Washington, D.C. runs the smallest Medicare Advantage market of any U.S. jurisdiction covered in this series: 20 plans citywide in 2026, compared to hundreds in large states. About 32,000 D.C. residents were enrolled in a Medicare Advantage plan in 2026, roughly 33% of the district's Medicare-eligible population, well below the 55% national average CMS and KFF report for 2026. That gap traces to D.C.'s unusual demographics: many Medicare-age residents are retired federal employees who keep Federal Employees Health Benefits (FEHB) coverage alongside Original Medicare instead of switching to a private MA plan.
What makes Washington, D.C. different: with only 20 plans citywide, the district has less carrier competition than most states, and the average premium of $27/month in 2026 runs nearly double the $14/month national MA average. Kaiser Permanente is one of only nine markets nationwide where Kaiser sells Medicare Advantage, and its D.C.-area HMO-POS plans post the district's highest Star Ratings. UnitedHealthcare's AARP-branded PPO carries the largest single enrollment. Confirm your doctors are in-network before enrolling: many D.C. residents see specialists across the Maryland and Virginia suburbs.
Washington, D.C.'s 2026 Medicare Advantage market is covered in full below: how many plans, which carriers, what to look for when shopping, and the key enrollment dates. Annual Election Period is October 15 to December 7, 2026, with coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in Washington, D.C.
In 2026, Washington, D.C. has 20 Medicare Advantage plans available, with 32,000 beneficiaries enrolled (33% MA penetration). The average monthly premium is $27 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Washington, D.C. (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| UnitedHealthcare | 5 | 4.0 | $15/mo |
| Kaiser Permanente | 4 | 4.5 | $10/mo |
| CareFirst BlueCross BlueShield | 4 | 3.5 | $40/mo |
| Aetna | 3 | 3.0 | $50/mo |
| Cigna Healthcare | 2 | 3.0 | $30/mo |
| Humana | 2 | 4.0 | $20/mo |
Source: CMS Medicare Open Enrollment Fact Sheet 2026 (District of Columbia), KFF Medicare Advantage 2026 Spotlight
Plan Types in Washington, D.C.: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Washington, D.C.| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 8 | $12/mo | Lower premiums, willing to use a defined network |
| PPO | 9 | $35/mo | Flexibility to see specialists in Maryland or Virginia |
| Special Needs Plan (SNP) | 3 | $0/mo | Dual-eligible (DC Medicaid + Medicare) and chronic conditions |
Washington, D.C. has no PFFS or MSA plans in 2026; all 20 plans are HMO, PPO, or SNP. PPO plans grew relative to HMO between 2025 and 2026 as carriers widened access to DMV-area specialists.
Source: CMS Medicare Open Enrollment Fact Sheet 2026 (District of Columbia), CMS Medicare Plan Finder Q4 2025
What to Look For in a Medicare Advantage Plan in Washington, D.C.
Picking a Medicare Advantage plan in Washington, D.C. is not just about premium. Here's what matters for shopping in 2026:
- Provider network reaching Maryland and Virginia. Washington, D.C. residents routinely see specialists in Bethesda, Silver Spring, or Northern Virginia. Confirm your doctors and preferred hospital are in-network before enrolling, since D.C.'s small footprint means many networks cross state lines.
- Prescription drug coverage (formulary). Most Washington, D.C. MA plans include Part D. Check that your medications are on the plan's formulary at a tier you can afford. The 2026 Part D out-of-pocket cap is $2,100, and insulin is capped at $35/month under the Inflation Reduction Act (signed August 16, 2022).
- Star Ratings. CMS rates plans 1 to 5 stars annually. In Washington, D.C., 44% of plans hold a 4-star rating or higher and none score below 3 stars, better on the low end than many larger states. Kaiser Permanente consistently posts the district's highest ratings.
- Extras (dental, vision, hearing, transportation). D.C. MA plans differ widely on supplemental benefits. With only 20 plans to compare, read each Evidence of Coverage closely rather than assuming extras match what a friend has in a different plan.
- Maximum out-of-pocket (MOOP). MA plans cap your annual in-network out-of-pocket spending. The 2026 federal MOOP ceiling for in-network MA is $9,250 (down $100 from $9,350 in 2025); Washington, D.C. plans set theirs anywhere from $4,500 to the federal ceiling. Original Medicare has no MOOP.
- Prior authorization burden. MA plans can require prior authorization for surgeries, imaging, and specialist referrals across state lines into Maryland or Virginia. Ask how often a Washington, D.C. plan requires PA if you see out-of-district specialists.
Key Medicare Dates in Washington, D.C.
Washington, D.C. Medicare and Medicare Advantage enrollees face several enrollment windows in 2026. Miss them and you may face delays or late penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already in a Washington, D.C. MA plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original + Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving into or out of Washington, D.C., losing employer or FEHB coverage, qualifying for DC Medicaid (dual eligible), or other life events. Typically a 2-3 month window.
Notable Extras in Washington, D.C. Plans
Washington, D.C. Medicare Advantage plans come with a few district-specific factors worth knowing about:
- Federal Employees Health Benefits (FEHB) overlap: Washington, D.C. has an unusually large share of retired federal workers who keep FEHB coverage into retirement instead of enrolling in Medicare Advantage. FEHB coordinates with Original Medicare, one reason D.C.'s 33% MA penetration rate runs well below the 55% national average. Compare your FEHB plan's total cost against a D.C. MA plan before you decide.
- Dual-eligible D-SNPs (DC Medicaid + Medicare): Washington, D.C. has pockets of high poverty, and the DC Department of Health Care Finance (DHCF) runs the district's Medicaid program. Residents who qualify for both DC Medicaid and Medicare can enroll in a Dual Special Needs Plan (D-SNP), typically with $0 premiums and $0 copays for primary care.
- Cross-border network reach into Maryland and Virginia: Because Washington, D.C. is geographically tiny, most MA carriers build networks reaching Montgomery and Prince George's Counties (Maryland) and Arlington and Fairfax Counties (Virginia). Verify a plan's network map covers the suburb where your specialist practices, not just downtown D.C.
- DC SHIP free counseling: DC SHIP, run by the DC Department of Aging and Community Living, offers free, unbiased Medicare Advantage plan comparisons and appeals help for Washington, D.C. residents, a useful second opinion before AEP.
Medicare Advantage vs Original Medicare in Washington, D.C.
Original Medicare (Parts A and B) plus Medigap and a standalone Part D plan gives Washington, D.C. residents nationwide provider freedom, useful if you split time between D.C. and elsewhere, but the combined premium typically runs $250-$450/month. Medicare Advantage bundles hospital, medical, and usually drug coverage into one plan, though D.C.'s average MA premium of $27/month in 2026 still runs higher than most large states given only 20 plans and limited carrier competition.
Federal retirees in Washington, D.C. face a third option most states don't: keeping FEHB coverage into retirement, which often costs less than Medigap or a D.C. MA plan and partly explains the district's low 33% penetration rate. Confirm your Medicare eligibility rules before AEP and compare all three options.
How Star Ratings work in Washington, D.C.
Washington, D.C. Medicare Advantage Star Ratings are published by CMS every October, rating plans 1 to 5 stars on roughly 40 quality measures covering chronic disease management, complaints, and Part D drug safety. Plans rated 4 stars or higher get quality bonus payments from CMS, often funding richer benefits the next plan year.
Washington, D.C.'s 2026 weighted-average Star Rating is 3.8, roughly in line with the national average, but the district stands out on its floor: 44% of plans hold 4 stars or higher and zero score below 3 stars. Kaiser Permanente posts the district's highest ratings at 4.5 stars, matching its performance in its other eight markets nationwide.
How to enroll in Washington, D.C. Medicare Advantage
Washington, D.C. residents enrolling in Medicare Advantage in 2026 follow the same federal process as every other state, but with only 20 citywide plans to compare. Use medicare.gov/plan-compare as your starting point: CMS publishes a personalized plan-finder tool keyed to your ZIP code that shows every Washington, D.C. plan you're eligible for.
- Step 1: Confirm Medicare Part A and Part B eligibility. You must already be enrolled in both before joining a Washington, D.C. MA plan. If you're newly turning 65, your Initial Enrollment Period covers this.
- Step 2: Gather your documents. You will need your Medicare card, your D.C. ZIP code, a list of current prescriptions for formulary lookup, a list of current doctors and hospitals for network checks (including any in Maryland or Virginia), and your DC Medicaid card if you are dual-eligible.
- Step 3: Compare plans at medicare.gov/plan-compare. Filter by your D.C. ZIP code and sort by Star Rating, premium, or maximum out-of-pocket. Washington, D.C. residents can also check the free DC SHIP counseling program for unbiased guidance.
- Step 4: Apply. You can enroll directly through medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or through the carrier directly. Most online enrollments take 10-15 minutes.
