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Medicare Advantage in Washington, DC

Last Updated on

October 6, 2016

If you’re a Medicare beneficiary in Washington, D.C. and looking for an alternative way of getting your Medicare benefits, you may want to consider signing up for Medicare Advantage (Medicare Part C). Under Medicare Advantage, you receive your Medicare benefits through a private health insurance company that are contracted with Medicare, rather than directly through the federal government. Availability and costs of Medicare Advantage plans in Washington, D.C. may vary. 

How Medicare Advantage works in Washington, D.C.

Medicare Advantage plans in Washington, D.C., as in the rest of the United States, contract with Medicare to provide your  Original Medicare, Part A and Part B, benefits (except for hospice care, which is covered under Part A). Some Medicare Advantage plans in Washington, D.C., may also offer additional benefits, like routine vision, hearing, and dental services, and fitness programs for seniors. Many Medicare Advantage plans in Washington, D.C., also offer prescription drug coverage.

In order to enroll in a Medicare Advantage plan in Washington, D.C., you must already be enrolled or be eligible to enroll in Original Medicare, Part A and Part B. Many beneficiaries are automatically enrolled in Original Medicare as soon as they’re eligible. If you’re not automatically enrolled, you can enroll in Original Medicare during your Period which begins three months before you turn 65, includes your birthday month, and ends three months after that month. If you don’t enroll in Original Medicare during this time period, you may have to pay a late-enrollment penalty for as long as you remain enrolled in Medicare. Another opportunity to enroll in Original Medicare is during the General Enrollment Period, which runs from January 1 to March 31 each year, but you might still have to pay the penalty fee.

If you’re enrolled in a Medicare Advantage plan in Washington, D.C. and decide to switch to a different plan or make certain other coverage changes, you can do so during the Annual Election Period. Also called the Fall Open Enrollment Period, it runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. You may also be able to switch Medicare Advantage plans in Washington, D.C. during a Special Election Period, under certain circumstances — for example, if you lose your current coverage, qualify for other coverage, or move to a new address.

If you want to switch from Medicare Advantage back to Original Medicare, Part A and Part B, you may do so during the Medicare Advantage Disenrollment Period (MADP), which runs from January 1 to February 14 each year in Washington, D.C. and the rest of the United States. 

Types of Medicare Advantage Plans in Washington, D.C.

Here’s a look at the main types of Medicare Advantage plans available in Washington, D.C.:

  • Health Maintenance Organizations (HMOs): An HMO, which is a common Medicare Advantage option, usually requires you to visit doctors, health-care providers, and hospitals listed in your plan’s network. You may also have to get a referral from your primary doctor to receive coverage for some health services.
  • HMO Point-of-Service (HMO-POS): An HMO-POS plan may offer more flexibility than an HMO, sometimes letting you go out-of-network for a number of health services, but generally at a higher cost.
  • Preferred Provider Organization (PPO)*: Under a PPO, you can generally benefit from even more flexibility than you would under an HMO-POS plan. A PPO usually allows you to choose doctors, health care providers, and hospitals outside of your plan’s network, but generally at a higher out-of-pocket cost.
  • Private Fee-for-Service (PFFS): A PFFS plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense.
  • Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account, which you generally use to pay for your health care expenses.
  • Special Needs Plan (SNP): This type of plan may be an option for Medicare beneficiaries with certain health conditions, those living in institutions, or people who qualify for both Medicare and Medicaid. Medicare SNPs include plans for patients with HIV/AIDS, chronic heart failure, or dementia, for example.
  • Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage into a single insurance plan. Most of the plan types listed above are MAPD plans. 

Comparing Medicare Advantage plans available in Washington, D.C.

As a Medicare beneficiary in Washington, D.C., it may be a good idea for you to compare all Medicare Advantage plans available in your area.

The availability and costs of Medicare Advantage plans can vary. You may find that some Medicare Advantage plans in Washington, D.C. offer premiums as low as $0, but always keep in mind that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, in order to keep your Medicare insurance coverage.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, such as prescription drug coverage. With all these options that may be available in Washington, D.C., you can see why it can be smart to compare plans with the benefits and costs suited to your individual health requirements.

To start comparing Medicare Advantage plans in Washington, D.C. today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.

If you need more information about Medicare insurance in Washington, D.C., access the following resources:

 

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.