Medicare Part D Plans in the District of Columbia (Washington D.C.)

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Medicare Prescription Drug Plans in he District of Columbia

Original Medicare offers many benefits, but it doesn’t cover prescription drugs. You’ll need to purchase a Medicare Part D plan to help with prescription drug costs or choose a Medicare Advantage Plan with prescription drug coverage.

District of Columbia has several options for Medicare Part D plans, some with a low monthly premium. Learn more about District of Columbia Medicare Part D prescription drug plans:

  • All District of Columbia Medicare recipients have access to a Medicare prescription drug plan in 2022.
  • There are 21 Part D prescription drug plans available in the District of Columbia in 2022.
  • Seven Part D prescription drug plans in th District of Columbia participate in the Part D Senior Savings Model, which offers lower out-of-pocket insulin costs than other plans.
  • The lowest 2022 Part D prescription drug plan monthly premium in District of Columbia is $7.10.

Read on to learn about enrollment, cost, and benefits of Medicare Part D plans in District of Columbia.

Medicare Part D Plans in the District of Columbia

Compare ratings of District of Columbia’s Medicare Part D plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars Fifth out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of 10
Premera 3.5 to 4.5 stars A B- 3 stars Not ranked
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Note: A.M. Best, BBB, NCQA, and J.D. Power ratings assess the insurance company as a whole or Medicare Advantage Plans, which often include prescription drug coverage.

What Medicare Part D Plans Cover

Medicare Part D plans offer prescription drug coverage. Each plan has a formulary, which is the plan’s list of covered drugs. Typically, Part D plans have drug tiers, which indicate the drug’s cost.

Part D Formularies

A Medicare Part D formulary is a list of all the drugs covered by the plan. All Medicare Part D plans are required to cover a wide range of prescription drugs for people with Medicare, with at least two drugs per drug category.

Medicare Part D Formulary Coverage
Drugs Part D plans must cover Drugs in these protected classes:
  • Anticonvulsants
  • Antidepressants
  • Antineoplastics (cancer drugs)
  • Antipsychotics
  • Antiretrovirals (HIV/AIDS drugs)
  • Immunosuppressants
Commercially available vaccines
Generic and brand-name drugs in commonly prescribed categories (such as antibiotics, insulin, and drugs for pain)
Drugs not covered by Part D plans Drugs you don’t self-administer which are covered by Medicare Part B, such as those in an outpatient hospital setting
Cosmetic medications
Cough and cold medications
Over-the-counter drugs
Prescription vitamins or minerals
Weight gain or loss medications
Erectile dysfunction drugs

If your specific drug is not on a plan’s formulary, it should have a similar drug available. You can ask for an exception if you need a drug that’s not on a plan’s formulary.

Part D Tiers

Usually, Medicare Part D plans categorize drugs in tiers, with each tier charging a different copayment amount. For example:

Medicare Part D Tiers
Tier Cost What’s covered
Tier 1 Lowest copayment Most generic prescription drugs
Tier 2 Moderate copayment Preferred brand-name prescription drugs
Tier 3 High copayment Non-preferred brand-name prescription drugs
Tier 4 or 5 (specialty tier) Very high copayment High-cost prescription drugs

Medicare Part D Plan Eligibility and Enrollment

You can enroll in a Medicare Part D prescription drug plan if you’re enrolled in Medicare Part A and/or Part B, or a Medicare Advantage Private Fee-for-Service (PFFS) Plan that doesn’t offer prescription drug coverage. You must be enrolled in Medicare Part A and B to join a Medicare Advantage Plan.

It pays to enroll in prescription drug coverage during your initial enrollment period, even if you don’t take prescription medications. If you don’t enroll during this period and have no creditable drug coverage, you’ll have a 1% penalty for each month you don’t enroll, which will be added to your Part D monthly premium.

Part D enrollment is available during specific enrollment periods:

Medicare Part D Enrollment Periods
Enrollment period When it happens What you can do
Initial Enrollment Period The seven-month period beginning three months before you turn 65 and three months after New enrollment
Annual Enrollment Period October 15 to December Enroll in a new plan, disenroll, or make a one-time switch from one plan to another.
Medicare Advantage Open Enrollment January 1 to March 31 Switch to a different Medicare Advantage Plan with or without drug coverage. Go back to Original Medicare and enroll in a Part D plan.

