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Medicare Advantage Plans in Dist. of Columbia

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Medicare Advantage plans in Washington, DC

If you’re a Medicare beneficiary in Washington, DC, you may be wondering how Medicare works and what your different coverage options are. Medicare is a federal program that provides health coverage for seniors and certain disabled individuals. You can get your coverage through Original Medicare, Part A and Part B, which is the federally administered program. Or, alternatively, you can enroll in a Medicare Advantage plan, which is available through private insurance companies that contract with Medicare.

Also known as Medicare Part C, Medicare Advantage plans are simply another way to get your Medicare Part A and Part B benefits. You’re still enrolled in the Medicare program if you have Medicare Part C; you’ll just be getting your Medicare coverage through your Medicare Advantage plan instead of through the federal government.

Medicare Advantage plans are required to cover at least the same level of coverage as Original Medicare, Part A and Part B. So no matter which Medicare Advantage plan you enroll in, you’ll always have the same baseline level of coverage. In addition, many Medicare Advantage plans also cover extra benefits beyond Original Medicare, which may include routine vision or dental, wellness programs, hearing, or prescription drugs.

There are several different types of Medicare Advantage plans. Keep in mind that availability may vary by location, and not every type of plan may be available where you live. However, some of the plan options that may be in your area include:

  • Health Maintenance Organization (HMO) plans: If keeping your costs low is important to you and you don’t mind having less provider flexibility, HMOs tend to have lower costs than other types of Medicare Advantage plans. You’ll need to use providers in the plan’s network for care, and you’ll be required to have a primary care doctor. If you need to see a specialist, you’ll need a referral first.
  • Preferred Provider Organization (PPO) plans: If you don’t mind paying more to have greater provider choice, PPOs could be a good fit. With PPOs, your cost sharing is lower if you use providers in the plan’s preferred provider network. However, if you like, you can also go out of network and pay higher copayments to see non-network providers. You don’t need to have a primary care doctor, and you can see specialists directly without referrals.
  • Special Needs Plans (SNP): These plans target beneficiaries with unique situations, including those who have certain chronic conditions; have Medicaid and Medicare; or live in an institution (such as a nursing home). You’ll need to meet the eligibility criteria of the Special Needs Plan to enroll. Special Needs Plans tailor plan benefits to help their members manage their health challenges. This may include care-coordination or social services, wellness programs, or specialized provider networks to help you better manage chronic illness; living situation; or Medicaid and Medicare benefits.
  • Private Fee-for-Service (PFFS) plans: If you travel frequently or don’t like having a provider network at all, you could consider a Private Fee-for-Service plan. These plans don’t have provider networks and, instead, let members use any doctor or hospital that will accept the plan’s terms and conditions and agree to provide the health-care service. Keep in mind that if you have this type of plan, you’ll need to find providers who will contact with the plan each time that you need care.
  • Medicare Savings Account (MSA) plans: These plans combine a high-deductible health plan with a medical savings account. Every year, the Medicare Savings Account plan deposits a certain amount into a savings account, which you can use to pay for covered medical costs before you’ve reached the plan deductible.

Medicare Advantage Prescription Drug plans in the District of Columbia

One advantage of Medicare Part C is that if you want prescription drug coverage (Medicare Part D), you can get it through a Medicare Advantage plan that includes this benefit. Medicare Advantage Prescription Drug plans cover Medicare Part A, Part B, and Part D benefits and give beneficiaries the convenience of having all of their Medicare benefits administered through a single plan. In contrast, Original Medicare beneficiaries who want prescription drug benefits must get it through a stand-alone Medicare Prescription Drug Plan.

Medicare Advantage plans vary when it comes to the specific prescription medications they cover. So it’s a good idea to check the plan’s formulary to make sure your prescription drugs are covered before enrolling in the plan. A formulary is a list of medications covered by the plan. Keep in mind that this formulary may change at any time. Your plan will notify you when necessary.

Remember, not every Medicare Advantage plan includes prescription drug coverage, so if you want it, make sure to double-check that the specific Medicare Advantage plan you’re considering includes this benefit.

Comparing Medicare Advantage plans in the District of Columbia

As you can probably tell, you may have many options when it comes to Medicare Part C. Keep in mind that coverage and costs will vary by plan. Some service areas offer Medicare Advantage plans with premiums as low as $0; however, even in this case, you’ll still be responsible for paying other costs, including the Medicare Part B premium and any cost sharing required by your plan. In other words, just because a Medicare Advantage plan may have a $0 premium doesn’t mean that you won’t have any other costs.

If you’re already enrolled in a Medicare Advantage plan, it’s a good idea to review your coverage every year to make sure it’s still meeting your needs and within your budget. A good place to start is by looking over your plan’s Evidence of Coverage and Annual Notice of Change documents, which are sent to plan enrollees every fall. These two documents include information on your Medicare Advantage plan’s benefits and costs — as well as any changes you can expect for the coming plan year. Armed with this information, you’ll be better informed as you research your Medicare plan options and decide whether to stick with your current Medicare plan or make changes to your coverage.


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