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There were nearly 14,000 people in the District of Columbia with a Medicare Advantage plan in 2017.¹
There are several major types of Medicare Advantage plans. In the District of Columbia, there are 13 different plans available as of 2018.²
In the District of Columbia, 44 percent of all Medicare Advantage plan enrollees belong to a local PPO plan, while 45 percent of beneficiaries belong to a Medicare cost plan. The major types of Medicare Advantage plans include:
A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.
Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.
A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.
A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.
Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans that are less popular among beneficiaries nationwide.
Total number of Medicare Advantage enrollees in the District of Columbia: 13,914 as of 2017¹
|Plan type||Percentage of District of Columbia enrollees (2017)|
Data reflects Medicare Advantage enrollment in the District of Columbia as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹
The Health Insurance Counseling Project (HICP) provides a free telephone hotline for Washington D.C. residents with Medicare or who are age 60 and over. The program, administered by the George Washington Law School, aims to help people better understand Medicare, Medicaid and private health insurance. They may be reached at 202-994-6272 (or 202-973-1079 for TTY use).
You can also explore more information about the insurance industry in Washington D.C. by visiting the Department of Insurance website.
¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.
²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.
TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.
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Last Updated: 4/24/2018