Medicare Advantage in the District of Columbia

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District of Columbia

Information about Medicare Advantage Plans in Washington, D.C.

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18 percent of Medicare beneficiaries in Washington, D.C. were enrolled in a Medicare Advantage (Medicare Part C) plan in 2019.1

There are 7 different Washington, D.C. Medicare Advantage plans in 2019.1

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of Washington, D.C. Read below to learn more about Medicare in the District of Columbia.

You can also learn more about other types of Medicare plans:

Average costs of Medicare Advantage in Washington, D.C.

The average premium paid by a Medicare Advantage plan enrollee in the District of Columbia in 2019 was $57 per month.

  • Average in-network out-of-pocket spending limit: $6,529
  • Average deductible in 2019 (weighted): $118.571

Individual plan premiums, deductibles and out-of-pocket costs may vary greatly depending on where you live and the plan you have.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Compare Washington, D.C. Medicare Advantage plan costs

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Medicare Eligibility & Enrollment

If you want to enroll in Medicare Advantage in Washington, D.C., you must first be enrolled in Medicare Part A and Part B, often referred to as Original Medicare.

To be eligible for Original Medicare at age 65, you must meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.

  • You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.

  • You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may also be eligible for Medicare benefits under 65 if:

  • You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.

  • You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).

  • You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

It’s important to note that if you have ESRD, you may not qualify for most Medicare Advantage plans. If you have ESRD, you may be able to enroll in a Washington, D.C. Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a Medicare Advantage Plan in Washington, D.C.

The first time you may be able to enroll in a Washington, D.C. Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Medicare Initial Enrollment Period graphic

Your Medicare IEP starts three months before your 65th birthday. It includes the month of your 65th birthday and then continues for another three months after your birthday.

Additional times at which you may sign up for a Medicare Advantage plan include:

Medicare Advantage Open Enrollment Period graphic

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you're already enrolled in a Part C plan, from January 1 to March 31 every year, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare AEP graphic

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

During AEP, you may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

You may potentially be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year for qualifying circumstances.

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period.

Find a Washington, D.C. Medicare Advantage plan

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Top-rated Medicare Advantage Plans in Washington, D.C. 2019

Each year, the Centers for Medicare & Medicaid Services (CMS) issues Star Ratings for all Medicare Advantage plans using a system of one to five stars.2

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 4 top-rated 2019 Medicare Advantage plans in Washington, D.C. that are rated four stars or higher.

Medicare Star Ratings
Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

Medicare Advantage plans are rated in the following five categories:

  • Preventive care and health maintenance (screenings, tests, vaccines, etc.)
  • Management of chronic conditions
  • Member experiences and ratings of the plan
  • Member complaints, problems receiving services and member retention
  • Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in the District of Columbia in 2019

To view a list of plans offered in your area within Washington, D.C., use our plan comparison tool.

Find a Washington, D.C. Medicare Advantage plan

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Private insurance companies offer Medicare Advantage plans in Washington, D.C.

Multiple insurance carriers may offer Medicare Advantage plans in Washington, D.C., depending on where you live.

Private insurance companies offer Medicare Advantage plans that may be unique to the plan area they serve.

Call to speak with a licensed insurance agent who can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

When you’re shopping for Medicare Advantage plans in Washington, D.C., you can compare plans from several different carriers by using some of the following information:

  • The Medicare Star Ratings can give you an idea of a plan’s overall quality.

  • Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.

  • Websites such as the Better Business Bureau and Consumer Reports can teach you about a company’s reputation among its customers.

  • You can read through Medicare Advantage plan reviews and testimonials from customers.

DC Medicare Advantage enrollees by plan type

The chart below illustrates the percentage of 2019 Washington, D.C. Medicare Advantage enrollees that are enrolled in each primary type of Medicare Advantage plan.1

Plan type Percentage of Washington, D.C. enrollees (2019)
HMO 85.72%
Local PPO 14.28%
Other Plans <1%

The major types of Medicare Advantage plans include:

  • HMO
    Health Maintenance Organization (HMO) 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.

  • PPO
    Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) 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.

  • PFFS
    A Private Fee-For-Service (PFFS) 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.

  • SNP
    A Special Needs Plan (SNP) 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.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2019 Washington, D.C. Medicare Advantage plans that are available where you live.

Local health insurance resources in Washington, D.C.

  • 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.