When it comes to Medicare, Washington D.C. is treated as its own state, in a way, meaning it has its own Medicare Supplement, Medicare Advantage, and Part D plans. However, Medicare Part A and Medicare Part B work the same way in the District of Columbia, just like they do in the 50 states.
With over 95,000 Medicare beneficiaries in Washington D.C., it’s important that these residents know all of their Medicare plan options before it’s too late.
Medicare Supplements in Washington D.C.
Medicare Supplements act as secondary coverage to Original Medicare Parts A and B. When you enroll in a Medicare Supplement plan, Original Medicare will pay first, and your supplement will pay second according to its benefit guidelines. If Original Medicare declines your claim, so will your Medicare Supplement plan.
There are about ten different Medicare Supplements plans available in today’s market, including some high-deductible options. Also called Medigap plans, Medicare Supplements can lower your out-of-pocket spending by potentially thousands.
For example, if you have a Medigap Plan G, you would only be responsible for paying the Part B annual deductible for any Original Medicare-approved service. Let’s pretend you had a surgery that Medicare approved. Medicare Part A and Part B would pay their share, then send the bill to your Plan G. Plan G would cover all of your cost-sharing expenses minus your Part B deductible. Instead of spending tens of thousands of dollars in Part B coinsurance for your surgery, you’d only pay a couple of hundred dollars.
In addition to Plan G, there are Medigap Plans A, B, C, D, F, K, L, M, and N, as well as a high-deductible Plan F (HDF) and high deductible Plan G (HDG). Washington D.C. Medicare beneficiaries have access to all Medigap plan options. However, only people eligible for Medicare before 2020 have Plan C, F, and HDF available to them.
Medicare Advantage plans in Washington D.C.
Medicare Advantage plans are entirely different than Medicare Supplement plans. Instead of having two payers as you would with a Medigap plan, with Medicare Advantage plans, you only have one payer – the Medicare Advantage plan. Medicare Advantage, Part C of Medicare, gets paid an allowance by Medicare to cover you for each year you’re enrolled in the plan. The plan then uses this money to pay for any of your medical claims that come their way.
While you still have to be enrolled in both Part A and Part B to have a Medicare Advantage plan, those parts won’t be paying any of your doctors. Therefore, your doctors are allowed to choose which Medicare Advantage plans they do and do not accept. For example, one of your doctors may accept all United Healthcare Medicare Advantage plans, whereas another one of your doctors only accepts Medicare Advantage plans from Blue Cross Blue Shield. This is one of the downfalls to Medicare Advantage plans.
However, there certainly are some pros to Medicare Advantage plans. For instance, Medicare Advantage plans tend to have a lower monthly premium than Medigap plans. This is because you still have copays and coinsurance to cover under a Medicare Advantage plan. Still, you’re protected from over-spending each year by the Medicare Advantage plan’s maximum out-of-pocket.
Common Questions About Washington D.C. Medicare:
These are some of the questions we get most often about Medicare Supplement plans in Washington D.C..
Washington D.C. offers all the Medicare Supplement options available. This includes plans such as Plan G, Plan N, and others. The specific plans available to you will depend on your zip code.
You can technically apply for a plan at anytime throughout the year, however, unless you are in your Medigap Open Enrollment window, you will likely have to answer health questions during your application.
There are about 7 Medicare Advantage plans available in Washington D.C. today. About 16% of Washington D.C. Medicare beneficiaries get their coverage from one of these Medicare Advantage plans.
How to choose the right plan for you
You should never choose a Medicare plan blindly. Be sure to compare all options in your area before settling. Some beneficiaries could be happy with either a Medigap or Medicare Advantage plan. However, for most beneficiaries, there is a clear, cost-effective option. A Boomer Benefits agent can help you figure out which option that is. Give us a call today at 817-249-8600, so we can go over your options in Washington D.C.