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Members of Congress and their staff obtain health insurance through the DC Health Link Small Business Market (SHOP), which is part of the Affordible Care Act.
Key details regarding their health insurance costs include:
Premium Subsidies: The federal government contributes to the premiums, typically covering 72% to 75% of the total cost, which is similar to other federal employees in the Federal Employees Health Benefits (FEHB) program.
Plan Selection: Members and staff generally select "Gold-level" plans.
Out-of-Pocket Costs: Members pay for the remaining portion of their premiums (approximately 28%) through pre-tax payroll deductions.
Additional Services: Members may opt into the Office of the Attending Physician (OAP) for an additional fee, which was approximately $650 per year in 2025. This offers basic services, such as routine exams and consultations, but is not a substitute for comprehensive insurance.

In summary, members pay market rates for premiums but receive a significant government contribution towards them.