Medicare in the District of Columbia

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/16/2018

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District of Columbia residents may have several choices when it comes to their Medicare coverage. You may opt to get your Medicare benefits through the federal arm of the program, called Original Medicare, Part A and Part B, or you may enroll in a Medicare Advantage plan (Medicare Part C) instead. If you stay with Original Medicare, you can add more coverage through private Medicare-approved insurance companies if you want to.

Types of Medicare coverage in the District of Columbia

  • Original Medicare, Part A and Part B, covers inpatient hospital care (Medicare Part A) and physician, preventive, and medically necessary services and equipment (Part B). Original Medicare has limited coverage for your prescription medications (aside from those you may get as a hospital inpatient or outpatient). There are certain costs associated with Original Medicare, such as copayments, depending on the service. You usually will not have a premium for Medicare Part A if you have worked at least 10 years (40 quarters) and paid Medicare taxes while working or if you qualify because of your spouse’s work history. Most beneficiaries pay a Medicare Part B premium.
  • Medicare Advantage plans (Part C) are offered through private Medicare-approved insurance companies as opposed to the federal government. Medicare Advantage plans must offer at least the same amount of coverage as Original Medicare, Part A and Part B (with the exception of hospice care). Some Medicare Advantage plans may cover additional benefits beyond Original Medicare, such as prescription drugs, routine vision and dental, or health wellness programs. Medicare Advantage plan costs and availability may vary.
  • Medicare Part D is optional prescription drug coverage. It’s available as a stand-alone plan that works alongside Original Medicare, Part A and/or Part B. If you have a Medicare Advantage plan, you can enroll in a plan that includes prescription drug benefits, also known as a Medicare Advantage Prescription Drug plan. These prescription drug plans are offered through private Medicare-approved insurance companies, and the costs can vary among plans. You don’t have to get this coverage. However, please note that if you don’t enroll when you’re first eligible and go without creditable prescription drug coverage for 63 consecutive days or more, you might be subject to a late-enrollment penalty if you enroll in Medicare Part D later. You may have to pay this late-enrollment penalty for as long as you have Medicare Part D.
  • Medicare Supplement insurance (Medigap) gives District of Columbia residents who are enrolled in Medicare Part A and Part B the option to cover some costs that Original Medicare doesn’t pay for, such as deductibles, copayments, coinsurance, Medicare Part B excess charges, and other out-of-pocket costs. There are 10 different Medigap plans in most states, sold by private companies, and each standardized plan has a different level of coverage.

Local resources for Medicare in the District of Columbia

  • Medicare Savings Programs in the District of Columbia: Residents in the District of Columbia with limited income may be able to get help with Medicare costs through Medicare Savings Programs. These can help with Medicare premiums, deductibles, copayments, and coinsurance costs.
  • District of Columbia State Health Insurance Counseling and Assistance Program (SHIP): The Health Insurance Counseling Project (HICP) provides free health insurance information, education, and counseling services to Medicare beneficiaries and seniors who live in the District of Columbia.

How to apply for Medicare in the District of Columbia

Applying for Medicare works the same way in the District of Columbia as it does in the rest of the United States. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. If you receive Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits, you may be automatically enrolled at age 65. You would also qualify for automatic enrollment before age 65 if you have received Social Security disability benefits (or certain Railroad Retirement Board disability benefits) for 24 months straight. You would be enrolled in the 25th month.

You may also qualify for Medicare, regardless of age, if you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or end-stage renal disease (ESRD).

If you’re not automatically enrolled, you can sign up for Medicare through Social Security or the Railroad Retirement Board in any of the following ways during your Initial Enrollment Period.

  • Online at SSA.gov.
  • By telephone at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • In person at your local SSA office.
  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

As you can see, you may have several choices about your Medicare coverage in the District of Columbia. Many people have questions about their options; I’d be glad to help you with that. You’re welcome to look at my profile; just click on the “View profile” link below. Want to set up a phone call with me, or have me send you Medicare plan information by email? The links under this article take care of that. How about checking out some plans on your own? For that, you can click on the Compare Plans button on the right side of this page.

 

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