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Medicare in District of Columbia

October 6, 2016

Once you reach the retirement age of 65, you may start thinking about the kind of health insurance you’ll need after you stop working. Like many Americans, you may realize that health insurance could become a major expense. This is where Medicare, a government-sponsored health insurance program, comes in. In some cases, you may be eligible for Medicare before age 65. Find out what kind of medical and hospital insurance coverage you can receive as a Washington, D.C. Medicare beneficiary.

Original Medicare for Washington, D.C. beneficiaries

Original Medicare encompasses Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). In Washington, D.C., as in the rest of the U.S., many people are automatically enrolled into the program (this generally happens if you’ve worked at least 10 years, or 40 quarters, while paying Medicare taxes). If you’re not automatically enrolled, you can enroll in Original Medicare during the Medicare Initial Enrollment Period. You’re also able to enroll in Medicare during the annual General Enrollment Period, which runs from January 1 to March 31. However, if you miss your seven-month Initial Enrollment Period, you might have to pay a late-enrollment penalty in the form of higher monthly premiums.

In Washington, D.C., as in the rest of the United States, you generally don’t have to pay a monthly premium for Medicare Part A (hospital insurance). If you have worked in the U.S. for at least 10 years (40 quarters), you won’t pay a premium for Part A. Medicare Part A generally includes the following health benefits:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Limited home health services

Washington, D.C. Medicare beneficiaries are generally also eligible for medical insurance under Medicare Part B, for which they have to pay a monthly premium. Washington, D.C. Medicare Part B may cover the following services and supplies:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs 

Medicare plan options in Washington, D.C.

Beneficiaries in Washington D.C. may have an alternative way to get Original Medicare benefits through the Medicare Advantage (Medicare Part C) program. Medicare Advantage plans are required to deliver and administer Original Medicare, Part A and Part B, benefits to their members. Many Medicare Advantage plans offer additional coverage, like routine dental, vision, and hearing benefits.

Medicare Advantage Prescription Drug plans in Washington, D.C. (and other states) combine health and prescription drug coverage. If you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you have to stay enrolled in Original Medicare and continue paying the Medicare Part B premium.

If you decide to stay with Original Medicare, another option you may have in Washington, D.C. is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Prescription drug coverage for Medicare beneficiaries is available through the Medicare Part D program, which lets private, Medicare-approved insurance companies offer plans designed to help cover expenses for prescription drugs. Costs for stand-alone Medicare Part D Prescription Drug Plans vary from one plan to another. Your plan may require payment of a monthly premium, annual deductible, and copayment or coinsurance.

As a Washington, D.C. Medicare beneficiary, you may have access to various Medicare Advantage plan options, so you might want to customize your search for plans based on your individual health and prescription needs. Feel free to enter your zip code in the form on this page to get started comparing plans in your area.

For more information about private Medicare insurance for Washington, D.C. beneficiaries, please see: