2023 Medicare Advantage Plans in Washington D.C.
Find Plans in your area with your ZIP Code
What are the Best Medicare Advantage Plans in Washington D.C.?
If you are thinking about getting out of Original Medicare and into a Medicare Advantage plan available in Washington D.C., you're not alone. Nearly half of the estimated 64 million people with Medicare will join a Medicare Advantage plan in 2023. Some join to get more benefits. Some join to save money. And some like a plan's doctors and other healthcare providers.
2024 Medicare Advantage Plans for Washington D.C. Beneficiaries
Be the first to know. Sign-up for 2024 Medicare Advantage plan notification HERE. The 2024 Medicare Part C information will be available in early October.
What are the Best Medicare Advantage Plans in Washington D.C.?
Our online tools will help you find top-rated Medicare Advantage plans in your region of Washington D.C.. The overview of Washington D.C.'s market below will give you a clear picture of your top options and who the best providers are. It also shows you how much you can expect to pay each month for a plan.
Table of Contents
Key Takeaways
- Medicare Advantage Plans are available to U.S. citizens and legal U.S. residents living in Washington D.C. who are enrolled in Original Medicare.
- Insurance plans are offered by private health insurance companies and provide an alternative way to receive Medicare benefits in your Washington D.C. County.
- Medicare Advantage Plans in Washington D.C. are required to provide at least the same benefits as Original Medicare, but they may also provide additional benefits such as vision, dental, and hearing coverage.
- Plans may also offer prescription drug coverage, which is not available with Original Medicare. A stand-alone Medicare Part D plans available in Washington D.C. can be added if the health plan does not include Part D.
- Medicare Advantage Plans in Washington D.C. may have different cost-sharing requirements than Original Medicare, such as copayments, coinsurance, and deductibles. Be sure to compare plans, including prices, quality and affordable out-of-pocket costs, to determine the best Medicare insurance for your situation.
- Medicare Advantage Plans in Washington D.C. may also have different provider networks than Original Medicare, so it is important to make sure that your preferred doctors and hospitals are in-network.
- Medicare Advantage insurance has specific open enrollment periods. Unlike Medicare Supplement plans, you cannot join, switch, or drop a plan outside of an enrollment period.
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Who Has The Best Plans in Washington D.C.?
Every year, the Centers for Medicare & Medicaid Services (CMS) reviews and rates all Medicare Advantage plans in Washington D.C. based on a 5-star scale. Input for the ratings comes from information that each plan self-reports, as well as individual member complaints. (Read more about Medicare star ratings.)
Washington D.C. has 5-star Medicare Advantage plans available in 2023. Not all states and locations do. This year, the highest rated Medicare plans available in Washington D.C. come from:
- Kaiser Permanente
We recommend evaluating the health plans from these Washington D.C. health insurance companies ahead of all others. Here's why. Simply put, more stars generally mean members will get better results. Members might get better service, phone support, and care from a 5-star than they would from a four-star plan.
CRUCIAL: Benefits are not the same throughout Washington D.C.. That's why it is so important to fully understand the advantages and disadvantages of Medicare Advantage plans specifically for you and your personal situation. Understanding Medigap vs Medicare Advantage is crucial. Evaluate benefits and costs carefully to find the plan best suited to your healthcare needs.
Complete List of Washington D.C.'s Providers for 2023
Approximately 5 health insurance providers offer Medicare Advantage plans in Washington D.C., including:
- Aetna Medicare
- Cigna
- Kaiser Permanente
- Lasso Healthcare
- UnitedHealthcare
Top Ranked 2023 Plans in Washington D.C.
According to the Centers for Medicare & Medicaid Services, here are the top 2023 Medicare Advantage Plans available in Washington D.C.:
Top Medicare Advantage Plans in Washington D.C.
| Provider | Plan ID | Plan Name | Premium | Limit | Stars |
|---|---|---|---|---|---|
| Kaiser Permanente | H2172-001 | Kaiser Permanente Medicare Advantage High DC (HMO-POS) | $108.00 | $5,700 | 5.0 |
| Kaiser Permanente | H2172-003 | Kaiser Permanente Medicare Advantage Standard DC (HMO-POS) | $23.00 | $6,900 | 5.0 |
| Kaiser Permanente | H2172-012 | Kaiser Permanente Medicare Advantage Value DC (HMO-POS) | $0.00 | $6,900 | 5.0 |
Whether or not you can join a plan from one of the top-rated providers depends on where you live. If your Washington D.C. County has the plan you want, and you qualify, you can enroll. Medicare Advantage plans are regional. Generally speaking, larger urban areas have more plan options than rural areas.
Best Plans in Washington D.C. by County
Choose your Washington D.C. County below to see the best (and the worst) 2023 plans.
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How to Find the Best Plan Available in Washington D.C.
You may be looking at plans for several different reasons, including turning 65 or the Annual Enrollment Period. Or, perhaps you are navigating a special enrollment event, such as moving to a new area. In all of these cases, there are a few important details you need to consider.
1. Consider Your Expected Utilization
Do you think you’ll take maximum advantage of your benefits (doctors, hospital inpatient care, tests, etc.)? If so, prioritize plans with lower out-of-pocket maximums and lower copayments, even if they have higher monthly premiums. Otherwise, look for plans with low monthly premiums. Just be aware that plans with low or no monthly premiums tend to have higher out-of-pocket maximums and/or higher deductibles.
2. Evaluate Your Prescription Costs
Prescription drugs are often the main reason that seniors pay more for healthcare. Because most Medicare Advantage plans include Part D coverage for prescriptions, it is important to ensure you get the right plan that covers your drugs at a cost you can afford.
