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.
Find a local Medicare plan that fits your needs
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.
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.
- Medigap or Medicare Supplemental Insurance plans can help you cover out-of-pocket costs like coinsurance and copayments.
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.
To join Medicare in D.C., start by contacting your local Social Security office. You can:
- Enroll online at the Social Security Administration website. [i]
- 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
Are you eligible for cost-saving Medicare subsidies?
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. [i]
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 extra benefits and savings do you qualify for?
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. [i] 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.
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.
Get real Medicare answers and guidance -- no strings attached.
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.
Get the health benefits and savings you’re entitled to.
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.
Are you paying extra for dental, vision and hearing benefits?
District of Columbia
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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.
District of Columbia Healthcare Finance
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
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.
Speak with an insurance agent that is licensed in District of Columbia about your Medicare questions.
Mon-Fri, 7am-7pm CT
Centers for Medicare and Medicaid Services
If you have general questions about Medicare in DC, or need help with current Medicare benefits.
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement