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Medicare in D.C.

Learn about enrollment, costs, and coverage with Medicare in D.C.

Reviewed by: Malinda Cannon, Licensed Insurance Agent. Written by: Vanessa Jerusalimiec.

Key Takeaways

  • Medicare in Washington, D.C. is available to U.S citizens and legal residents over age 65.

  • Original Medicare Parts A and BOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). cover hospital and medical healthcare.

  • Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans may offer additional coverage such as prescription drug coverage and dental, vision, and hearing coverage.

 

Washington D.C. is packed with historical and iconic buildings including the Capitol, the White House, and the Lincoln Memorial. Our nation’s capital is also home to famous museums like the Smithsonian that draw visitors from around the world.

Stay healthy while you take in all the District has to offer. Here’s our complete guide to Medicare in D.C.

What is Medicare D.C.?

Medicare is a federally funded health insurance program for adults over age 65. You can enroll in Medicare in Washington, D.C. in two ways: enroll in Original Medicare, or join a Medicare Advantage plan.

Original Medicare

Medicare Parts A and B cover most hospital and medical expenses. This includes preventative services and medically necessary treatments.

  • Original Medicare out-of-pocket expenses can be steep. You’ll need to reach your yearly deductible before insurance kicks in, and you will continue to pay co-insurance throughout the year.
  • To get medication coverage, you will need to enroll in a separate Part D plan.

Medicare Advantage Plans

Medicare Advantage in D.C. replaces your Original Medicare coverage. Advantage plans provide hospital and medical benefits as well as prescription drug coverage. These plans can also include additional coverage for dental, vision, and hearing services.

How Do I Apply for Medicare in D.C.?

To join Medicare in D.C., start by contacting your local Social Security office. You can:

  • Enroll online at the Social Security Administration website. [1]
  • Phone Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
  • Visit the Social Security office in person at 1300D Street SW, 20024.

Once you enroll in Medicare, you can choose to stay in Original Medicare, add Part D coverage, or enroll in a Medicare Advantage Plan.

When Can I Enroll in Medicare in D.C?

The best time to enroll in Medicare is during your Initial Enrollment Period. This seven-month period starts three months before the month you turn 65. If you miss your enrollment period, you may have late penalties, so it’s a good idea to enroll as soon as you’re eligible. Other enrollment periods include:

  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Open Enrollment Period: Oct. 15 to Dec. 7

Who is Eligible for Medicare in D.C.?

All U.S. citizens and permanent residents over age 65 are eligible for Medicare in D.C. Younger adults can also qualify for Medicare if:

  • They’ve collected social security disability benefits for at least 24 months
  • They are living with End-Stage Renal Disease (ESRD)
  • They have Lou Gehrig’s Disease or ALS

How Do I Get Free Health Insurance in D.C.?

Dual eligible adults who qualify for both Medicare and Medicaid can get insurance coverage at no cost. Medicaid is a federal program that helps low-income adults pay for healthcare. If you have an annual income of less than $17,131, you can enroll in D.C. Medicaid. [2]

When you access hospital or medical care, Original Medicare pays first. Then, Medicaid will cover most or all of the remaining out-of-pocket costs.

What is the Average Cost of a Medicare Part D plan?

Medicare Part D covers prescription medications. Plan premiums can start as low as $0, but the average monthly cost of a Medicare Part D plan in 2021 is $41 per month. [3] Each Part D plan has a unique formulary or list of covered medications. Before enrolling in a Part D plan, check if your current prescriptions are on the list.

What Medicare Covers D.C.?

Medicare offers comprehensive coverage to adults over age 65.

Medicare Part A provides hospital insurance. This includes:

  • Inpatient hospital visits
  • Nursing facility care
  • Limited home healthcare

Medicare Part B is medical insurance. Coverage includes:

  • Outpatient care
  • Doctor’s visits
  • Lab screenings such as blood work and X-rays
  • Preventative care
  • Durable medical equipment like a walker or wheelchair

Medicare Part C is a comprehensive health insurance plan. Coverage can include:

  • Hospital coverage
  • Medical coverage
  • Prescription drug coverage
  • Additional coverage for services like dental, vision, and hearing care

Medicare Part D offers prescription drug coverage. Each plan has a formulary that lists what medications are covered. The formulary also shows how much you’ll pay in coinsurance and copayments.

