If you’re a Medicare beneficiary in Washington, D.C., you may want to consider signing up for a Medicare Supplement (or Medigap) plan. Medigap plans in Washington, D.C., may help cover health-care costs associated with Original Medicare, Part A and Part B, such as copayments, coinsurance, deductibles, and other out-pocket expenses. Since there may be a variety of Medigap plans available in your area, it may be a good idea to familiarize yourself with what each plan covers, and get help selecting one that works for your health and budget needs.
How Medicare Supplement plans work in Washington, D.C.
There are 10 standardized Medigap plans in D.C. (and in most states), and they’re identified by one of 10 letters (A, B, C, D, F, G, K, L, M, and N). All plans of the same letter offer the same benefits, and the same 10 plans are generally available in 47 states, plus Washington, D.C.. Three states – Massachusetts, Minnesota, and Wisconsin – offer different Medigap plans. Also note that some companies may offer additional innovative benefits.
In order to join a Medicare Supplement (Medigap) plan in Washington, D.C., you must already be enrolled in Original Medicare, Part A and Part B. You may want to sign up for a Medigap plan during your Medigap Open Enrollment Period, which starts the first day you are both age 65 or older and enrolled in Medicare Part B. This enrollment period lasts for six months. During this time frame, you can sign up for any Medicare Supplement plan available in your area, with the insurance company of your choosing, and not be subject to medical underwriting or any restrictions for pre-existing conditions (although waiting periods may apply). This means that an insurance company can neither deny nor charge you more for a Medigap plan in Washington, D.C.. If you decide to apply for a Medigap policy outside of this time, you may be denied coverage or charged more for the insurance policy.
It’s very important for you to know that even if you sign up for a Medicare Supplement plan, you must remain enrolled in Original Medicare, Part A and Part B, and go on paying your Medicare Part B premium, in order to keep your health insurance coverage. Since Medigap plans are meant to supplement and not replace Original Medicare, failure to pay your Medicare Part B premium may result in your being disenrolled from Medicare and losing your health coverage.
Also be aware that Medigap plans currently sold in Washington, D.C., do not offer prescription drug coverage. The same is true in all states, so you may want to enroll in a stand-alone Medicare Part D Prescription Drug Plan if you want to receive coverage for drug expenses. Medicare Part D Prescription Drug Plans in Washington, D.C., and the rest of the United States are available through private, Medicare-approved insurance companies.
Types of Medicare Supplement plans in Washington, D.C.
Here’s a quick look at what the 10 standardized Medicare Supplement plans that may be available in Washington, D.C., have to offer. In this table, note that an X means the item is covered; a percentage indicates the portion of the service that’s covered; and a blank cell means the service is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C*||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance hospital costs up to an additional
365 days after Medicare benefits are exhausted
|Medicare Part B copayment or coinsurance coverage||X||X||X||X||X||X||50%||75%||X||X|
|First 3 pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled Nursing Facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B ‘excess charges’||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Medicare Part B preventive care coinsurance||X||X||X||X||X||X||X||X||X||X|
|Out-of-pocket limits apply|
Also note the following about Medigap plans in Washington, D.C.:
* As of January 1, 2020 people new to Medicare can’t buy plans that cover the Medicare Part B deductible. This means that Medicare Supplement Plans C and F will no longer be available to new Medicare enrollees. However, if you already have a Plan C, Plan F, or high deductible Plan F, you can keep it. If you were eligible for Medicare before January 1, 2020, you also may be able to buy Medicare Supplement Plan C, F, or high deductible Plan F.
- Medicare Supplement Plan F is the most comprehensive of the 10 plans available, covering almost 100% of Medicare-associated costs, excluding the Medicare Part B premium.
- Medicare Supplement Plan F offers a high-deductible version in which beneficiaries are required to pay a certain amount out-of-pocket before the plan begins coverage.
- Plan G will offer a high deductible option starting Jan 1, 2020, according to AHIP, America’s Health Insurance Plans.
- Once you reach the out-of-pocket limits indicated in the table above, Medicare Supplement plans K and L pay 100% of covered services for the calendar year.
- Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance.
- Medicare Supplement Plan N does not cover the $20 copayment on doctor’s visits and the $50 copayment on emergency room visits.
Choosing a suitable Medicare Supplement plan in Washington, D.C.
As stated earlier, Medicare Supplement plans in Washington, D.C., with the same letter designation don’t vary in coverage or benefits. However, each independent insurance company offering Medicare Supplement plans can determine its own monthly premium structure. This means that if you live in Georgetown, in Ward 2, you may pay more or less than a resident of Capitol Hill, in Ward 6, for an identical Medicare Supplement plan. It may be a good idea to compare all Medicare Supplement plans available in your area, and then choose a Medigap plan in Washington, D.C., based on your personal health and budget needs.
To get more information about Medicare insurance in Washington, D.C., check out the following resources:
- Medicare in Washington, D.C.
- Medicare Advantage in Washington, D.C.
- Medicare Part D in Washington, D.C.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.