Medicare in Washington D.C.

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  • Residents of Washington D.C. who are over age 65 are probably eligible for Medicare. Find out more about this coverage option and what plans you can choose from.

What Medicare Plans Are Available in Washington D.C.?

The city of Washington D.C. is a unique entity. Even though it isn’t a state, it’s treated that way in regard to Medicare. This means those within the District have plenty of options available for Medicare coverage. Options include Medicare Part A and B, which is often called Original Medicare, Medicare Part C, which is called Medicare Advantage, and Part D. There is also Medicare supplemental insurance or Medigap coverage.

Within the District of Columbia there were a total of 94,520 Medicare beneficiaries as of 2020. Of that number, 74,116 of those were utilizing Original Medicare while 20,404 were using Medicare Advantage.

Medicare Part A

Medicare Part A is one of the Original Medicare components. If you have, or qualify for, a Part A plan, Medicare provides coverage for hospitalization, including inpatient hospital care, short-term nursing facility care, hospice and even home health care. Inpatient rehabilitation and psychiatric care are both covered as well.

Part A is not limited only to the care itself though. Part A also offers coverages for the medicine you received as part of a hospital stay as well as your meals, nursing care and even shared and semi-private rooms. 

Medicare Part B

Medicare Part B is considered the second part of Original Medicare and is focused on outpatient and preventative types of services. Part B includes coverages for things like medically necessary diagnostic testing as well as the costs associated with the equipment related to these services. It also covers preventive services like standard checkups and routine office visits.

In addition to those coverages, vaccinations, intravenous antibiotics and other clinically administered drugs may be covered under the Part B umbrella. The same is true for limited mental health care issues such as residential drug and alcohol treatment. Medical transportation to and from those services is covered as well. Lastly, clinical research, including experimental drug trials for things like Alzheimer’s, are covered under Part B. Keep in mind though these services are limited to providers who have agreed to accept Medicare  

Medicare Advantage Plans

Medicare Advantage or Part C plans are not part of Original Medicare but are a method of offering an alternative way of service delivery and add-on services. Part C plans are not offered directly through the Social Security Administration like Part A and B but are instead purchased through a third party who then bills the SSA.

For some, these plans can sometimes be easier to use than the traditional Original Medicare plans. Plus, these plans often also offer coverages in excess of Original Medicare, including benefits like vision and dental coverage as well as prescription drugs.

Medicare Part D

Medicare Part D is specifically designed to help cover the cost of prescription drugs. It’s an add-on coverage that is an optional part of your total Medicare package. Part D plans are issued by private insurance and authorized to bill Medicare for the costs surrounding filling prescriptions at retail pharmacies.  

Medicare Supplemental Insurance and Medigap

Medicare supplemental insurance, or Medigap, plans are ones in which the coverage is aimed at covering the “gaps” in your other coverages. These plans are a supplemental insurance rather than a primary coverage and help offset costs not otherwise covered. This includes coverages for things like deductibles and copays.

Who Is Eligible for Medicare in Washington D.C.?

Most people age 65 or older qualify for Medicare, and if you start receiving Social Security benefits at least 4 months prior to that birthday, you’re usually automatically enrolled. If that’s the case, you’ll receive a Medicare card in the mail letting you know, most likely prior to your birthday. If you’re not 65, you might still qualify for Medicare coverage if you have certain types of disabilities. Regardless, you’ll need to be familiar with the enrollment periods to ensure you’ve got your coverage.

Initial Enrollment

The first thing that you need to be familiar with is the Initial Enrollment Period (IEP). This is the initial enrollment period for you as an individual. During this time period you can sign up for Medicare Parts A and B as a brand-new enrollee. It’s the time when you are first eligible to sign up for Medicare and it starts 3 months prior to the month you turn 65 and lasts until 3 months past the month of your 65th birthday.

Medicare Advantage Enrollment

Every year from January 1st to March 31st there is a general enrollment period in which you can switch coverage from a Medicare Advantage plan to another one or to Original Medicare.

Annual Enrollment Period

Each year in the fall there’s what’s called the annual enrollment period (AEP). It runs from October 15th to December 7th. During this period, you can join, drop or make changes to your specific Medicare plan.

Special Enrollment

If you find yourself facing changes in your life and you need to enroll in Medicare, then you might qualify for a special enrollment. If you were on an employer’s plan that changed or ended, if you’re moving out of your plan’s coverage area or experiencing some other major life change, you might be eligible to sign up outside your IEP without a penalty.

How Do I Enroll in Medicare in Washington D.C.?

If you need to sign up for Medicare Part A or B, you apply by way of the Social Security Administration. There are multiple options for this. You can do so online through the Social Security website, you can apply by going to your local Social Security office or you can call SSA at 1-800-772-1213. Live representatives are available to answer your calls between 7:00 a.m. and 7:00 p.m. Monday through Friday. You can receive recorded information all other hours.

Contact Information for Washington D.C. Medicare, Medicaid and Insurance Help

If you need further assistance, HelpAdvisor has plenty of information about Medicaid in Washington D.C.. You can also contact the Washington D.C. health insurance help center online .

In addition to those, the Senior Service Network  and George Washington Law School’s Health Insurance Counseling Project both have resources available.