Medicare plays a key role in providing health and financial security to beneficiaries residing in the District of Columbia (DC). With more than 94,200 DC beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in DC. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in the District of Columbia?

Medicare covers most District of Columbia residents who are 65 or older, and it also covers disabled District of Columbia residents. In general, Medicare enrollment in District of Columbia works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

District of Columbia Medicare Enrollments

73,501

Original Medicare Plans
(Part A and B)

20,777

Medicare Advantage & Other Health Plans

58,757

Stand-alone Medicare
Part D (Drug plans)

94,278

Total Medicare Beneficiaries
in District of Columbia

DC Medicare Advantage Plans (Part C)

Only 20% of DC Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in DC who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 20,777 beneficiaries enrolled in Medicare Advantage and other plans in DC. Only 20% of DC Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 11 Medicare Advantage plans are available in DC. $0 is the lowest monthly premium for a Medicare Advantage plan in DC.

DC Medicare Supplement (Medigap) Insurance Plans

In DC, insurers can voluntarily choose to offer Medigap plans to beneficiaries under 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

There are at least eight insurers that offer Medigap plans in DC. Since DC doesn’t regulate Medigap plans, federal rules apply in the District rather than state regulations like the rest of the country. In DC, insurers can voluntarily choose to offer Medigap plans to beneficiaries under 65.

DC Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 38,750 Medicare beneficiaries in DC enrolled in Part D prescription drug plans and 20,007 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 25, Part D plans available in DC, with premiums ranging from about $14 to $97 per month.

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in the District of Columbia

  • The DC State Health Insurance Assistance Program (SHIP) provides free health insurance information, education, and counseling services to Medicare beneficiaries and seniors who live in DC. In addition to assistance with health insurance issues, SHIP also assists seniors with resolving unpaid medical bills, making appeals for denials of medical services, and obtaining prescription medications.

    SHIP can answer questions and provide assistance on issues relating to health insurance including Medicare, Medicaid, Medigap (Medicare supplemental insurance), Medicare+Choice (Medicare managed care), long-term care insurance, long-term care, federal employee health benefits, unpaid medical bills, HMOs, durable medical equipment, and hospice care. Contact: Call (202) 727-8370

  • The Qualified Medicare Beneficiary (QMB) program helps District residents who are eligible for Medicare pay for their Medicare costs. This means that Medicaid will pay for the Medicare premiums, co-insurance, and deductibles for Medicare-covered services. It also means that you will receive extra help with your costs under the Medicare prescription drug benefit (Part D), which will limit the amount you pay for your prescriptions to only a few dollars each. Contact: Call (202) 994-6272

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of DC. Our process makes it easier for you to access your Medicare eligibility in DC so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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