Medicare in Washington, DC runs on federal rules, so a District resident pays the same standard Part B premium as everyone else: $202.90 a month in 2026. What DC adds is free, unbiased help choosing a plan and figuring out what you owe.

The District's free Medicare help comes from DC SHIP, the State Health Insurance Assistance Program at the DC Department of Aging and Community Living. DC SHIP counselors sit down with you to compare Medicare Advantage, Medigap, and Part D plans, and the counseling is free and unbiased.

In This Guide

How Medicare Works in DC

Medicare coverage follows federal rules, so what's different in DC is mostly the local help layered on top. The first big choice every District resident makes is how to get their coverage.

Original Medicare or Medicare Advantage

Original Medicare is Part A and Part B. Medicare Advantage (also called Part C) is another way to get your Part A and Part B coverage, through Medicare-approved plans offered by private companies that must follow Medicare's rules. Most Medicare Advantage plans also include Part D drug coverage.

If you join a Medicare Advantage plan, you still have Medicare and keep the same rights and protections as in Original Medicare. Advantage plans may also cover things Original Medicare doesn't, like fitness programs and some vision, hearing, and dental services.

To join a Medicare Advantage plan, you need Part A and Part B, you have to live in the plan's service area, and you must be a U.S. citizen or lawfully present in the U.S. A pre-existing condition doesn't keep you out, and you can only be in one Advantage plan at a time. One warning if you or your spouse still have job-based or union coverage: joining an Advantage plan can cost you that coverage, and you may not be able to get it back, so Medicare says to talk to your benefits administrator first.

Networks, referrals, and prior approval

If your parent already has doctors they trust, the plan type is the first thing to check, because it decides whether those doctors stay in the picture. Medicare Advantage plans come in several types, including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service plans, Special Needs Plans, and Medical Savings Account (MSA) plans, and the area where you live might have all, some, or none of these types. In a Medicare Advantage HMO, you'll generally have to use the plan's network except for emergencies, out-of-area urgent care, or temporary out-of-area dialysis, and many HMOs require a referral from your primary care doctor before you can see a specialist. A Medicare Advantage PPO generally lets you go out of network for covered services, but you'll usually pay more for it.

Any Medicare Advantage plan may require approval before it covers certain services or items, and if the plan says no, you may have to pay the full cost. If your parent sees a particular specialist at a District hospital, check that doctor against the plan's network before you enroll.

Special Needs Plans (SNPs) are coordinated care plans that enroll only people with special needs, and every SNP must include Medicare drug coverage. Compare the plans actually offered at your DC ZIP code on the Medicare Plan Finder.

Drug coverage has its own rules

Here's the trap to avoid: if you pick an HMO or PPO Medicare Advantage plan that doesn't include drug coverage, you can't add a separate Part D plan to fill the hole. The rule runs the other way for Medical Savings Account plans and some Private Fee-for-Service plans: they don't include drug coverage, and with one of those you can join a separate Medicare drug plan. Skipping drug coverage can cost you later, too: if you have no creditable drug coverage and sign up for Part D down the road, you may owe a Part D late enrollment penalty.

What Medicare Costs in DC in 2026

Here are the standard 2026 amounts that apply to District residents, the same as anywhere else in the country.

Cost 2026 amount
Part B standard monthly premium $202.90
Part D out-of-pocket cap on covered drugs $2,100 a year
Skilled nursing facility care, days 1–20 $0 a day after the $1,736 Part A deductible
Skilled nursing facility care, days 21–100 $217 a day

The Part B premium is Medicare's standard 2026 amount. The Part D cap comes from CMS. The skilled nursing figures come from medicare.gov's 2026 skilled nursing facility coverage rules.

What a Medicare Advantage plan costs

In a Medicare Advantage plan, you still pay the monthly Part B premium, and you may also pay the plan's own premium. Some Medicare Advantage plans may have a $0 plan premium, and some may help pay all or part of your Part B premium. Each plan sets its own premiums, deductibles, and copays every year, and those costs and rules can change from one year to the next.

Every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services, and once you reach your plan's limit, you pay nothing for covered services for the rest of the year. The Medicare Advantage out-of-pocket limit is set plan by plan, and a plan may have separate in-network and out-of-network limits, so look it up in each plan you compare.

If you're already in a Medicare Advantage plan, watch your mailbox this fall. Your plan's Annual Notice of Change lists what changes in January, including coverage, costs, and the provider network, and plans send a printed copy by September 30. Our guide to Original Medicare vs. Medicare Advantage goes deeper on the trade-offs.

Part D drug costs in 2026

The Inflation Reduction Act redesigned Part D and eliminated the old coverage gap, long known as the "donut hole." In the initial coverage phase, you pay 25% coinsurance until your out-of-pocket spending reaches $2,100; after that, you pay nothing for covered Part D drugs for the rest of 2026. Certain payments made on your behalf, such as Extra Help, count toward the 2026 $2,100 Part D out-of-pocket cap.

Every Part D plan also has to offer the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs into capped monthly payments across the year. The Medicare Prescription Payment Plan doesn't lower what you owe; it helps if you face big drug bills early in the year. Our Part D out-of-pocket cap guide explains how the cap works.

When to Enroll or Switch

Medicare's calendar trips people up more than its costs do. Miss the right window and you can end up waiting for coverage, or paying a Part B penalty for as long as you have Part B.,

Window When What you can do
Initial Enrollment Period 7 months: the 3 months before the month you turn 65, that month, and the 3 months after Sign up for Part A and Part B
Medicare Open Enrollment October 15 to December 7 each year Switch between Original Medicare and Medicare Advantage, or join, drop, or switch a Part D plan; changes start January 1
Medicare Advantage Open Enrollment January 1 to March 31 each year If you're already in a Medicare Advantage plan, make one switch to another Advantage plan or back to Original Medicare
General Enrollment Period January 1 to March 31 each year Sign up for Part B if you missed your Initial Enrollment Period; coverage starts the month after you sign up

Medicare's enrollment windows are federal, set out on medicare.gov's enrollment pages.,

If you start Social Security or Railroad Retirement benefits at least 4 months before you turn 65, you're enrolled in Part A and Part B automatically; if you aren't collecting those benefits yet, you have to sign up yourself through the Social Security Administration.

This fall's Open Enrollment

Your plan must get your enrollment form by December 7, and a new health or drug plan starts January 1. If you've looked at your options and you're happy with your current coverage, you don't have to do anything; it continues automatically, along with any changes to its benefits or costs for the new year.

The January-to-March Medicare Advantage Open Enrollment Period only works for people already in a Medicare Advantage plan. The Medicare Advantage Open Enrollment Period can't be used to move from Original Medicare into Medicare Advantage, or to switch drug plans if you're in Original Medicare. A change made during the Medicare Advantage Open Enrollment Period takes effect the first day of the month after the plan gets your request.

Outside the yearly windows, certain life events, like moving out of your plan's service area or losing other coverage, can open a Special Enrollment Period to change a Medicare Advantage or drug plan. Someone who lives in a nursing home or a similar long-term care facility also isn't limited to the yearly windows for joining, switching, or dropping a Medicare Advantage plan.

Still working past 65?

If you have health coverage through your job or your spouse's job, a Special Enrollment Period lets you sign up for Part B later without a penalty. The job-based Part B Special Enrollment Period ends 8 months after the job or the group health coverage ends, whichever happens first. COBRA and retiree coverage don't count: their ending doesn't open a Special Enrollment Period for Part A or Part B. See our guide to special enrollment periods if you're in this spot.

Late enrollment penalties

  • Part B: If you don't sign up when first eligible and don't qualify for a Special Enrollment Period or a Medicare Savings Program, your Part B premium goes up 10% for each full 12-month period you could have had Part B, for as long as you have Part B.
  • Part D: If you go without Part D or other creditable drug coverage, a penalty of 1% of the national base beneficiary premium ($38.99 in 2026) is added for each full month you went without it, for as long as you have Part D. People with creditable drug coverage or Extra Help generally don't pay the Part D late enrollment penalty.

Notice the Medicare Savings Program exception in the Part B rule: someone who qualifies for one isn't hit with the Part B late enrollment penalty. If money is part of why you waited, ask DC SHIP whether you qualify for a Medicare Savings Program before you assume the Part B penalty applies. More on late enrollment penalties if you've already missed a window.

Medigap in DC

Medigap, also called Medicare Supplement Insurance, helps pay out-of-pocket costs in Original Medicare, not in Medicare Advantage. If you're in a Medicare Advantage plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare, and you can't use Medigap to pay your Advantage plan's copays, deductibles, or premiums.

