Social media is awash with claims members of Congress receive free health care for life. That’s not true. They can enroll in a ACA plan and pay their premium share, but coverage stops when they are out of office unless the retire. They are treated like all federal employees.
Under the rules implementing the Patient Protection and Affordable Care Act, Members of Congress and designated congressional staff who want to receive the federal employer contribution must enroll in a Gold-level plan through the DC Health Link SHOP marketplace. They are not able to receive the employer contribution with Bronze, Silver, or Platinum plans.
The reason is administrative. The U.S. Office of Personnel Management determined that Gold-level plans most closely matched the actuarial value of the federal employee health benefits Congress previously received.
So, in practice:
- Members of Congress buy coverage through the ACA-created DC Health Link exchange.
- They choose from Gold-level ACA plans offered there.
- They receive the same type of employer premium contribution that other federal employees receive, provided they enroll in one of those eligible Gold plans.
A member with family coverage might pay approximately $400 to over $1,000 per month in premiums, depending on the plan selected. The lower cost plan would have higher out of pocket costs for healthcare.
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