Best Medicare Advantage Plans in Washington D.C. for 2023
Find Plans in your area with your ZIP Code
If you live in Washington D.C. and you're thinking about enrolling in a Medicare Advantage plan, you're not alone. This year nearly half (48%) of all people with Medicare will join a Medicare Advantage plan because they want lower costs, more benefits, and access to more doctors and other healthcare providers.
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 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 available to U.S. citizens and legal U.S. residents living in Washington D.C. who are enrolled in Original 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..
- 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 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... 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 copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., 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.. Be sure to compare plans, including prices, quality and affordable 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., 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-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get....
- 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.?
The Centers for Medicare & MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Service (CMS) rates and reviews Washington D.C.'s Medicare Advantage plans based on a 5-star rating scale. Information from members and data provided by plans is used to determine a plan's star rating.
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 ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs., 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 |
The top providers listed above do not tell the full story. That's because your Washington D.C. County may or may not have one of the top-rated plans. Unlike Original Medicare, Medicare Advantage plans are regional. Read How Does Medicare Advantage Work to learn more.
Best Plans in Washington D.C. by County
Choose your Washington D.C. County below to see the best (and the worst) 2023 plans.
For fast, friendly assistance call 1-855-728-0510 (TTY 711) .
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 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.. 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
Utilization is what determines your overall cost. Healthy individuals use fewer healthcare services. These people can save money by evaluating plans with low 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. . Be aware that these plans often have higher copayments and a higher maximum out-of-pocket limit.
The opposite is true if you have one or more health conditions and frequently use healthcare services, especially hospital inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition.. In this case, plans with higher monthly premiums, low copayments, and low maximum out-of-pocket limits will help you save money.
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 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.
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 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 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 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. 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-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... 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 pros and cons 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 authorizationPrior authorization is a process used by health plans to control healthcare costs. Most HMO plans and some PPO plans require authorization before receiving certain treatments, medical services, or prescription drugs. 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?
At a minimum, every Medicare Advantage plan sold in Washington D.C. must cover all of the benefits offered in Original Medicare. However, plans are not required to cover healthcare services in the same way. Medicare Part A covers 80% of hospital stays, skilled nursing, home health careHealth care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered..., and hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care. Part B covers 80% of doctor visits, lab tests, and other outpatient services. But, Medicare Advantage plans can set their own copays, and often charge more than 20%. On the positive side, plans must set an annual out-of-pocket limit.
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, 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. also ranked the best Medigap Plans in Washington D.C..
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- Medicare.gov, "5-star special enrollment period", Last Accessed October 20, 2022
- Medicare.gov, "Medicare Advantage Plans", Last Accessed October 1, 2022
- KFF.org, "An Overview of the Medicare Part D Prescription Drug Benefit", Last Accessed October 19, 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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About
The Medicare Advantage information on the page was researched and published by David Bynon, and was last updated on .
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.