Guide to Medicare in Washington, D.C.

Medicare is the federal health insurance program for those over the age of 65 (and some disabled people). It’s available in all 50 states and the District of Columbia. While the government program is federal, carriers offer different plans in every county and zip code. That means that plans in D.C. can vary from plans available in the state of Maryland and other surrounding areas. 

Use this guide as a starting point for figuring out which type of Medicare coverage is right for you. Then, one of our licensed agents can help you select a great plan for your needs.

Click below to learn more about DC Medicare:

• D.C. Medicare Eligibility
• What Does Washington D.C. Medicare Cost?
• What Does Medicare Cover in D.C.?
• D.C. Medicare Plans
• Washington, D.C. Medicare Doctors
• D.C. Area Senior Resources
• Getting Both Medicare and Medicaid in D.C.
• How to Apply for Medicare in D.C.

D.C. Medicare Eligibility

There are a few ways to qualify for Medicare in D.C. You can qualify for Medicare by:

• Turning 65
• Getting diagnosed with ALS
• Getting diagnosed with ESRD
• Entering your 25th month of SSDI

What Does Washington D.C. Medicare Cost?

Original Medicare costs don’t depend on location, but private Medicare plan costs can. Your Original Medicare costs will depend on what plans you enroll in and what savings programs you qualify for. If you stick to Original Medicare, you’ll be responsible for 20% of the costs for your covered Medical (Part B) services (this can change if you enroll in a Medicare Supplement plan or are eligible for other savings).

In 2019, the Part B deductible 2019 is $185, and the premiums range from $135.50 per month to $460.50 per month (depending on your income). 

Medicare Part A costs in 2019 include*:

• Deductible: $1,364
• Copayments/Coinsurance: Depends on length of hospital stay
• Premium:
  • $0/month if you worked and paid Medicare taxes for more than 39 quarters
  • $240/month if you worked and paid Medicare taxes for between 30-39 quarters
  • $437/month if you worked and paid Medicare taxes for less than 30 quarters

*Costs can change based on savings programs and supplemental policies.

What Does Medicare Cover in D.C.?

The traditional Medicare program provides the same coverage in all 50 U.S. states. Your coverage can be different if you decide to enroll in a private plan. Original Medicare includes Part A, which covers inpatient hospital-related benefits, and Part B, which covers outpatient medical benefits. Part A covers inpatient and outpatient hospital stays, hospice, and some home health services. Part B covers preventative care like your annual wellness visit, outpatient mental health, lab tests and X-rays, durable medical equipment, and ambulance travel.

If you’re looking for other benefits, like dental, vision, and prescription drugs, you’ll want to look at Medicare Advantage plans. If you’re looking for more financial coverage, you might want to consider Medicare Supplements.

D.C. Medicare Plans

Our Medicare Plan Finder tool allows you to search through some of the plans available in the D.C. area so that you can make educated choices regarding your healthcare. Our licensed agents can then be available to help answer your questions and help you sort through all of your options for Medicare in Washington, D.C.

D.C. Medicare Advantage Plans (MA)

D.C. Medicare Advantage plans are offered by private companies, not the federal government. That means that even though they are still regulated by Medicare, they are able to offer additional benefits that Original Medicare cannot offer. That can include fitness benefits, dental, vision, prescription drugs, and even meal delivery. 

You’re probably thinking that all those extra benefits are expensive. They can be, but some people are eligible for Medicare Advantage plans with $0 premiums! Costs depend on your location, the type of Medicare Advantage plan, any assistance you may receive, and how much coverage you’re looking for.

D.C. Medicare Supplement Plans (Medigap)

Supplemental insurance can mean a few different things, but in Medicare, it often means Medicare Supplements. Don’t get confused – Medicare Supplements are ALSO called Medigap plans.

Medicare Supplements are different from Medicare Advantage plans. Even though they are another form of private health insurance that works alongside Medicare, Medicare Supplements do not typically add health coverage. Instead, they can add financial benefits by covering your copayments, deductibles, etc. If you think Medigap is right for you, head straight to our Medicare Plan Finder tool to find out which plan may be best for you, or call 844-431-1832 during business hours to get connected with a licensed agent.

D.C. Medicare Part D Prescription Drug Plans

You can get Medicare prescription drug coverage in D.C. in two different ways. You can either enroll in a Medicare Advantage plan that comes with a prescription drug benefit, or enroll in a stand-alone prescription drug plan. Keep in mind that you cannot have both a Medicare Advantage plan and a prescription drug plan at the same time, so you’ll have to choose one.

Washington, D.C. Medicare Doctors

A great way to find Hawaii doctors who accept Medicare is by visiting Medicare.gov’s provider finder tool. 

If you have a Medicare Advantage plan or other private insurance, your network may be a little different. Find out if your plan carrier has its own doctor finder tool. Use your plan’s doctor finder or ask your agent for help to make sure that your favorite doctors, hospitals, and specialists are in your network.

D.C. Area Resources for Seniors

DACL (Department of Aging and Community Living): Reach out to DACL for assistance with long-term healthcare services within the District of Columbia. 

Medicare Plan Finder: We have licensed agents who provide free assistance with selecting Medicare plans! It doesn’t cost anything more to speak with an agent than if you had applied directly through the carrier. The difference is that an agent can offer you multiple plans, providing a bias-free approach. We also have a Medicare Plan Finder tool that you can use to compare plans before you meet with an agent.

Senior Wellness Centers: The Department of Aging and Community Living has wellness centers throughout the D.C. area that provide programs such as nutrition and exercise classes, creative arts, and training programs.

D.C. Medicare Offices

You can get the information you need online at Medicare.gov or by calling Social Security. However, if you’re still having trouble, CMS does have an office in D.C. We’ve also listed out the addresses of some other offices that may be a good resource for you.

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CMS (Centers for Medicare and Medicaid Services)

200 Independence Ave., S.W.

Washington, DC 20001

410-786-3000

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District of Columbia Healthcare Finance

Office of the Ombudsman

441 4th St., NY (9th and 10th Fl.)

Washington, DC 20001

877-685-6391

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Department of Human Services

64 New York Avenue NE, 6th FL.

Washington DC 20002

202-671-4200

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Social Security Office

Postal Plaza Shopping Center

1905-B 9th St. NE

Washington, DC 20018

1-800-772-1213 (TTY 1-800-325-0778)

Getting Both Medicare and Medicaid in D.C.

If you qualify for both Medicare and D.C. Medicaid and there is a plan available in your area, you may be able to enroll in a Medicare Advantage Dual-Eligible Special Needs Plan. These plans generally have very low or no out of pocket costs to you and can provide benefits for Medicare and Medicaid covered services. Medicaid qualifications are based on income and other local regulations. For help with finding plans in your area, call 844-431-1832.

D.C. Medicaid Dual Medicare Application

If you are eligible for a dual-eligible special needs plan, you may have several options available to you. Speak with an agent to find out which one is best for you, and they can help you learn how to enroll and where to find the application. You may need to apply for Medicaid first (if you haven’t already). You can find the D.C. Medicaid application here.

How to Apply for Medicare in D.C.

If you receive benefits from the Railroad Retirement Board or Social Security, you may be automatically enrolled in Medicare. If you are not automatically enrolled, you can enroll through the Social Security website, in-person at a Social Security office, or by calling 1-800-772-1213. 

To enroll in Part D, Medicare Advantage, or Medicare Supplements, start searching for D.C. area Medicare plans here or get in touch with an agent, here. You can also call our office at 844-431-1832 during our business hours (8 AM to 4:30 PM CST/MST).