Fun Facts
Name the plan
Healthy DC Plan
To qualify for the Plan, you must be
An adult, 21-64 years old
Name 3 covered benefits
Primary care visits
Specialist visits
Urgent care
Hospitalizations
Emergency care
Laboratory services
Prescription drugs (separate formulary)
Preventive care
Hospice services (180 days per benefit period)
Home health services (90 visits per episode)
Emergency transportation
Mental/BH outpatient and inpatient services
Substance abuse disorder outpatient and inpatient services
Outpatient rehabilitation (30 visits per episode)
T/F: If I get pregnant, I can continue to get coverage under the Healthy DC Plan
No
ACDC Healthy DC Plan LOB Name
LOB 5420
What kind of plan is it?
Basic Health Plan
To participate in the Healthy DC Plan, I must pay a monthly premium of
$0!
A benefit or service I can't access as a Healthy DC Plan enrollee is
•Dental
•Vision
•Non-emergency transportation
•Community BH supports – any specialty BH services (assertive community treatment, supportive housing, etc)
•Acupuncture
•Cosmetic surgery
Hearing aides
Long-term care
Private duty nursing
Weight loss programs
Routine foot care
What must I do once I become pregnant?
Report pregnancy via the Healthy DC Plan Contact Center
T/F: As a COS member, I can refer a Healthy DC Plan enrollee to CM.
F - not at this time.
Date coverage is effective
January 1, 2026
Where do I go to apply?
DChealthlink.com or call 833-432-7526. If losing Medicaid eligibility, many are automatically enrolled
When I go to the hospital or to a doctors visit outside of the District, will Healthy DC Plan cover my visit?
No - if you use a provider outside of the plan's provider network, you will pay the full cost of the services
What benefits do I receive while pregnant?
Covered by Medicaid. Coverage through pregnancy and 12 weeks PP. Can enroll in Bright Start.
Who should I notify if I identify an enrollee who is pregnant?
My supervisor
3 states that have this plan type
Minnesota, Oregon, DC
To qualify for the plan you must fall into these immigration categories
U.S. Citizen or lawfully permanent non-resident
To look up providers or pharmacy formulary I look here
ACDC Healthy DC Website
Enrollees are eligible for CM if they are referred by their provider.
The Healthy DC Plan formulary is located where?
On the ACDC Healthy DC Plan website
The ACA Marketplace in DC is called
DC Health Link
To qualify, your FPL must fall between
138% and 200% of the FPL
If I transitioned to the Healthy DC Plan, can I keep my existing PCP that I had prior to the transition?
If they are contracted with ACDC Healthy DC Plan you can see them. ACDC is actively adding providers to its Healthy DC Plan network. You can check the online directory in real time.
How can enrollees be referred to CM?
By calling the Complex Queue Line: 202-408-2233
Emailing: HealthyDCCM@amerihealthcaritas.com
I am on the phone with a Healthy DC Plan enrollee with complex medical needs. What do I do?
Continue assisting members with basic needs, benefits questions, and navigating services as usual
If you notice a member who may need extra support:
Do not promise or suggest CM services
Instead, send a brief email to the CM team (HealthyDCCM@amerihealthcaritas.com) with:
Member name + ID
Reason for concern
Any urgent issues