There are multiple ways to enroll in Medicare Part D prescription drug plans:

  • Enroll on the Medicare Plan Finder or on the plan’s website.
  • Complete a paper enrollment form.
  • Call the plan.
  • Call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.

When you join a Medicare drug plan, you’ll give your Medicare Number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

What Medicare Part D Costs in the District of Columbia

You’ll pay a monthly premium and be subject to an annual deductible and copays for each prescription with a Medicare Part D plan.

  • Lowest Part D monthly premium in the District of Columbia: $7.10
  • Maximum annual deductible: $480
  • Copays: As low as $0 for preferred generic in the initial coverage phase
Compare your 2022 Medicare Part D plan costs in Washington, District of Columbia:
PDP Plan name Monthly premium Deductible Tiers/Initial coverage phase copay/coinsurance Coverage gap phase Catastrophic coverage phase
Aetna Medicare SilverScript SmartRx  $7.10 $480 Preferred generic: $1

Generic: $19

Preferred brand: $46

Non-preferred drug: 49%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

Humana Walmart Value Rx Plan  $22.70 $480 Preferred generic: $1

Generic: $4

Preferred brand: 15%

Non-preferred drug: 41%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

Wellcare Value Script $12.90 $480 Preferred generic: $0

Generic: $4

Preferred brand: $42

Non-preferred drug: 47%

Specialty tier: 25%

Generic drugs:

25%

Brand-name drugs:

25%

Generic drugs:

$3.95 copay or 5% (whichever costs more)

Brand-name drugs:

$9.85 copay or 5% (whichever costs more)

The initial coverage phase starts when you meet your deductible and ends when you and your plan have spent $4,430. You then enter into the coverage gap phase (also known as the “donut hole”) until your out-of-pocket spending reaches $7,050. You pay a small amount for prescription drugs for the remainder of the year while you are in the catastrophic coverage phase.

If you have limited resources, you may be able to get financial assistance through Medicaid, Extra Help, or Pharmaceutical Assistance Programs in your state.

How to Choose a Medicare Part D Plan in the District of Columbia

Consider these factors as you compare Medicare prescription drug plans available in your area:
Monthly premium You’ll pay this amount every month whether or not you use your benefits. You should have access to at least one low-cost plan in your area.
Additional costs How much will it cost to use your benefits? Understand your deductible, copayments, and coverage during the gap and catastrophic phases.
Provider network Check to make sure your preferred pharmacies are in network to keep costs as low as possible.
Drug coverage/formulary See if your drugs are on the plan’s formulary and how much they cost each time you fill a prescription. You may want to talk with your doctor about a generic or alternative version of a drug you need.
Plan ratings Consider the quality of the plan based on Medicare star ratings, ratings from independent organizations such as the NCQA (which rates Medicare Advantage Plans that typically include drug coverage), and reviews from plan members.

Medicare Part D Resources in the District of Columbia

Need help choosing a Part D plan or help paying for your prescription drugs? Counselors in District of Columbia can help you find the best Part D coverage for your needs. They can also help if you’re having trouble getting an exception approved or have a denied claim. Get in touch with these Medicare resources in District of Columbia:

District of Columbia Medicare Resources
District of Columbia D.C. Department of Aging and Community Living Website | (202) 724-5626 The District of Columbia 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.
District of Columbia D.C. Health Insurance Counseling Project (HICP) Website | 202-727-8370 The city’s Health Insurance Counseling Project (HICP), provided through the Department of Aging and Community Living, is the state’s trusted source for Medicare information, including guidance for choosing Medicare Advantage plans. Certified counselors offer free, unbiased and personalized information sessions.
District of Columbia Office of Disability Rights – DC Medicaid and Medicare Website | (202) 724-5055 The District of Columbia D.C. office is primarily focused on people with disabilities, but it offers a good overview of Medicaid and Medicare programs on its site.
CMS Region 3 Office Website | [email protected] Contact the CMS regional office in Philadelphia for assistance with prescription drug coverage.
DC ADAP Website | (202) 671-4810 This program provides HIV/AIDS medications to low-income individuals who do not have adequate prescription drug coverage.
Extra Help Website | 1 (800) 633-4227 Extra Help can offer assistance paying Medicare prescription drug plan costs.
Pharmaceutical Assistance Program Website Enter your prescription drugs to get help paying for them.
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