Understand Medicare in Washington D.C.
Medicare, the United States federal medical insurance program, provides coverage for almost 94,000 people in the District of Columbia who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $506 per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 17 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in the District of Columbia.
Medicare Plans in the District of Columbia
|Compare ratings of the District of Columbia’s Medicare plan providers:|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||J.D. Power ranking|
|Aetna||4 stars||A+||A+||6th out of 9|
|Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||5th out of 9|
|Cigna||4 stars||A-||Not rated||8th out of 9|
|UnitedHealthcare||3.5 stars||A-||A-||4th out of 9|
Medicare Plan Options in Washington D.C.
Residents of Washington D.C. have multiple Medicare plans to choose from. Many are tiered to help Washington D.C. seniors find the plan that is best suited to their lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Washington D.C.’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
|Original Medicare (Parts A and B)||Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|Medicare Advantage Plans (Part C)||Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|Medicare Prescription Drug Coverage Plans (Part D)||Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|Medicare Supplement Insurance Plans (Medigap)||Some Washington D.C. seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
Medicare in the District of Columbia by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|73,305||Part A: $0 to $506 per month*
Plan B: $164.90 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Washington D.C.
Understanding Medicare coverage can be a challenge. Older residents and their caregivers in Washington D.C. have access to organizations that offer guidance as well as programs and services for those who are aging. These include the district’s Area Agencies on Aging (AAAs), local public health agencies, and nonprofit groups.
Washington D.C. Department of Aging and Community Living
The Washington D.C. Department of Aging and Community Living offers several programs and services aimed at helping senior residents and their caregivers. These include health insurance counseling, assistance for those who have Alzheimer’s disease, senior wellness centers, and more.
Contact information: Website | (202) 724-5626
Washington Office of Disability Rights – DC Medicaid and Medicare
The Washington D.C. office is primarily focused on people with disabilities, but it offers a good overview of Medicaid and Medicare programs on its site.
Contact information: Website | (202) 724-5055