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.
QUINNSCOMMENTARY 
Retirement benefits for members of Congress, are abusive – given that the taxpayers who are funding those benefits generally don’t themselves have a pension.
Members of Congress qualify for an immediate, full pension if they are age 62 with 5 years of service, age 50 with 20 years of service, or any age with 25 years of service. To carry their health insurance into retirement with a government contribution, they must be continuously enrolled for the five years prior to retiring.
For a Member of Congress retiring at age 62 with exactly five years of service, a “full” pension generally equals $14,790 per year.
The formula for congressional service provides 1.7% of the average of your three highest consecutive years of salary (“high-3”) for each of the first 20 years served.
5 × 1.7% x $174,000 = $14,790!
Essentially, for those who live 25 years, to age 87, this is a pension with nominal dollar benefits > $360,000 – more than two years of salary paid in monthly installments.
. Yes, Members of Congress participate in Medicare. However, retiring members of Congress (as little as age 62 and 5 years) only pay 30% of the premium cost for their coverage, or once Medicare eliible, for their Medicare Supplement.
Few Americans qualify for employer-sponsored coverage, let alone employer sponsored coverage with an employer contribution. Asking them to subsidize the cost of coverage by people who used to make $174,000 a year for the reset of their life is abusive.
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