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*
- Maternity, pre-natal care, and labor and delivery**
*Check formulary for details. Medication coverages may have changed.
**If you are a CareFirst Community Health Plan District of Columbia Healthy DC plan member and you become pregnant, you are eligible to enroll in D.C. Medicaid. Please immediately notify Healthy DC Plan so that they may help you enroll in D.C. Medicaid. You may log into your account at https://www.dchealthlink.com, call Healthy DC Plan at 833-432-7526 or CareFirst Member Services at 833-536-2167. Until your coverage transitions to D.C. Medicaid, your Healthy DC Plan will continue to cover your prenatal, maternity, and delivery services.
What's Not Covered?
Healthy DC Plan does not cover the following:
- Care management programs
- 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 are eligible to enroll in D.C. Medicaid. Medicaid will cover you, including delivery and 12 months of post-partum care.
Learn More