Are there health insurance benefits for former House members?
Executive summary
Former members of the U.S. House do not automatically keep Capitol medical privileges but they can access federal health plans in limited circumstances: they may purchase FEHB coverage after leaving office only if they are eligible for a federal retirement annuity and have been enrolled continuously in congressional (DC SHOP) coverage for five years prior to retirement [1]. While sitting Members buy insurance through the DC SHOP (DC Health Link) with a government employer contribution similar to other federal employers [2] [3], dependents and former Members are ineligible for care at military treatment facilities [4].
1. How current Members get insured — the DC SHOP swap
Since implementation of the ACA requirement for Congress, Members and designated staff obtain employer-sponsored health plans through the District of Columbia’s small-business exchange (DC Health Link / DC SHOP), rather than the Federal Employees Health Benefits Program (FEHBP); the Office of Personnel Management explains the government contribution for congressional service is tied to plans purchased through that DC SHOP marketplace [2] [3].
2. What the government pays while they serve
Congressional coverage functions like an employer plan: the government pays a share of premiums for plans bought on DC SHOP, and Members may also buy dental/vision/long‑term care options on similar federal programs; analyses and plan guides note the government contribution is comparable to employer contributions elsewhere and Members pay the remainder rather than receiving free health care [3] [5] [6].
3. The military-care exception that doesn’t extend to former lawmakers
The Congressional Research Service notes the Office of the Attending Physician and military treatment facilities provide services to current, active congressional personnel but explicitly states dependents and former Members are not eligible for care at military treatment facilities [4]. Available sources do not mention any routine lifetime entitlement for former Members to receive care at military hospitals [4].
4. Post‑service access: FEHB is conditional, not automatic
Multiple sources — a CRS summary, Snopes and reporting summarizations — say former Members may enroll in FEHB only if they meet ordinary federal retirement eligibility (i.e., are eligible for a federal annuity) and if they had five continuous years of enrollment under the DC SHOP prior to retirement; in other words, access after leaving office is possible but contingent on meeting retirement and prior-enrollment rules [1] [7] [4]. Sources emphasize this is not “free for life” coverage [7].
5. Grey areas and common misconceptions
The widely circulated claim that ex-Members get perpetual, free government health care is contradicted by the cited materials: members don’t get lifetime free care by virtue of a single term, and they may be barred from FEHB participation unless they meet the five‑year and retirement criteria [7] [1]. The Congressional Institute and other explainers also make clear Members cannot participate in FEHBP while serving; they use DC SHOP instead [3]. If you want a single rule that covers all former Members, available sources do not mention one — instead they describe conditional, pathway-based access [1].
6. How age and Medicare factor in
Reporting notes that many Members are Medicare‑eligible while still in office; those individuals commonly rely on Medicare after leaving Congress if eligible, which is separate from FEHB/DC SHOP rules [8]. Available sources do not give a comprehensive count of how many former House members rely on Medicare versus FEHB post‑service [8].
7. Why the rules exist — incentives and optics
The shift to DC SHOP was made after ACA rules and intended to align Members with the exchange marketplace they legislated; observers and watchdogs framed this move as both a practical and symbolic change so lawmakers purchase plans through the same kind of marketplace used by ordinary Americans in DC [2] [3]. Critics still point out that employer contributions and high-tier plan options make congressional coverage relatively generous compared with many private‑market options [7] [6].
Limitations: this analysis uses only the supplied documents and news snippets; it does not include more recent legislative changes or agency memos not in the provided set. For any specific ex‑Member’s eligibility (for FEHB, military care or retiree health), consult the OPM guidance and CRS report cited above [2] [4] [1].