Plan Coverage
Have a question? Member Services can help. Give us a call using the number on the back of your CareFirst member ID card.
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**
* Does not include pregnancy.
** Check formulary for details. Medication coverages may have changed.
What's Not Covered?
Healthy DC Plan does not cover the following:
- Care management programs
- Maternity and pre-natal care
- Abortion
- Adult Dental and Adult Vision
- Out-of-network care
- Well-being programs
- Non-emergency transportation
- Acupuncture
- Chiropractic
- Cosmetic surgery
- Hearing aids
- Private duty nursing
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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