Moving between Medigap and Medicare Advantage is a bigger decision than it looks. If you drop a Medigap policy to join a Medicare Advantage plan, you may not be able to get the same policy back later., There is one safety net: if you join a Medicare Advantage plan for the first time and aren't happy with it, you have a federal "trial right" to buy a Medigap policy and a separate drug plan if you return to Original Medicare within 12 months of joining.

The District's own Medigap rules are covered in our DC Medicare Supplement guide; here are the essentials. Under 26-A DCMR §2210, an insurer can't turn you down for a Medigap policy or charge you more because of your health if you apply before or during the 6 months that begin the first month you're both 65 or older and enrolled in Part B. If certain other coverage ends, such as an employer plan that supplements Medicare or a Medicare Advantage plan that stops serving your area, 26-A DCMR §2209 gives you a guaranteed-issue right to certain Medigap policies if you apply no later than 63 days after that coverage ends and include proof of the date it ended. Under D.C. Code §31-3707, you can return a new Medigap policy within 30 days of its delivery and get your premium refunded if you're not satisfied for any reason. For a problem with an insurer or agent, such as a claim dispute or a sales misrepresentation, the DC Department of Insurance, Securities and Banking (DISB) takes complaints at (202) 727-8000 or disbcomplaints@dc.gov.

Before you buy or drop a Medigap policy, talk it through with DC SHIP, whose counselors help District residents compare and choose Medigap policies. Our Medigap open enrollment and Medigap guaranteed-issue guides cover the federal buying windows in detail.

Help Paying Medicare Costs in DC

If money is tight, don't stop at the standard price list. Medicare Savings Programs and Extra Help are the programs to ask about first, and DC SHIP (below) checks whether you qualify and helps you apply.

People with full Extra Help, the Part D Low-Income Subsidy, pay a $0 Part D deductible in 2026. A $0 deductible isn't the same as free drugs: in 2026, a full-subsidy enrollee with income under 150% of the poverty level pays no more than $5.10 for a generic or $12.65 for a name-brand drug until reaching $2,100 in out-of-pocket costs, then $0 for the rest of the year.

For the District's own Medicare Savings Program rules and income limits, see our DC Medicare Savings Programs guide, or call DC SHIP at (202) 727-8370 to check your situation. Our Extra Help guide covers the drug side.

Free Help Choosing a Plan: DC SHIP

So how do you actually pick a plan in DC without a salesperson in the room? Call DC SHIP.

DC SHIP is the District's State Health Insurance Assistance Program, a service of the DC Department of Aging and Community Living (DACL). DACL's 2026 fact sheet describes SHIP as a free, federally funded program that gives unbiased Medicare counseling. DC SHIP counselors help District residents with:

  • One-on-one Medicare counseling
  • Comparing and choosing Medicare Advantage, Medigap, and Part D plans
  • Denied claims, billing errors, and appeals
  • Screening and applying for Medicare Savings Programs and Extra Help

DC SHIP also helps family members and caregivers, plus case managers, social workers, and health care providers who want to understand Medicare.

To reach DC SHIP, call (202) 727-8370 or email ship.dacl@dc.gov; DACL lists its service location as 250 E Street SW, Washington, DC 20024. See DACL's health insurance counseling page for details.

For questions about your own Medicare coverage, the federal line is 1-800-MEDICARE (1-800-633-4227), where you can talk or live chat with a person 24 hours a day, 7 days a week, except some federal holidays. TTY users call 1-877-486-2048. If you're in a Medicare Advantage or Part D plan, call the plan first using the number on your member card.

Want a second set of eyes before you call? Chat with Brevy's care navigator at brevy.com.

What Medicare Won't Cover

Two gaps catch DC families off guard.

Routine dental, vision, and hearing. Original Medicare doesn't cover routine dental care like cleanings, fillings, and dentures, routine eye exams for glasses, or hearing aids. Many Medicare Advantage plans add some of these benefits, but what's covered varies widely, so check the specific plan. More in our dental, vision, and hearing guide.

