Medicare Plans in Washington D.C.
Medicare beneficiaries in Washington D.C. can choose from a variety of options. However, sorting through the plans to find the right level of coverage can be overwhelming. That’s why we created this guide to help you sort through the Medicare plans in Washington D.C. to find the coverage you need.
Who’s eligible for a Medicare Plans in Washington D.C.?
Medicare is a federally sponsored program that provides healthcare services to those who qualify, by either age or disability/illness. Individuals generally become eligible for Medicare plans in Washington D.C. once they reach 65 years of age. Persons under the age of 65 may also qualify if they have been receiving Social Security Disability Insurance (SSDI) for two years or have been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD).
To qualify, you must be a citizen or permanent resident, having lived in the US for the past five years. In addition, you or your spouse must have worked and paid Medicare taxes for at least 10 years.
If you are unsure about your eligibility or will be turning 65 in the next six months, we’re here to help. Talk to a licensed insurance agent now by calling the number above.
What are the Medicare Plans in Washington D.C.
Orginial Medicare Part A & Part B
Original Medicare is made up of two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, care received at a skilled nursing facility, and hospice care.
Part B (Medical Insurance) covers outpatient medical services and supplies that are considered medically necessary. Part B also covers some preventive care, like flu shots and cardiovascular screenings.
It’s important to recognize that Original Medicare does not cover everything. For example, it generally does not cover prescription medications, hearing exams/hearing aids, long term care, dental care, or eyeglasses. That’s why there is a wide variety of different types of Medicare plans available, to help obtain a more comprehensive coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are provided by Medicare-approved private insurance companies and work as an alternative to Original Medicare (Parts A and B). These plans must provide the same coverage as Original Medicare (with the exception of hospice care, which remains covered by Part A). They can also provide additional benefits, such as dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
To enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Premiums for these plans can start at $0, increasing with the level of coverage selected. You’ll need to continue paying your Part B premium in addition to your Part C premium.
Medicare Prescription Drug Plans (Part D)
Prescription Drug coverage is generally not covered by Original Medicare or Medigap Plans. Stand-alone Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare (Parts A and B) to add prescription drug coverage. With these plans, a tier system is used to grade medications, and copays/coinsurance for each medication are set in accordance with their tiers. Drugs graded in the lowest tiers have the lowest copays/coinsurance, and vice versa. Each plan provides a drug formulary for you to see which tier(s) your medications fall into. This allows you to compare plans and select one with the best overall value for your specific prescription needs.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans add an additional layer of coverage to your Original Medicare by filling in coverage gaps. Medigap plans are provided by Medicare-approved private insurance companies and work alongside your Original Medicare to help reduce your out-of-pocket costs by paying certain healthcare costs, like copayments, coinsurance, and deductibles.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.
You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Medicare Initial Enrollment Period
7-Month Initial Enrollment Period | Begins 3 months before the month you turn 65
*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.
KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.
Additional Medicare Resources in Washington D.C.
The state’s Health Insurance Counseling Project (HICP) is part of the insurance commissioner’s consumer protection services. HICP provides free assistance and counseling regarding Medicare and health care choices.
Washington D.C.’s Medicare Savings Program is available to Medicare beneficiaries whose income falls below a certain level to help pay for certain medical expenses, like premiums and deductibles.
Sources: Medicare.gov; www.law.gwu.edu; http://doh.dc.gov/