Know your options for Medicare plans in Washington, D.C., whether you’re looking for Original Medicare or Medicare Advantage.
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Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Washington, D.C. has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$170.10 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
Washington, D.C. Medicare Advantage programs have networks and may only be available in certain areas of Washington, D.C.. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Washington, D.C. is $37.59 (in 2022).
Washington, D.C. Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Washington, D.C. has 16 plans available in 2022. Medicare Advantage has continued to rise in popularity with residents of Washington, D.C..
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||Better Business Bureau (BBB) rating||National Committee for Quality Assurance (NCQA) rating||J.D. Power ranking|
|3.9 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|4 stars||A||Not rated||3.5 to 4 stars||Third out of 10|
|5 stars||A+||A-||4 to 4.5 stars||First out of 10|
|4.2 stars||A||Not rated||3.5 to 4 stars||Seventh out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|AARP Medicare Advantage Choice Plan 1 (PPO)||$0||$0||Health: $750
|Cigna Preferred Medicare (HMO)||$0||$0||Health: $0
|Kaiser Permanente Medicare Advantage Value DC (HMO)||$0||$0||Health: $0
Plans calculated based on D.C. ZIP code 20004.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
District of Columbia Part D premiums start at $7.10 a month.
Currently, there are 21 stand-alone PDPs in Washington, D.C.. Seven of the stand-alone plans and 2 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|3.8 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|4 stars||A||Not rated||2.5 to 3.5 stars||Third out of 10|
|4.2 stars||A-||A+||3.5 to 4 stars||Fourth out of 10|
|4.2 stars||A||A+||2.5 to 4 stars||Seventh out of 10|
|3.7 stars||Not rated||A-||2.5 to 3.5 stars||Ninth out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartRx (PDP)||$7.10||$42.60||$480|
|Wellcare Value Script||$12.90||$77.40||$480|
|Humana Walmart Value RX||$22.70||$136.20||$480|
Plans calculated based on D.C. ZIP code 20004.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 9 standardized plans available in Washington, D.C. designated by different letters of the alphabet (A, B, C, D, F, G, K, L, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to Jan. 1, 2020.
A Plan G for a 65-year-old nonsmoking female in D.C. ranges from $110 to $311 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Plan F||$132 to $339||$0||$0 hospital (Part A)
$0 medical (Part B)
|Plan G||$110 to $311||$0||$0 hospital (Part A)
$233 medical (Part B)
|Plan N||$87 to $288||$0 Generally your cost for approved Part B services with some $20 and $50 copays||$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in D.C. ZIP code 20004.
Residents of Washington, D.C. have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual Washington, D.C. spending per beneficiary||Spending per beneficiary compared to the national average|
|74,116||Part A: $0 to $499 per month*
Part B: $170.10 **
|$10,679||No data available|
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in Washington, D.C.. The organizations have people knowledgeable in the programs specific to your area. Most of the services provided are free. An example is the Department of Aging and Community Living State Health Insurance Assistance Program (SHIP), which offers Medicare guidance and education for free.
Never be afraid to ask questions. Get started with these District of Columbia Medicare resources:
|Organization||How you can get help||Contact Information|
|DC Office of Disability Rights||Can provide you with legal advocacy for a wide range of disabilities. Some of the services include investigating violations involving abuse, neglect, civil rights, and discrimination.||Website | (202) 724-5055|
|DC Office of the Health Care Ombudsman and Bill of Rights||The office can answer any questions you have about insurance you bought for yourself and/or your family, or if you have insurance provided by an employer who does business only in Washington, D.C..||Website | (877) 685-6391|
|Department of Aging and Community Living SHIP||Medicare beneficiaries, their families, and caregivers living in Washington, D.C. can access free health insurance information, counseling, education, and assistance. SHIP counselors are trained to get you the information you need and can work with you directly to understand the ins and outs of Medicare so you can make informed decisions about your health care and insurance coverage.||Website | (202) 727-8370|
|Department of Health Care Finance (DHCF)||The Department of Health Care Finance can help if you are having a hard time affording health coverage and you have questions about eligibility for Medicaid or if you have questions about your current Medicaid benefits.||Website | (202) 442-5988|
|Washington, D.C. Department of Human Services||Washington, D.C. Department of Human Services empowers every District resident to reach their full potential by providing meaningful connections to work opportunities, economic assistance, and supportive services.||Website | (202) 671-4200|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.