3. Understand Your Additional Coverage Needs
Original Medicare only covers your major medical services, leaving you to pay for dental, vision, hearing, and other healthcare services, or get additional coverage. Fortunately, a growing number of Medicare Advantage plans cover many of the essential services not covered by your Part A and Part B benefits.
4. Consider Your Healthcare Providers
Medicare Advantage plans have healthcare provider networks. Unfortunately, not all specialists and primary care doctors accept all plans. Many people on Medicare in Washington D.C. tell us it's difficult to find a plan their doctors take. We can help!
Should I Choose an HMO or PPO plan?
There are many plan options available when shopping for Medicare Advantage plans in Washington D.C., including HMO and PPO options. These are some of the differences you should consider before making a plan selection.
- With an HMO you may pay less out-of-pocket, but you will need to choose a primary physician to coordinate your care. Referrals for specialists are often required. Except in an emergency, you must remain within the provider network.
- With a PPO you are not required to get referrals for specialty care. You have the option to get health care outside of the plan's provider network. However, typically you will pay more and the out-of-pocket maximum for out-of-network care will be higher.
Need help choosing? Call 1-855-728-0510 (TTY 711) for plan assistance. There's no obligation.
Find Plans in your area with your ZIP Code
Eligibility
Medicare Advantage plans are available to people ages 65 and older. They are also available to individuals with certain disabilities. When eligible, you can generally join one of these Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Medical Savings Account (MSA) Plan
You must live in the service area (i.e., County) of the plan you want to join. If you reside outside the plan's service area for part of the year, ask if the plan will cover you there. You must also have both Medicare Part A and Part B and be a U.S. citizen or a legal resident.
Alternatives
Medicare Advantage Plans are an alternative to Original Medicare coverage. However, there is another option. You can keep your Original Medicare benefits and add one of the best Medicare Supplement plans in Washington D.C. for additional coverage. And, there are Washington D.C. Medicare Part D plans for coverage of prescription drugs.
Many experts feel Medicare Supplement insurance plans offer superior financial coverage and the most flexibility. Plus, benefits rarely change and you can get a policy outside of a Medicare enrollment period. However, plans may not be affordable for all Washington D.C. seniors.
Due to the fact that Medicare Supplement plans cover more costs than Medicare Advantage Plans, their monthly premiums are generally higher. If you cannot afford Medicare's out-of-pocket costs, another alternative is a dual-eligible Medicare Special Needs Plan in Washington D.C.. D-SNP plans help Washington D.C. seniors who qualify for both Medicare and Medicaid. D-SNP plans offer quality care at very affordable prices.
Next Steps
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Frequently Asked Questions
Still have questions? These common questions and answers might help.
What are the disadvantages of a Medicare Advantage plan?
Medicare Advantage plans have several potential disadvantages. For instance, most plans require their members to use their network of providers. Also, costs are also largely based on your use of healthcare services, making it more difficult to budget for healthcare costs. And, most plans make members get referrals to see a specialist or prior authorization to receive a service. Read about all five disadvantages of Medicare Advantage plans.
How much do Medicare Advantage plans cost in Washington D.C.?
A Medicare Advantage plan in Washington D.C. costs an average of $29.44. This is just the monthly premium. You should also consider the out-of-pocket expenses of a plan if you have any chronic conditions, which include a plan's copays and deductibles. Prescription drug benefits are also included in most Medicare Advantage plans, but they have their own out-of-pocket costs.
What is every Medicare Advantage plan required to include?
Approved Medicare Advantage plans sold in Washington D.C. must, at a minimum, cover everything that's in Original Medicare. But plans do not have to cover healthcare services at the same cost as Original Medicare. For example, Medicare Part A covers about 80% of hospital stays, skilled nursing care, home health care, and hospice care. Whereas Part B provides coverage for about 80% of outpatient services, including lab tests and doctor visits. Medicare Advantage plans set their own copays and deductibles, and often charge more than 20%. However, plans have an annual limit and Original Medicare doesn't.
Methodology and Sources
Our analysis of the top-rated Medicare Advantage plans in Washington D.C. excludes employer group plans, Medicare-Medicaid Plans (MMPs), Medicare Savings Account Plans (MSAs), Special Needs Plans (SNPs), and plans that do not include Part D benefits.
CMS rates and reviews health plans in several categories, including delivery of health care, member experience and customer service. When comparing plan ratings, we use state-specific data, not CMS' nationwide figures.
Medicare Advantage plan data is sourced from CMS public use files (see: Citations & References). When needed, we combined affiliated companies to calculate insurer averages.
Our research does not include Washington D.C.'s Medicare Advantage SNP Plans. We evaluate these plans separately. We also did not include plans without Part D benefits for prescription drugs, employer plans, or Medicare-Medicaid Plans (MMPs). If you're not looking for a Medicare Advantage plan but want to cover out-of-pocket costs that Original Medicare plan doesn't cover, MedicareWire also ranked the best Medigap Plans in Washington D.C..
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- CMS.gov, "CMS Releases 2023 Medicare Advantage and Part D Star Ratings", Last Accessed October 6, 2022
- Medicare.gov, "Medicare Advantage Plans", Last Accessed October 1, 2022
- KFF.org, "Medicare Advantage in 2022: Enrollment Update and Key Trends", Last Accessed November 5, 2022
- Medicare.gov, "Things to know about Medicare Advantage Plans", Last Accessed October 12, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed January 13, 2023
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed January 13, 2023
- CMS.gov, Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023, Last Accessed September 29, 2022
- CMS.gov, Medicare Marketing Guidelines, Last Accessed February 2, 2023
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Our content follows the guidance provided by the Medicare Marketing Guidelines on CMS.gov. If you believe the information on this page is inaccurate, please contact us.