Resources for DC beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In District of Columbia you can reach SHIP at (202) 994-6272.
Snapshot of Medicare in District of Columbia
Total Medicare enrollment in DC
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 23 percent each. Those with the lowest percentage are Alaska (11 percent) and Utah (12 percent). In raw numbers, Alaska has the least recipients at 83,863 and California (which has about an eighth of the country’s population within its borders) has the most at 5.6 million (14 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,075 Medicare enrollees in 2015).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 83 percent of DC Medicare enrollees. The balance — 17 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (25 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 10 percent, followed by New Jersey, and North and South Dakota at 13 percent each.
DC Medicare spending per recipient
In 2014, Medicare’s per-enrollee spending in DC was $9,490. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas like Alaska). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
Medicare spending overall
In total Medicare spending, District of Columbia ranks #49 out of 51, with $856 million in spending in 2009 (latest available data). With the largest and smallest numbers of recipients, itʼs no surprise that California accounts for $50.6 billion of overall Medicare spending while Alaska spends only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009. Alaska and Wyoming were the only two states with lower total Medicare spending than DC in 2009.
Medicare Advantage in District of Columbia
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
There were 8,272 people in DC enrolled in Medicare Advantage plans in 2015. That’s about 13 percent of the state’s total Medicare population. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.
Minnesota is the only state where more than half (53 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska is the only state to have zero percent enrolled in Medicare Advantage, although five states have Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire and Vermont with 7 percent, and Maryland and Delaware with 8 percent.
Stand-alone Medicare Prescription Drug plans
DC had 39,018 Medicare beneficiaries – about 44 percent of the District’s total Medicare population – enrolled in stand-alone prescription drug plans in 2015. DC has 24 plans with premiums ranging from about $18 to $87 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.
But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries nationwide, including those who have Part D coverage as part of their Medicare Advantage plan.