Medicare in D.C.
Written by: Vanessa Jerusalimiec
Reviewed by: Malinda Cannon, Licensed Insurance Agent
Medicare in Washington, D.C. is available to U.S citizens and legal residents over age 65.
Original Medicare Parts A and B cover hospital and medical healthcare.
Medicare Advantage (Part C) 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
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.
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.
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.
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 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 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 2022 is $33 per month. 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.
Get real Medicare answers and guidance -- no strings attached.
What Is the Best Medicare Plan for 2022?
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.
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, 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.
Before enrolling in a Medicare Advantage plan, consider some of these pros and cons, and decide if a Medicare 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 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.
Are you paying extra for dental, vision and hearing benefits?
Washington, D.C. Medicare by the Numbers
District of Columbia
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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.
Washington, D.C. Medicare Resources & Contacts
Beneficiaries spend an average of $1,474.87 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:
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