An ACA provision requires members of Congress and their staff to receive their insurance through DC Health Link, the exchange market in Washington, D.C. Before 2014, lawmakers and their staff were included in the Federal Employee Health Benefits Program.
In addition to federal benefits, many members of Congress are also eligible for Medicare. In 2023, 34% of senators and about 16% of representatives were over the age of 70, according to Pew Research Center.
Jack Hoadley, PhD, a professor emeritus at the Health Policy Institute of Georgetown University’s McCourt School of Public Policy, told Becker’s most people who still receive employer-based coverage after aging into Medicare enroll in Part A only.
Medicare Part A covers inpatient hospital care and has no premium. Part B, which costs about $175 a month, covers other medical costs.
“What most people do is enroll [in] Part B after they stop working, or for whatever reason, no longer have workplace-based coverage,” Dr. Hoadley said. “Whether it’s a member of Congress or staff, they’re certainly eligible to sign up for Medicare once they turn 65, but typically, they would not sign up for anything other than Part A.”
The federal government pays between 72% and 75% of the premium costs for congressional members, employees and their family members, the same amount it contributes to premiums for employees in the FEHB Program.
In the private sector, employees contribute an average of 22% of their premium costs, with employers paying the remaining 78%, according to 2022 data from the Bureau of Labor Statistics.
Employees paid about 33% of the cost of premiums for their dependents, and employers paid the remaining 67%.
Though most people with employer-sponsored insurance do not receive their insurance through the ACA marketplace, members of Congress experience health benefits much like other working Americans, Dr. Hoadley said.
“They’re going to understand how that works — the ups and downs in the premiums — the same way others who buy that insurance on the exchange might appreciate that,” he said. “I think they’re experiencing this as citizens. I think that’s a good thing, and that certainly was the intent when they were brought on to the exchanges.”
What about presidents?
The President, Vice President and their immediate families receive care through the White House Medical Unit, a unit of the White House Military Office.
According to a January report from the Defense Department, the unit had 60 staff members as of 2019, including physicians, physician assistants, nurses and psychologists.
Presidents can choose to enroll in private insurance — but with medical staff on call 24/7 at the White House, there is little need to.
In 2013, former President Barack Obama enrolled in a bronze ACA plan, with a premium of about $400 a month. The former president said the choice was largely symbolic, as he received his healthcare through the military, Politico reported at the time.
Former presidents are eligible for medical treatment at military facilities, though they must pay for this care.
Additional benefits
Members of Congress have access to a few additional health benefits. For an annual fee of $500, members can receive routine exams, consultations and some diagnostic tests from the Office of the Attending Physician.
Members of Congress are also authorized to receive medical care at military hospitals and facilities, though they have to pay for the care they receive there.
Most Americans don’t have access to a physician down the hall from their office, but on the whole, benefits for lawmakers are structured the same as most employees, Dr. Hoadley said.
“The fact that there are some long-term financial pressures for maintaining the health of the Medicare program is something that matters to them as individuals as much as it matters to them as officials. That’s a plus,” he said. “They certainly experience workplace coverage much like any other worker in the economy does.”
