Medicare Advantage Plans in Washington D.C.

Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are private health plans available to people with Medicare benefits. Unlike Original Medicare, they are not the same in all states. In fact, plans in every Washington D.C. County are different. For this reason, you must shop and compare plans locally.

You can compare all the available plans in your area by using our zip code lookup tool above or by clicking on your county below. Continue reading to find out more about Washington D.C.'s Medicare Advantage program and how it compares to other options.

Compare the Best Medicare Advantage Plans in Washington D.C. by County

What is a Washington D.C. Medicare Advantage Plan?

Traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. covers about 80% of all major medical costs. It does not cover minor medical, including vision, hearing, and dental, and it does not offer prescription drug coverage. The Medicare Advantage plans available in Washington D.C. can include minor medical benefits but are not required to. Most do include coverage for your prescriptions. To get a Medicare Advantage health plan (also known as Part C of Medicare), you must first have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits.

Althought the extra benefits, particularly a prescription drug plan, are nice to have, it's important to fully understand what you're getting if you enroll in a Medicare Advantage plan in Washington D.C.. Specifically, Medicare Advantage is managed care health insurance, and the plan controls your access to healthcare providers. If you have ever had an HMO or PPO plan through your employer's group health insurance, you have a pretty good idea of what managed care health insurance is all about.

Original Medicare vs. Washington D.C. Medicare Advantage Plans: How Do They Compare?

The big differences between Original Medicare coverage and what you get with a Medicare Advantage plan in Washington D.C. are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.

Medicare Advantage vs. Medicare: The Pros and Cons

1. Doctor Choice:
• Medicare Advantage: Must use healthcare providers within the plan's network.
• Original Medicare: Use any Medicare-approved provider you choose.
2. Copays, CoinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  and DeductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.:
• Medicare Advantage: Each plan can charge what they want for copays and coinsurance, making it challenging to compare actual costs.
• Original Medicare: Coinsurance and deductibles are predictable and you can get a Medicare supplement to help pay these costs.
3. Out-of-Pocket Limits:
• Medicare Advantage: You're protected by the plan's annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance for the rest of the year.
• Original Medicare: No out-of-pocket limit.
4. Prescriptions:
• Medicare Advantage: Most plans come bundled with a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan for prescription coverage.
• Original Medicare: You must buy a stand-alone Medicare Part D plan.
5. Travel:
• Medicare Advantage: You're covered for travel emergencies within the USA but not for routine doctor visits outside of your home county.
• Original Medicare: You're covered anywhere you go in the USA and its territories.
6. Eligibility :
• There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

Washington D.C. Medigap Coverage vs. Medicare Advantage

Three of the most common questions we get from Washington D.C. seniors are:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans?
• Is it better to have Medicare Advantage or Medigap?

Let's answer these three questions right now.

Why Washington D.C. Medicare Advantage Plans are Bad

People that say Medicare Advantage plans are bad simply misunderstand them and don't know how they work. Over 42 percent of all Medicare beneficiaries choose Medicare Advantage enrollment and like their care. However, these plans are not suitable for everyone living in Washington D.C..

In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. believes that Medicare Advantage is the best option for healthy people, people with Medicare Advantage retiree benefits, and for people who qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..

Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.

You can check out supplemental Medicare insurance in Washington D.C. on our Washington D.C. Medicare supplements page.

Are There Disadvantages to Joining a Medicare Advantage Plan in Washington D.C.?

As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay. This fact remains the same no matter what type of Medicare Advantage plan you are considering (e.g., HMO, PPO, PFFS, Cost, or HSA).

Medicare Advantage plans have a monthly premium, but it's generally less than a Medicare supplement, and some plans even have a $0 premium. But, you also pay when you use health care. These are the copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). Most of your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. come when you use healthcare services.

With a Medicare supplement plan, you pay most of your costs in advance with monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . Depending on the level of coverage you choose, the plan can cover all of your copays, coinsurance, and deductibles except the annual Part B deductible. This makes your monthly healthcare costs more predictable, particularly if you have serious health problems.

When Should I Consider Medigap Instead of Medicare Advantage?

1. If your budget allows, keep your Original Medicare benefits and a Medicare Supplement Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N. These are the top 3 best Medigap plans that can help you manage your out-of-pocket costs the best, giving you complete peace of mind.
2. If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and pay just a little to see your doctor (up to $25 per visit).
3. If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
4. If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
5. If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
6. If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
7. With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
8. With Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
9. Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or return to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on June 27, 2022.