Plan Coverage
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What’s Covered?
The Healthy DC Plan covers the following in-network services:
- Preventive services and screenings
- Sick visits
- Labs, imaging and x-rays
- Urgent care (in-network only)
- Emergency care
- Inpatient/outpatient hospitalization (prior authorization required)
- Mental health and substance abuse disorder
- Durable medical supplies
- Diabetic supplies (prior authorization required)
- Fertility*
- Prescription drugs**
- Maternity and pre-natal care***
* Does not include pregnancy.
** Check formulary for details. Medication coverages may have changed.
*** If you are pregnant, federal law does not allow Healthy DC Plan to cover you. You can enroll in DC Medicaid. You must immediately let Healthy DC know so you can be enrolled in DC Medicaid. Either log into your account at https://www.dchealthlink.com or call Healthy DC Plan at 833-432-7526 or let Community Health Plan of District of Columbia know to help get your pregnancy covered.
What's Not Covered?
Healthy DC Plan does not cover the following:
- Care management programs
- Labor and Delivery***
- Abortion
- 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.
- Out-of-network care
- Well-being programs
- Non-emergency transportation
- Acupuncture
- Chiropractic
- Cosmetic surgery
- Hearing aids
- Private duty nursing
- 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).
Thinking of Starting A Family?
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.
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