DC has approximately 100,000 Medicare beneficiaries — a small market by absolute size but distinctive in composition. A high share of DC’s Medicare population consists of federal retirees who must coordinate Medicare with the Federal Employees Health Benefits (FEHB) program. A separately significant share consists of dual-eligibles — DC residents enrolled in both Medicare and DC Medicaid.1
What Medicare covers, and what it doesn’t
The biggest misconception in caregiving: Medicare is health insurance, not long-term care insurance. Medicare covers short rehab after a hospital stay. It does not cover ongoing custodial care — assisted living, memory care, or long-term nursing-home care — once skilled rehabilitation ends.
What Medicare does cover:
- Part A (Hospital). Inpatient stays, skilled nursing rehab up to 100 days post-hospital, hospice, limited home health.
- Part B (Medical). Doctor visits, outpatient procedures, durable medical equipment, mental health, preventive care, ambulance.
- Part D (Drugs). Prescription drug coverage, standalone or bundled into a Medicare Advantage plan. Federal retirees often have FEHB drug coverage that eliminates the need for a separate Part D plan.
What Medicare does not cover:
- Assisted living (any state, any setting)
- Memory care
- Custodial nursing home beyond the 100-day rehab window
- Long-term in-home aide hours for personal-care support
- Dental, vision, hearing (Original Medicare; some MA plans and FEHB plans add these)
FEHB and Medicare: the DC coordination problem
DC has the highest concentration of federal retirees of any US jurisdiction. Most federal retirees keep their Federal Employees Health Benefits (FEHB) coverage after retirement and add Medicare at 65. The coordination question is one of DC SHIP’s most frequent topics.2
Standard approach for federal retirees:
- Enroll in Medicare Part A.Free for most people based on payroll tax history. Even FEHB retirees should enroll in Part A — it’s free and provides hospital coverage that supplements FEHB.
- Decision on Medicare Part B. Costs approximately $185/month in 2026, with higher IRMAA surcharges at higher incomes. Most federal retirees enroll in Part B because it becomes primary coverage and FEHB becomes secondary, dramatically lowering out-of-pocket exposure. Skipping Part B saves the premium but exposes the retiree to higher cost-sharing under FEHB-only coverage. OPM generally recommends Part B enrollment for retirees who want maximum protection.
- Decision on Medicare Part D.Most FEHB plans have prescription drug coverage that meets Medicare’s creditable-coverage standard, meaning the retiree does not need a separate Part D plan and avoids the late-enrollment penalty. Verify the FEHB plan’s creditable-coverage status before declining Part D enrollment.
- Skip Medigap. FEHB functions similarly to Medigap for federal retirees enrolled in both Medicare and FEHB. Buying a Medigap policy on top of both is usually duplicative and wasteful.
Original Medicare vs. Medicare Advantage in DC
For DC residents who aren’t federal retirees with FEHB, the standard Medicare choice still applies: Original Medicare (Parts A and B, usually with Medigap and Part D) or Medicare Advantage.
DC’s Medicare Advantage penetration is below the national average — approximately 30-40% in 2025 compared with roughly 54% nationally.3 DC has fewer MA plans than larger states, narrower networks within those plans, and a generally less competitive Advantage market.
When Original Medicare + Medigap usually beats Advantage in DC
- Your parent travels frequently. Original Medicare works nationally with any Medicare-accepting provider; Advantage plans have networks.
- Your parent has a serious or complex condition and wants specialist access without referrals or prior authorizations.
- Your parent values predictable out-of-pocket costs and can afford a Medigap monthly premium (approximately $180–$320 for Plan G in DC).
When Advantage may beat Original Medicare
- Your parent lives in DC year-round and is generally healthy.
- The total monthly cost of Original Medicare Part B + Medigap + Part D exceeds your parent’s budget.
- Your parent values the extras (dental, vision, hearing, gym, sometimes meal delivery) that some Advantage plans bundle.
Medigap in DC
For DC residents who don’t have FEHB:
- Plans are federally standardized. Plan G in DC offers the same benefits as Plan G anywhere else.
- Pricing rules vary by carrier. DC carriers may use age-rated, attained-age-rated, or issue-age rating.
- Guaranteed issue applies during the 6-month Initial Enrollment Period when your parent turns 65 or first enrolls in Medicare Part B. Outside that window, insurers may use medical underwriting.
Medicare Savings Programs in DC
If your parent has limited income, they may qualify for one of the federal Medicare Savings Programs (MSPs), administered in DC by DHCF:
- QMB (Qualified Medicare Beneficiary). Pays Part A and Part B premiums, deductibles, and coinsurance. Income limit approximately $1,255/month individual (2026). DC’s thresholds may be more generous than federal floors.
- SLMB (Specified Low-Income Beneficiary). Pays Part B premium only.
- QI (Qualifying Individual). Pays Part B premium. First-come first-served annual funding.
Annual Enrollment Period (AEP) in DC
Medicare AEP runs from October 15 through December 7 each year. During this window your parent can:
- Switch from Original Medicare to Medicare Advantage (or vice versa)
- Switch from one Advantage plan to another
- Add, drop, or change a standalone Part D plan
DC sees less aggressive AEP marketing than Florida or California, but the choice still matters — especially for non-federal-retiree DC residents who are responsible for their own Medicare plan selection. Use Medicare.gov’s Plan Finder to compare plans by total annual cost.4
Where to get free help in DC
DC Health Insurance Counseling Project (HICP) — DC SHIP — is housed at George Washington University Law School. Volunteers and staff provide free, unbiased Medicare counseling, including FEHB-Medicare coordination help. Call 1-202-739-0668.5
For DC Medicaid questions where Medicaid and Medicare interact (dual-eligibility, long-term care benefits), see our DC Medicaid guide.