Jane Dotson
Members of Congress in the US do not receive free health insurance for life. In fact, since the Patient Protection and Affordable Care Act (ACA) came into effect in 2014, members of Congress have been required to purchase their health insurance through the exchanges offered by the ACA. They can also enrol in health savings accounts if they opt for high-deductible health plans. While members of Congress do not get free health insurance, they do have access to free or low-cost care through the Office of the Attending Physician and free medical outpatient care at military facilities in the DC area.
| Characteristics | Values |
|---|---|
| Are members of Congress guaranteed lifetime medical insurance? | No |
| Do members of Congress pay for their health insurance? | Yes |
| How much do members of Congress pay for their health insurance? | Approximately 28% of their annual healthcare premiums through pre-tax payroll deductions |
| What type of health insurance do members of Congress have? | Members of Congress purchase their insurance through the District of Columbia's Small Business Health Options Program (SHOP) exchange, also known as DC Health Link |
| Do members of Congress have access to free or low-cost health care? | Yes, members of Congress have access to free or low-cost care through the Office of the Attending Physician and free medical outpatient care at military facilities in the DC area |
| Can members of Congress purchase FEHBP insurance after leaving office? | Yes, if they are eligible for retirement and have had five years of continuous healthcare coverage under their DC SHOP plans |
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What You'll Learn
- Members of Congress do not receive free health care
- Congress members can receive free or low-cost health care at the Office of the Attending Physician
- Congress members can receive free outpatient care at military facilities in DC
- Congress members must purchase insurance through the Affordable Care Act exchanges
- Congress members can purchase FEHBP insurance after leaving Congress if eligible for retirement
Members of Congress do not receive free health care
Before the ACA, members of Congress received the same healthcare insurance benefits as any other federal employee through the Federal Employees Health Benefits Program (FEHBP). However, during the mark-up of the ACA bill, lawmakers inserted a provision that requires members of Congress to obtain their health insurance through ACA exchanges. As of January 1, 2014, members of Congress purchase their insurance through the District of Columbia's Small Business Health Options Program (SHOP) exchange, also known as DC Health Link.
While members of Congress do not receive free health care, they do have access to two areas of free or low-cost health care that the average citizen cannot access. Firstly, they can access the Office of the Attending Physician for an annual fee to receive limited care for routine examinations, consultations, and certain diagnostic tests. Secondly, in the Capital region only, they may receive free medical outpatient care at military facilities.
It is important to note that members of Congress pay 100% of their premiums for dental, vision, and long-term care insurance with after-tax dollars. Additionally, upon separation from political life, members of Congress may purchase FEHBP insurance if they are eligible for retirement and have had five years of continuous healthcare coverage under their DC SHOP plans.
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Congress members can receive free or low-cost health care at the Office of the Attending Physician
Members of Congress (MOC) and their staff are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act. They pay approximately 28% of their annual healthcare premiums through pre-tax payroll deductions, while the federal government subsidizes approximately 72% of the premium cost.
In addition to this, members of Congress can receive free or low-cost health care at the Office of the Attending Physician. For an annual fee, they can receive limited care for routine examinations, consultations, and certain diagnostic tests. However, these services do not include surgery, dental care, or eyeglasses, and any prescriptions must be filled at the member's expense.
The Office of the Attending Physician is one of two areas where members of Congress can receive free or low-cost health care that the average citizen cannot access. The other is free medical outpatient care at military facilities in the D.C. area. If members of Congress require inpatient care or are outside the Capital region, they must pay 100% of the full cost of that military healthcare.
Prior to the passage of the Affordable Care Act, members of Congress received the same healthcare insurance benefits as any other federal employee through the Federal Employees Health Benefits Program (FEHBP). FEHBP offers about 300 different private healthcare plans, including five government-wide, fee-for-service plans, and many regional health maintenance organization (HMO) plans. It also includes high-deductible, tax-advantaged plans.
