-network provider. But be prepared to pay higher monthly premiums. In Washington, D.C., you can choose from 99 HMOs and 30 PPOs.
Weigh the cost of premiums vs. the cost of care
Getting a cheaper health plan makes sense if you don't require substantial medical care, including routine examinations. You're in the best position to assess how to optimize your savings. Start by identifying the most reasonable MOOP cost based on your needed coverage. From this shortlist, you can narrow your choices. To show you how much rates can vary based on the metal tier plan, we found that Kaiser Permanente's KP DC Silver 3300/30%/HSA/Vision costs roughly $428 per month with a MOOP of $6,650. Meanwhile, the KP DC Standard Platinum 0/20/Vision is $641 per month and comes with a MOOP of $2,000.
Consider Washington D.C. Medicare or Medicaid if You’re Eligible
Residents of Washington, D.C., over 65 or who have an illness or disability may qualify for Medicare, which is a federal government program providing affordable health care. Medicare covers the following services:
- Part A (Hospital Insurance): Covers hospital stays, nursing care, hospice care and some home-based care.
- Part B (Medical Insurance): Covers outpatient care, physician visits, preventive care and medical supplies.
- Part D (Prescription Drug Coverage): Covers prescription drugs and required vaccinations.
We also encourage you to see if you qualify for Medicaid. Medicaid comes at zero cost for Washington, D.C., residents meeting eligibility requirements. You may be eligible if your income is below 138% of the Federal Poverty Level. You can receive Medicare and Medicaid at the same time. In the case of "dually eligible" individuals, Medicare takes care of costs for covered services, followed by other insurance you have, while Medicaid kicks in last.
Frequently Asked Questions About Health Insurance in Washington D.C.
Buyers likely have questions about plan costs and availability. Here are MoneyGeek’s answers to some frequently asked questions to guide you in picking out the right plan.
About Mark Fitzpatrick