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Medicare in Dist. of Columbia

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Medicare in the District of Columbia – By the Numbers

Medicare provides health insurance coverage for people age 65 or older or for those under age 65 who suffer from specific medical disabilities. To qualify for benefits, you must be an American citizen or legal permanent resident of at least five continuous years. Consider the following Medicare statistics from the Centers for Medicare & Medicaid Services (CMS) about Medicare enrollment in Washington, D.C. (in 2018):

  • Total number of beneficiaries enrolled in Medicare in the District of Columbia: 92,890
  • Number of beneficiaries with Medicare prescription drug coverage: 56,543
  • Number of beneficiaries with Medicare Advantage plans (or other Medicare health plans): 17,341

Health-care reform and Medicare

In 2010, the Patient Protection and Affordable Care Act took effect. It included the following changes to the Medicare program:

  • Phasing out the coverage gap (“donut hole”) – Medicare beneficiaries who enter the Medicare Part D coverage gap now get additional savings on brand-name and generic drugs. Drug manufacturer discounts and government subsidies help reduce your prescription costs if you reach the coverage gap. The Affordable Care Act will close the “donut hole” completely by 2020.
  • Improved preventive care – Eliminates deductibles, copayments, and other cost sharing for certain preventive services covered under Medicare Part B. This includes coverage of free annual wellness check-ups starting in 2011.

Private insurance companies must have contracts with Medicare to offer Medicare Advantage plans and Medicare Prescription Drug Plans. Depending on the terms of the contract between the plan and Medicare, not every plan is available statewide or in all service areas. Each year, the plan must renew its contract with Medicare, so the availability of a plan in a specific service area is subject to change.

District of Columbia Medicare resources

Washington, D.C. seniors and those eligible for Medicare can also refer to the following resources for additional information on Medicare within the District of Columbia.

District of Columbia Qualified Medicare Beneficiary Program Qualified Washington, D.C. beneficiaries can save money on Medicare each year through savings programs for people with limited income or resources.

District of Columbia Health Insurance Counseling Project (HICP) This agency provides information to District of Columbia residents about Medicare, including assistance on understanding your Medicare rights/protections and how to submit an appeal or complaint about medical coverage or care.

Source: Statistical data from the Centers for Medicare & Medicaid Services (CMS) “Medicare Enrollment Dashboard,” from the CMS Office of Enterprise Data & Analytics, February 2019.

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