Long-term care. Medicare doesn't cover custodial care, meaning help with daily activities like bathing, dressing, and using the bathroom, when that's the only care a person needs. The custodial-care exclusion is the core reason Medicare doesn't pay for long-term stays in a nursing home or assisted living facility. What Part A does cover is short-term skilled nursing facility care, which generally requires a qualifying inpatient hospital stay of at least three days in a row first, for up to 100 days per benefit period: $0 a day for days 1 to 20 after the $1,736 deductible, $217 a day for days 21 to 100, and nothing after day 100. Time under observation or in the emergency room before admission doesn't count toward Medicare's 3-day inpatient stay for skilled nursing facility coverage, even if you're there overnight. Medicare's 3-day rule isn't always a dead end: you may not need the 3-day inpatient stay if your doctor participates in an Accountable Care Organization (ACO) approved for a "Skilled Nursing Facility 3-Day Rule Waiver," and a Medicare Advantage plan may also waive the 3-day minimum. And if you re-enter the same or another skilled nursing facility within 30 days of leaving one, you don't need another 3-day qualifying hospital stay to get more skilled nursing facility benefits.

Medicare points people who need long-term care to Medicaid, if they meet their state's eligibility rules, or to private long-term care insurance, and a Medigap policy doesn't fill the long-term care gap either. Our guide to how to pay for senior care in Washington, DC lays out the options, and DC Medicaid long-term care covers the Medicaid route.

Frequently Asked Questions

How do I get help choosing a Medicare plan in DC?

DC residents have two free routes that don't involve a salesperson. For one-on-one advice, DC SHIP, the District's State Health Insurance Assistance Program at the DC Department of Aging and Community Living, gives free, unbiased Medicare counseling at (202) 727-8370 or ship.dacl@dc.gov. To research on your own first, the Medicare Plan Finder shows the Medicare Advantage and Part D plans actually offered at your DC ZIP code.

Is Medicare different in DC than in other states?

Medicare's coverage, costs, and enrollment windows are federal, so the 2026 standard Part B premium is $202.90 a month in DC, as it is nationwide. What can differ by where you live is the menu of Medicare Advantage plans: the area where you live might have all, some, or none of the Medicare Advantage plan types, so compare what's offered at your own ZIP code.

Do I have to sign up for Part B at 65 if I'm still working in DC?

Not necessarily. If you have health coverage through your own or your spouse's current job, the job-based Part B Special Enrollment Period lets you sign up later without a late enrollment penalty, and if you sign up while still working, or within the first full month after the employer coverage ends, you can ask to delay your Part B start date by up to 3 months. The job-based Part B Special Enrollment Period doesn't apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD) or you're still in your Initial Enrollment Period.

Can I switch Medicare plans after I enroll?

Yes, at set times. During Medicare Open Enrollment, October 15 to December 7, you can switch between Original Medicare and Medicare Advantage or change Part D plans. From January 1 to March 31, people already in a Medicare Advantage plan get one more change.

Can I keep my Medigap policy if I join a Medicare Advantage plan?

You can't use Medigap to pay a Medicare Advantage plan's costs, and if you drop your Medigap policy to join an Advantage plan, you may not be able to get the same policy back.

Learn More

MedicaidDC Medicare Savings ProgramsDC Medicare Savings Programs pay Medicare premiums, deductibles, and coinsurance. See the District's 2026 QMB income limits ($4,010 single) and how to apply. MedicaidDistrict of Columbia Medicaid: A Guide for Seniors and FamiliesDistrict of Columbia Medicaid is run by DHCF: 138% FPL adult coverage, a $4,000 asset limit for long-term care, the EPD Waiver, and QMB up to 300% FPL. FinancialHow to Pay for Senior Care in Washington, DCHow to pay for senior care in Washington, DC: a semi-private nursing home room runs $146,730 a year, and DC Medicaid's 2026 income limit is $2,982 a month. MedicareQMB Balance Billing ProtectionsIf you're in Medicare's QMB program, federal law bars doctors from billing you for cost-sharing. Why QMB members can't be billed, and what to do if you are. MedicareMedicare Plans and Coverage in MarylandMedicare in Maryland for 2026: Part A and B costs, Medicare Advantage, Part D, the 30-day Medigap birthday rule, savings programs, and free SHIP help. MedicareMedicare in Virginia: Plans and CoverageMedicare in Virginia for 2026: Part A and B costs, Medicare Advantage, Part D, SCC-regulated Medigap, Medicare Savings Programs, and free VICAP counseling. MedicareMedicare Enrollment PeriodsWhen to sign up for Medicare without a lifelong penalty: the 7-month Initial Enrollment Period, working past 65, the GEP, and what each late penalty costs.

Find personalized help choosing a Medicare plan in Washington, DC at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.