DISTRICT OF COLUMBIA · 1 COUNTIES · 2027 FILINGS · SEPTEMBER 2026
What does employer health coverage cost in District of Columbia?
District of Columbia has one of the lowest marketplace increases in the country for 2027: 9.6%.
Employer group plans asked for 17.6%. The good news District of Columbia employers have that most states don't: a PPO is filed in every one of the 1 counties, so a move to marketplace plans doesn't cost your people their out-of-network coverage.
District of Columbia, by the filings
What did insurers actually file for District of Columbia?
Every figure below comes from the filings insurers submitted to regulators. 2027 numbers are requested, not approved. Approvals land in October.
| District of Columbia | Figure | What it tells you |
|---|---|---|
| 2027 requested change, marketplace plans | +9.6% +9.0% to +10.2% across 3 insurers | 48th highest of 51. The national median is 15.3%. |
| 2027 requested change, employer group plans | +17.6% +4.7% to +25.2% across 6 insurers | Group asked for 8.0 points more than marketplace here. |
| 2026 approved change | +9.0% marketplace +9.3% group | Compounded with 2027, that's roughly 20% to 28% on top of 2025. |
| Lowest cost silver plan, age 40, typical county | $565 per month $565 to $565 across counties | The number a CHOICE Arrangement contribution has to cover to pass the IRS affordability test. |
| Counties with a PPO or POS plan filed | 1 of 1 | Out-of-network coverage is purchasable everywhere in the state. In 18 states it isn't purchasable anywhere. |
| Typical county, lowest cost silver by plan type | $565 HMO · $676 PPO | A PPO costs about $111 per month more here. |
| Marketplace vs group cost per member per month, 2026 | $769 marketplace $805 group | Marketplace plans cost less per member here. District of Columbia is one of 22 states where that's true. |
| Insurers competing per county | 3 to 3 | Every District of Columbia county has at least 3 insurers competing. |
| Out-of-network plans sold off the marketplace | none filed | Nothing extra off the marketplace in District of Columbia. The on-marketplace plans above are the whole individual shelf. |
What it means for a District of Columbia employer
District of Columbia got off lightly this year. Does that mean there's nothing to do?
A 9.6% request is the good end of the national range. It also means the easy explanation for a high renewal isn't available to you, so whatever your cost looks like is about your plan, not the market.
The District of Columbia-specific read: marketplace plans cost less per member per month than group plans here, and out-of-network coverage still exists, so a CHOICE Arrangement is worth pricing properly rather than dismissing. Run it on your own census by county, not on a state average.
Where the money actually is at these rates: not the plan type, the design changes inside it. Sourcing 2,000+ medications at a $0 copay for the whole household. Unlimited virtual primary and behavioral care so a $0 visit replaces an urgent care trip. A supplemental layer that pays the employer back every pay period instead of adding a line item.
Those have landed at $2,000+ per employee per year in real client projects, with about $988 per employee per year in new cashflow on top of that and independent of it. About $100K per year for every 50 people. $0 upfront, billed out of savings, live in 30 to 45 days. Same broker, same doctors, same cards.
Compare the 12 plan designs · All 50 states and DC · PPO availability by county · Benchmark your cost
If your District of Columbia renewal came back flat instead of 9.6%, what would you put the difference into first?
Results vary by group size, plan design, and utilization.
Sounds concerning? You have options.
So what are the actual options in District of Columbia?
District of Columbia still has out-of-network coverage on the shelf, so nothing here is closed off. The question isn't whether you have options. It's which one costs less on your census.
Here's the part that isn't anyone's fault. The systems that surface plan options only surface what's already inside them. The marketplace shows you what insurers filed for the marketplace. Your broker shows you the markets their appointments reach. Both are doing their job. Neither one can show you what sits outside it.
99% of the brokers we talk to have never had visibility to our programs. They sit outside their commissioned channels.
| What you run today | What changes | Range observed |
|---|---|---|
| Fully insured, mid-market | Level-funded, shelf-rated, or a partially self-funded design, so a good claims year comes back to you instead of staying with the carrier. | 15 to 25% of plan cost |
| Already self-funded | Stop-loss restructured, a captive layer, and claims priced off a defensible benchmark instead of a billed charge. | 20 to 30% of plan cost |
| Any plan, any funding | Layers that sit on top of what you already run. 2,000+ medications at $0 to the whole household. Unlimited virtual primary and behavioral care. A supplemental layer that pays the employer back every pay period. | $2,000+ per employee per year plus up to about $988 per employee per year in new cashflow about $100K per year for every 50 people |
| A group plan you can't move yet | A GCHRA or EBHRA running alongside it, so people buy what they actually need with pretax dollars without touching the plan itself. | No audited range published. Depends entirely on take-up. We won't print a number we haven't measured. |
| Ready to leave the group plan | A CHOICE Arrangement. Defined contribution instead of a defined plan. Your cost becomes a number you set rather than a renewal you receive. | Priced per census. Whether it beats your group plan depends on the county mix in your census, not the state average. |
Why the ranges are keyed to what you run today and not to a product name: that's how they were measured. Every range above comes from completed client projects, grouped by the employer's starting point. We don't publish a savings percentage next to "level-funding" or "captive" as a category, because nobody measured a category. If you see a number like that anywhere, ask what it was measured on.
$0 upfront. Billed out of savings. Live in 30 to 45 days. Same broker, same doctors, same cards. First-year ROI has landed at 10 to 16x across completed projects.
Compare all 12 plan designs · Benchmark your own cost · Get it priced on your census
If one of these came back at the low end of its range for your District of Columbia group, which line in your budget would you want it to pay for first?
Ranges are what we have observed across completed engagements. They are not a guarantee, not a quote, and not an offer of coverage. Your result depends on group size, plan design, census, and utilization.
Where these District of Columbia numbers come from
Rate changes are the midpoint of what each insurer requested in District of Columbia, from the CMS rate review service, pulled September 17, 2026. 2027 figures are proposed and still under review; regulators can trim them before approvals land in October. County premiums are the lowest cost plan per metal level for a 40-year-old non-smoker before any subsidy, from the CMS marketplace plan and rate files for plan year 2026, covering all 1 District of Columbia counties.
The marketplace versus group cost comparison uses the 2026 average premium per member per month from the insurers own filings on both sides, weighted by enrollment. It is an average across each plan's enrolled mix, not a same-metal, same-plan-type quote. Plan-type availability counts every marketplace plan filed in every District of Columbia county and asks whether any of them is a PPO or POS, because the split that matters is whether a doctor outside the network is covered at all. Off-marketplace plans are counted separately, at state level, from the insurers' 2026 rate filings.
Nothing here is a quote.
