Washington DC Medicare insurance was created by the federal government to provide more affordable health care coverage to persons over the age of 65 and for under-65 workers with certain disabilities. This program is available in all US states as well as the District of Columbia. DC’s local government also offers assistance programs for Medicare beneficiaries here.
Medicare coverage begins with Original Medicare, which is made up of Part A and Part B. Part A is ordinarily premium-free, and it covers inpatient care along with other hospital services. Part B costs $134 a month for beneficiaries who earn less than $85,000 a year. Both Part A and Part B have deductibles, copays, and coinsurance costs which are out of pocket expenses for Medicare beneficiaries.
Beneficiaries who are unsatisfied with Original Medicare Coverage can compensate for the coverage “gaps” through Supplemental “Medigap” plans. These are available from Medicare-approved private health insurance companies.
These plans can provide coverage for Medicare prescription medication, which is a type of coverage known as Medicare Part D. They can also cover additional healthcare services that are not covered by Original Medicare. Some plans even help pay for the out of pocket expenses for Part A and Part B.
Medicare Advantage Plans are also known as Medicare Part C. A plan of this type combines the coverage of Original Medicare with additional benefits. These extra benefits can include Part D coverage and other healthcare services not covered by Part A and Part B.
Medicare Advantage Plans can be purchased from Medicare-approved private carriers. Each Advantage plan is different in the extra benefits they offer, although they all contain Original Medicare coverage at a minimum.
Unlike other states, the Medicare Savings Programs for the DC area is much less stringent. It is also mainly a single MSP, known as the program for Qualified Medicare Beneficiaries. This program has an income limit of $3,035 per month for an individual to qualify, while the combined income of a married couple needs to be less than $4,115 per month. There are also no asset limits for this program.
The QMB program for Washington DC pays for the premiums of Medicare Part A and Part B. It also pays for the deductibles and coinsurance for services that are covered by Medicare. It also qualifies beneficiaries for the Extra Help program, which helps pay for Medicare Part D prescription medication costs.
The QMB program is typically for those whose income is too high for DC Medicaid, but it is possible for those with Medicaid coverage also to receive QMB benefits. Receiving both QMB and Medicaid benefits is known as the Qualified Medicare Beneficiary Plus (QMB Plus) Program. This program also helps those who are eligible for Medicaid benefits under the Aged, Blind, or Disabled category.
Typically, to be able to receive the Qualified Medicare Beneficiary Plus (QMB Plus) Program benefits, an individual must have an income of less than $1,032 per month while a 2-person household should earn less than $1,392 per month.
Medicare is a somewhat complicated topic filled with complex rules, details, and application procedures. The law mandates that each state offer a program to assist in counseling Medicare beneficiaries, and there are several such programs available in the District of Columbia.
One of these programs is the Health Insurance Counseling Project (HICP) run by the George Washington Law School. This provides free counseling and education for Medicare beneficiaries. The services even assist senior beneficiaries in obtaining their prescription medications and in dealing with unpaid medical bills. Medicare Beneficiaries in DC can call HICP at 202-994-6272 and TTY 202-973-1079.
The other resource for Medicare beneficiaries is the District of Columbia Office on Aging (DCOA). The DCOA offers counseling on health insurance matters for older adults over the age of 60 as well as for persons with disabilities and their caregivers.
DCOA also funds the Senior Service Network. This network is made up of numerous community-based non-profit and private organizations that offer direct counseling sessions and answers questions for the senior adult residents in the DC area. The services are free and not partial to any particular health insurance company.