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Congress members can receive free outpatient care at military facilities in DC
Members of Congress (MOC) do not receive free health care. They pay approximately 28% of their annual healthcare premiums through pre-tax payroll deductions. They also have access to free or low-cost care through the Office of the Attending Physician.
However, members of Congress can receive free outpatient care at military facilities in Washington, DC. This is because, given the location of Congress in DC, the DC SHOP, or DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which members of Congress and designated congressional staff will purchase health insurance in order to receive a government contribution.
This free outpatient care at military facilities in DC is one of two areas where members of Congress can receive free or low-cost health care that the average citizen cannot access. The other is the aforementioned access to the Office of the Attending Physician.
It is important to note that if members of Congress are outside of the Capital region or if they need inpatient care, they must pay 100% of the full cost of that military health care.
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Congress members must purchase insurance through the Affordable Care Act exchanges
Members of Congress are not guaranteed lifetime medical insurance. In fact, they are required by law to purchase health insurance through the exchanges offered by the Affordable Care Act (ACA), also known as Obamacare. This means that members of Congress must select a plan from the individual marketplace, just like millions of other Americans.
Prior to the passage of the ACA, members of Congress received their health insurance benefits as any other federal employee would, through the Federal Employees Health Benefits Program (FEHBP). However, during the creation of the ACA, lawmakers inserted a provision (Section 1312(d)(3)(D)) that specifically requires members of Congress and designated congressional staff to obtain their health insurance through the ACA exchanges. This change took effect on January 1, 2014.
The ACA requires members of Congress to purchase insurance through an exchange or another program approved by the law, such as Medicare. They cannot use the insurance offered to federal employees, which was previously available to them through the FEHBP. This is in line with the general principle of the ACA, which is to encourage individuals to obtain health insurance and provide more affordable options.
While members of Congress must purchase insurance through the ACA exchanges, they do receive some financial assistance from the federal government. The government subsidizes approximately 72% of the premium cost. Additionally, members of Congress can set aside a portion of their salary in Flex 125 savings plans, allowing them to pay for healthcare and childcare expenses with pre-tax dollars. They also have access to free or low-cost care through the Office of the Attending Physician and free medical outpatient care at military facilities in the Washington, D.C. area.
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Congress members can purchase FEHBP insurance after leaving Congress if eligible for retirement
Members of Congress are not guaranteed lifetime medical insurance. However, they do enjoy certain benefits that the average citizen cannot access. For instance, they have access to the Office of the Attending Physician, where they can receive limited care for routine examinations, consultations, and certain diagnostic tests for an annual fee. They can also receive free medical outpatient care at military facilities in the DC area.
Before the Affordable Care Act (ACA) or Obamacare, members of Congress received the same healthcare insurance benefits as any other federal employee through the Federal Employees Health Benefits Program (FEHBP). However, during the ACA bill mark-up, a provision was inserted that requires members of Congress to obtain their health insurance through ACA exchanges. As a result, since 2014, members of Congress have been purchasing their insurance through the District of Columbia's Small Business Health Options Program (DC SHOP) exchange, also known as DC Health Link.
While members of Congress do not receive free health care, the federal government subsidizes approximately 72% of the premium cost. They also have the option to set aside salary in Flex 125 savings plans to help pay for healthcare and childcare expenses. Additionally, if they purchase dental and vision coverage, they pay 100% of their premiums through pre-tax dollars.
After leaving Congress, members who are eligible for retirement and have had five years of continuous healthcare coverage under their DC SHOP plans may purchase FEHBP insurance. This means that even if the Affordable Care Act is repealed, members of Congress have a fallback plan to return to the FEHBP, an option that around 20 million other Americans will not have.
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Frequently asked questions
No. Members of Congress are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act.
Federal subsidies for insurance under FEHBP remain stable at 72%, so members of Congress pay around 28% of their annual healthcare premiums through pre-tax payroll deductions.
Members of Congress have access to 57 different ACA insurance plans at the bronze, silver, gold, and platinum levels through the District of Columbia's Small Business Health Options Program (DC SHOP) exchange, also known as DC Health Link.
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