What is the Best Medicare Plan for 2021?

Medicare plans aren’t a one-size-fits-all solution. The best Medicare plan depends on your healthcare needs. You could enroll in Original Medicare or a Medicare Advantage plan and be perfectly happy with your coverage.

  • Original Medicare has few network restrictions, so you can access care from most healthcare providers. However, Original Medicare has higher out-of-pocket costs and out-of-pocket limits.
  • Medicare Advantage in D.C. has lower costs and a cap on yearly spending. But Advantage plans have smaller provider networks, and you’ll need to schedule appointments with in-network providers.

Ask the Experts at GoHealth: If you’re unsure which Medicare plan in D.C. is right for you, our licensed insurance agents can help you weigh the pros and cons and find the best plan. Call us today at 1-855-792-0088 TTY: 771.

Who Has the Best Medicare Plan?

Original Medicare is a federally funded healthcare program offering coverage to adults aged 65 and over. Medicare Parts A and B are administered by the Social Security Administration. Medicare Part C and Part D plans are offered by private insurance agencies, and each plan has unique coverage options.

Is Medicare Advantage a Rip-off?

Depending on your healthcare needs, an Advantage plan might not be the best choice for you.

  • Pros include long-term savings, a cap on out-of-pocket spending, coordinated care, and additional coverage options for vision and dental services.
  • Cons can include less flexibility, fewer in-network care providers, and state-specific coverage.

Before enrolling in a Medicare Advantage plan, consider some of these pros and cons, and decide if an Advantage plan is right for you.

Which Company Has the Best Medicare Advantage Plan?

Several private insurance providers offer Medicare plans in D.C. When comparing plans, check the Medicare star rating for each plan. This system helps you compare plans and find out who has the best Medicare plans in D.C. Look for plans with a 4- or 5-star rating to find the best Advantage plans.

GoHealth provides Medicare Advantage plans in D.C. with low premiums and comprehensive coverage. Give us a call and find out what Medicare plans can work for you.

Washington, D.C. Medicare by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 77,937 people are enrolled in Medicare in Washington, D.C. The total number of beneficiaries enrolled in Medicare Advantage in Washington, D.C. is 18,330. The previous year, 16,069 enrolled in Medicare Advantage. Medicare Advantage participation in Washington, D.C. went from 21.12% to 23.52% year over year. If you’d like to dive deeper into how Medicare in Washington, D.C. breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of District Of Columbia>
77,937
Beneficiaries with Part A & Part B
18,330
Medicare Advantage Beneficiaries
23.52%
Medicare Advantage Participation Rate
57.37%
% Female
42.63%
% Male
1.14
Average HCC Score
$12,208.26
Actual Per Capita Costs
40.97%
% Eligible for Medicaid
35.72%
% of Beneficiaries with an Emergency Department Visit
21.86%
Hospital Readmission Rate
29.82%
% Non-Hispanic White
61.11%
% African American
4.29%
% Hispanic
4.78%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Washington, D.C. Medicare Resources & Contacts

Beneficiaries spend an average of $12,208.26 each year on Medicare in Washington, D.C. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Washington, D.C.-based resources, like these, may be able to help:

District of Columbia Healthcare Finance

1-877-685-6391

https://healthcareombudsman.dc.gov/

What should I know about D.C. Healthcare Finance?

If you have questions about the health insurance you’ve bought, contact the Department of Insurance.

Department of Human Services

202-671-4200 (TTY: 711)

https://dhs.dc.gov/

What should I know about Washington, D.C. DHS?

If you have questions about health coverage eligibility or having a hard time affording coverage, contact Washington, D.C.’s Medicaid Program.

Washington, D.C. Department of Veterans Affairs

1-877-327-0022

https://benefits.va.gov/benefits/

What Should I Know about DCVA?

If you are a veteran and have a question or concern about veterans’ health care benefits, contact your Veterans Affairs office.

Nationwide Resources

Speak with an insurance agent that is licensed in District of Columbia about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in DC, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.