Medicare Plan Options

Residents of the District of Columbia have several options when it comes to Medicare enrollment. If you don’t have any chronic health issues, you may get all the coverage you need from Original Medicare. For broader coverage that pays for additional services and providers, you may want to enroll in Medicare Advantage. Supplemental plans are also available to make prescriptions more affordable and reduce the amount you pay for Medicare deductibles, copays, and coinsurance.

Original Medicare

Original Medicare is the standard Medicare plan for older adults and younger adults who receive disability benefits. Part A covers the services you receive while admitted to an inpatient facility, including nursing care, lab tests, X-rays, and surgical procedures. Part B covers preventive care, some screening tests, and services used to diagnose and/or treat medical conditions. Each time you receive a covered service, you’ll pay a percentage of the Medicare-approved amount (coinsurance). In addition to your monthly premium, you’ll also pay a deductible for Part A and Part B.

Medicare Advantage Plans

Under the District of Columbia’s Medicare Advantage program, you have the option of purchasing your Medicare coverage from a private insurance company. Every company that sells Medicare Advantage Plans in the District of Columbia has been approved by Medicare and must continue meeting the Medicare requirements for as long as it participates in the program. Also known as Medicare Part C, Medicare Advantage combines Part A and Part B coverage with additional benefits, such as prescriptions and routine vision care, giving you a more complete insurance option.

Medicare Prescription Drug Coverage Plans

If you sign up for Original Medicare, your plan won’t include prescription coverage, so you may want to purchase a Part D supplement from a Medicare-approved insurance company. Medicare Part D is an add-on plan that pays for prescription medications, reducing your out-of-pocket costs. Most Medicare Advantage Plans include prescription coverage, but if you choose a plan that doesn’t, you can pair Medicare Advantage with Medicare Part D to ensure you have the right level of coverage for your needs.

Medicare Supplement Insurance Plans

Even if you qualify for premium-free Part A, you’ll still have to cover your Part B premium, Medicare deductibles and coinsurance, and the cost of Part D coverage. These out-of-pocket costs can be overwhelming, especially if you’re on a fixed income. Medicare Supplement Insurance Plans, commonly referred to as Medigap, cover some of these costs, so you don’t have to bear the burden yourself. Some Medicare Supplement Insurance Plans even cover the cost of medical care you receive while traveling outside the United States.

Medicare in the District of Columbia by the Numbers

People enrolled in Original Medicare  Average plan cost People enrolled in Medicare Advantage
72,982 Plan A: $0 to $471 per month*

Plan B: $148.50 per month**

20,404

*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 the District of Columbia

With so many coverage types and a limited amount of time to enroll each year, you must review your Medicare options carefully and seek help if anything is unclear. The District of Columbia has several organizations with experienced staff and volunteers available to explain each plan, help you estimate your annual out-of-pocket costs, and determine if you qualify for any special Medicare programs. Protect yourself by contacting one of these organizations before you enroll.

Department of Aging and Community Living

The Department of Aging and Community Living operates the State Health Insurance Assistance Program for the District of Columbia. SHIP counselors educate residents on their Medicare options and provide information to help older adults avoid identity theft and Medicare scams. Once you sign up for Medicare, you can contact SHIP if you need help understanding your Medicare statements or have questions about your out-of-pocket costs. DACL staff members are also available to help you apply for SNAP benefits, Medicaid, and other forms of assistance.

Contact Information: Website | 202-724-5626

The George Washington University Law School operates several clinics to ensure residents have access to affordable legal services. One such program is the Health Insurance Counseling Project, which serves D.C. residents who have Medicare or are at least 60 years old. HICP offers free counseling to help older adults understand their options for Medicare, Medigap, long-term care insurance, and hospice care. Volunteers are also available to look over your unpaid medical bills and determine if you qualify for help paying them.

Contact Information: Website | 202-994-7463

Qualified Medicare Beneficiary Program

If you can’t afford your out-of-pocket Medicare costs, you may qualify for the District of Columbia Qualified Medicare Beneficiary program. Managed by the Department of Health Care Finance, the QMB program helps Medicare-eligible residents of the District of Columbia pay for Medicare deductibles, Medicare coinsurance, Part A and Part B premiums, and prescription drug costs associated with Medicare Part D. To be eligible for the QMB program, your income can’t exceed 300% of the federal poverty level. For 2021, that would be a maximum of $3,219.99 for a one-person household and $4,355.01 for a two-person household.

Contact Information: Website | 202-724-5506

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