Medicare in D.C.
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.
Medicare in 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’s 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 coinsurance 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. Medicare 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.
What Medicare coverage is right for my specific situation?
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.
- 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.
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.
Let’s find your ideal Medicare Advantage plan.
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 adults with low and limited incomes pay for healthcare. If your income meets the requirements, both Medicare and Medicaid will work together to cover your healthcare needs.
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 premium of a Medicare Part D plan in 2024 is $55.50. 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 in 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
- Outpatient care
- Doctor’s visits
- Lab screenings such as blood work and X-rays
- Preventative care
- Durable medical equipment like a walker or wheelchair
- Hospital coverage
- Medical coverage
- Prescription drug coverage
- Additional coverage for services like dental, vision, and hearing care
Find the Medicare Advantage plan that meets your needs.
What Is the Best Medicare Plan for 2024?
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 Medicare Advantage plans have smaller provider networks, and you’ll need to schedule appointments with in-network providers.
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, a Medicare 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.
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 Medicare 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.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 79,549 people are enrolled in Medicare Part A and B in the District of Columbia. The total number of beneficiaries enrolled in Medicare Advantage increased from 20,204 to 22,330 year over year. Medicare Advantage participation in the District of Columbia went from 25.69% to 28.07% year over year. If you’d like to dive deeper into how Medicare in the District of Columbia breaks down across the state, we provide a glance at who is using Medicare and how.
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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
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
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
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 a GoHealth insurance agent that is licensed in District Of Columbia about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration 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
1-800-722-1213
TTY 1-800-325-0778
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.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Medicaid Eligibility. Benefits.gov
- CMS Releases 2024 Projected Medicare Part D Average Premium. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.