Paul Sanchez
Members of Congress do not receive free healthcare for life, or even while serving in office. This is a popular misconception, and some members of Congress have described their medical insurance as the standard to beat. Before the Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010, members of Congress received the same healthcare insurance benefits as any other federal employee through the Federal Employees Health Benefits Program (FEHBP). However, since 2014, members of Congress have been required to obtain their health insurance through ACA exchanges. They choose a gold-level Obamacare policy and receive federal subsidies that cover 72% of the cost of the premiums.
| Characteristics | Values |
|---|---|
| Do members of Congress get free medical care for life? | No |
| Do members of Congress get free medical care while serving in office? | No |
| What type of health insurance do members of Congress receive? | Employer-subsidized, private coverage through the exchanges established under the ACA. |
| Do members of Congress receive free health care? | No, but they can choose a gold-level Obamacare policy and receive federal subsidies that cover 72% of the cost of the premiums. |
| Do members of Congress have access to an attending physician? | Yes |
| Can members of Congress receive non-emergency care? | Yes, but they must pay an annual fee to access it. |
| Do members of Congress contribute to Medicare? | Yes |
| Do members of Congress have any other health insurance-related retirement benefits? | No |
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What You'll Learn
Members of Congress do not receive free healthcare
Prior to the passage of 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 and designated congressional staff members to obtain their health insurance through ACA exchanges. As of 1 January 2014, members of Congress and staff 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 completely free healthcare, they do have access to certain benefits that the average citizen cannot access. For example, they can receive free or low-cost care through the Office of the Attending Physician, and they are eligible to set salary aside in Flex 125 savings plans to help pay for healthcare and childcare expenses. In addition, in the Capital region, they may receive free medical outpatient care at military facilities. However, if they are outside of the Capital region or need inpatient care, they must pay 100% of the full cost of that military healthcare.
It is worth noting that the benefits received by members of Congress are similar to those offered by many large employers. For example, if they enroll in high-deductible health plans, they can also enroll in health savings accounts. Additionally, they pay 100% of their premiums for dental, vision, and long-term care insurance through pre-tax or after-tax dollars, depending on the type of coverage. Overall, while members of Congress do not receive entirely free healthcare, they do enjoy certain benefits and subsidies that may reduce their overall healthcare costs.
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Congress members must purchase private insurance
Contrary to popular belief, Congress members do not receive free health care. They are required by law to purchase private health insurance. Before the Affordable Care Act (ACA) was passed, members of Congress were covered by private insurance under the Federal Employees Health Benefits Program (FEHBP). This program offered a range of private health care plans, including government-wide fee-for-service plans, regional health maintenance organization (HMO) plans, and high-deductible, tax-advantaged plans. All these plans covered hospital, surgical, physician, mental health, and prescription drug services, as well as protection against very large medical expenses.
However, since the passage of the ACA in 2014, Congress members have had to obtain their health insurance through the ACA exchanges, just like uninsured individuals and small businesses. They are not exempt from buying health insurance and face even stricter requirements than most Americans. Specifically, they purchase insurance through the District of Columbia's Small Business Health Options Program (SHOP) exchange, also known as DC Health Link.
Through DC Health Link, Congress members can choose from 57 different ACA insurance plans at the bronze, silver, gold, and platinum levels. However, the Office of Personnel Management has ruled that they may only receive an employer contribution if they purchase insurance at the gold tier. At this level, federal subsidies cover approximately 72% of the premium cost, with Congress members paying the remaining 28% through pre-tax payroll deductions.
In addition to their private insurance, Congress members (but not their families) have access to limited free or low-cost health care through the Office of the Attending Physician and free medical outpatient care at military facilities in the Washington, D.C., area. These benefits are similar to those offered by many large employers.
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The Federal Employees Health Benefits Program
The program offers a wide range of plan options, including Fee-For-Service, Health Maintenance Organization, High Deductible, and Consumer-Driven Health Plans. These plans provide different levels of coverage and benefits to meet the diverse needs of federal employees and their families. For example, Fee-For-Service plans offer a wide selection of healthcare providers, while High Deductible plans offer lower premiums and access to health savings accounts.
The FEHBP is known for its flexibility and comprehensive coverage. In certain situations, such as emergencies or treatment at non-plan facilities, the program relaxes requirements to ensure that members receive the care they need. It also provides access to additional medication supplies in case of emergency. Furthermore, the FEHBP ensures that no one can be refused or charged more for pre-existing conditions, and dependents under 26 are covered under the plan.
Prior to the implementation of the Affordable Care Act (ACA), members of Congress received health insurance benefits through the FEHBP. However, with the passage of the ACA, lawmakers mandated that members of Congress and designated congressional staff members obtain their health insurance through ACA exchanges. As a result, members of Congress now purchase insurance through the District of Columbia's Small Business Health Options Program (SHOP) exchange, also known as DC Health Link. While they do not receive entirely free health care, they still receive federal subsidies that cover approximately 72% of the premium cost.
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Congress members can access the Office of the Attending Physician
Members of Congress do not receive free health care. They are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act (ACA), also known as Obamacare. They can choose a gold-level ACA policy and receive federal subsidies that cover 72% of the cost of the premiums. They pay approximately 28% of their annual healthcare premiums through pre-tax payroll deductions.
However, members of Congress can access the Office of the Attending Physician, led by Dr Brian Monahan, who holds the rank of rear admiral in the US Navy. Dr Monahan was appointed to the position by President Barack Obama in 2009. The Office of the Attending Physician provides members of Congress with physicals and routine examinations, on-site X-rays and lab work, physical therapy, and referrals to medical specialists. For an annual fee, members of Congress can receive limited care for routine examinations, consultations, and certain diagnostic tests.
The Office of the Attending Physician played a central role in the response to the 2001 anthrax attacks on Senator Tom Daschle's Senate office, taking nasal swabs from the nearly 6,000 staff, employees, and visitors potentially exposed to the harmful bacteria. The former Attending Physician, Rear Admiral Dr John Eisold, and his staff also provided initial treatment to Senator Tim Johnson when he suffered an intracerebral bleed caused by a cerebral arteriovenous malformation before he was admitted to George Washington University Hospital.
In addition to the services provided by the Office of the Attending Physician, members of Congress can also receive free medical outpatient care at military facilities in the DC area.
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Congress members can receive free outpatient care at military facilities
Contrary to what some people believe, members of Congress do not receive free health care. Before the Affordable Care Act (ACA), often referred to as Obamacare, was passed, members of Congress received health insurance benefits through the Federal Employees Health Benefits Program (FEHBP). This was the same as other federal employees. However, a provision was added to the ACA that required members of Congress and designated congressional staff to obtain their health insurance through ACA exchanges. As a result, members of Congress are now required by law to purchase health insurance through these exchanges.
The federal government does provide a subsidy that covers approximately 72% of the cost of premiums for members of Congress. This is the same percentage as for other federal employees who purchase insurance through FEHBP. Members of Congress pay around 28% of their annual healthcare premiums through pre-tax payroll deductions. They can also use pre-tax dollars to pay for dental and vision coverage and long-term care insurance premiums. Additionally, members of Congress can set salary aside in Flex 125 savings plans to help pay for healthcare expenses.
While members of Congress do not receive entirely free health care, they do have access to free or low-cost care through the Office of the Attending Physician. They can also receive free outpatient care at military facilities in the Washington, D.C. area. This outpatient care is only available to current members of Congress and not their staff or family members.
Overall, while members of Congress do pay for a significant portion of their health insurance, they have access to benefits that provide them with more affordable healthcare options than the average citizen.
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Frequently asked questions
No, members of Congress do not receive free health insurance. They are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act. They can choose a gold-level Obamacare policy and receive federal subsidies that cover 72% of the cost of the premiums.
Members of Congress can choose from 57 different ACA insurance plans at the bronze, silver, gold, and platinum levels. They can also enroll in health savings accounts if they enroll in high-deductible health plans.
No, members of Congress do not get free medical care for life or even while serving in office. They pay part of the premium each month, which varies based on the plan chosen.
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