No, members of Congress do not get free healthcare. They pay premiums out of their own paychecks for a plan they buy through an ACA exchange, with the federal government covering part of the cost the same way any large employer does. What fuels the myth is a separate benefit: a low-cost on-site clinic at the Capitol and free outpatient care at military medical facilities in the Washington, D.C. area. Neither replaces insurance.
What Members Actually Pay for Insurance
Every member who enrolls in a health plan has premiums deducted from their paycheck. The government’s share is set by a formula in federal law: it pays 72% of the weighted average of all plan premiums, but never more than 75% of the premium for the specific plan the member picks. Whichever number is lower is what the government contributes.15 U.S. Code 8906 – Contributions The member covers the rest, pre-tax.2U.S. Office of Personnel Management. Cost of Insurance
For the 2026 plan year, the maximum biweekly government contribution is $324.76 for self-only coverage and $711.17 for self-plus-one coverage.3U.S. Office of Personnel Management. Premiums If a member picks a plan that costs more than the cap, they absorb the full difference. Rank-and-file members earn $174,000 a year,4Congress.gov. Congressional Salaries and Allowances: In Brief so the premium share is a real household expense, not a token deduction.
The Capitol Clinic and Military Facilities
Here’s where the “free healthcare” idea comes from. The Office of the Attending Physician runs an on-site clinic in the U.S. Capitol that provides primary care, emergency treatment, lab work, X-rays, and physical therapy to members. The annual fee is reported at roughly $650, or about $54 a month, with no additional copays or deductibles for services delivered in the clinic. Compared with what a typical American pays each month before touching a copay, that reads as close to free.
Members can also get free outpatient care at military medical facilities in the D.C. area, and the Attending Physician’s office refers them at no charge. These perks sit on top of a member’s insurance. They cover routine and urgent care in Washington. They don’t cover hospitalization, specialists, prescriptions, or care for family members back in a member’s home state, which is why members still need a full insurance plan.
Where Members Buy Their Coverage
Before 2014, members enrolled in the Federal Employees Health Benefits Program like any other federal worker. Section 1312 of the Affordable Care Act changed that: members and certain congressional staff now have to buy their insurance through an ACA exchange rather than the standard FEHB channel.5U.S. Office of Personnel Management. As a Member of Congress or Designated Congressional Staff, Why Am I No Longer Able to Be Covered by an OPM-Contracted FEHB Plan OPM designated the District of Columbia’s Small Business Health Options Program exchange, known as DC Health Link, as the marketplace.6Centers for Medicare & Medicaid Services. Members of Congress and Staff Accessing Coverage through Health Insurance Exchanges That’s still where they shop for 2026 coverage.
The money didn’t change with the venue. Members receive the same government contribution toward their premiums as other federal employees, under the same 72%/75% formula.2U.S. Office of Personnel Management. Cost of Insurance
What Happens When They Leave Office
Health coverage doesn’t follow a former member automatically. To carry FEHB into retirement, they must qualify for an immediate annuity, meaning pension payments start within one month of leaving office. They also have to satisfy the five-year rule: continuous enrollment in an FEHB plan, TRICARE, or a combination for the five years immediately before retirement. Members who served fewer than five years must have been continuously enrolled from their first opportunity to sign up.7U.S. Office of Personnel Management. Continuing FEHB Coverage into Retirement
Members who meet those requirements keep the same government premium contribution active employees and other federal retirees receive. A one-term House member who serves two years and doesn’t qualify for an immediate annuity loses access to FEHB when they leave, which is the piece the “free healthcare for life” version of the story leaves out.