- Step 5: Confirm your coverage start date. AEP enrollments start January 1, 2027; SEP enrollments typically start the first of the following month. You will receive a member ID card and Evidence of Coverage within 7-10 business days.
- Common reasons Washington, D.C. MA applications are delayed or denied: late Part B enrollment, an address outside the plan's D.C.-area service zone, missing DC Medicaid documentation for a D-SNP application, identity verification mismatches, and applying to a dual-eligible SNP without proof of dual status.
$0 premium plans in Washington, D.C. for 2026
Washington, D.C. has a handful of $0 monthly premium Medicare Advantage plans in 2026, and CMS confirms 100% of D.C. beneficiaries can access at least one $0 premium option. $0 premium doesn't mean $0 cost: you still pay the Part B premium ($202.90/mo in 2026) plus any drug copays, deductibles, and out-of-pocket costs.
$0 premium plans in Washington, D.C. for 2026 detail| Carrier | Plan Type | Star Rating | Service Area |
|---|
| UnitedHealthcare (AARP) | HMO | 4.0 | Washington, D.C. citywide |
| Kaiser Permanente | HMO-POS | 4.5 | Washington, D.C. citywide |
| Cigna Healthcare | HMO | 3.0 | Washington, D.C. citywide |
| Humana | HMO | 4.0 | Washington, D.C. citywide |
Washington, D.C. $0 premium plan availability sample for 2026. Full list at medicare.gov/plan-compare keyed to your ZIP code. Star Ratings reflect the 2026 plan year.
Source: CMS Medicare Open Enrollment Fact Sheet 2026 (District of Columbia), CMS Medicare Plan Finder Q4 2025
Dual eligibility and D-SNPs in Washington, D.C.
Washington, D.C. residents who qualify for both DC Medicaid and Medicare are dual eligible. The DC Department of Health Care Finance (DHCF) administers the district's Medicaid program and coordinates with CMS on Dual Special Needs Plans (D-SNPs), which combine both programs into one plan with typically $0 premiums and $0 primary care copays. Washington, D.C. offers 3 SNP plans in 2026, a meaningful share of the district's 20-plan total.
Dual eligibility also unlocks a special enrollment right: beneficiaries can change MA plans, or move between MA and Original Medicare, once per quarter in Q1, Q2, and Q3, plus again during AEP. A mid-year change in DC Medicaid status also triggers a Special Enrollment Period, so check current Medicaid income limits before assuming you no longer qualify.
Frequently Asked Questions
How many Medicare Advantage plans are available in Washington, D.C. in 2026?
Washington, D.C. has 20 Medicare Advantage plans available citywide in 2026, per the CMS Medicare Open Enrollment Fact Sheet, down from 22 in 2025, one of the smallest MA markets in the country. Because D.C. has no counties, every resident sees the same 20 plans, though eligibility still depends on your ZIP code. Run a ZIP-code search at medicare.gov to see your exact options.
What is the average Medicare Advantage premium in Washington, D.C. for 2026?
The average Medicare Advantage premium in Washington, D.C. is $26.97 per month in 2026 (rounded to $27), down from $36.26 in 2025 but still well above the national MA average of $14 per month. The higher D.C. premium reflects a smaller carrier market with less price competition. Several D.C. plans, including options from UnitedHealthcare, Kaiser Permanente, Cigna, and Humana, still charge $0 monthly premium.
When can I sign up for Medicare Advantage in Washington, D.C.?
The main window is the Annual Election Period (AEP), October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or a Special Enrollment Period triggered by moving into or out of D.C., losing employer or FEHB coverage, or qualifying for DC Medicaid. Existing enrollees can switch plans during MA Open Enrollment (January 1 to March 31, 2026).
Who has the best Medicare Advantage plans in Washington, D.C.?
Kaiser Permanente leads Washington, D.C. in Star Ratings at 4.5 stars, the highest in the district, though it runs a closed-network HMO-POS model. UnitedHealthcare's AARP-branded PPO carries the largest total enrollment and broader access to Maryland and Virginia specialists. Humana rates 4.0 stars with a smaller D.C. footprint but a strong drug formulary. The best plan depends on whether your doctors are in D.C., Maryland, or Virginia.
Can I switch from Medicare Advantage back to Original Medicare in Washington, D.C.?
Yes. You can switch back during AEP (October 15 to December 7) or MA Open Enrollment (January 1 to March 31). Returning to Original Medicare doesn't guarantee you can buy a Medigap policy in D.C.: insurers generally aren't required to sell outside your initial Medigap window, except under guaranteed issue rights. Federal retirees keeping FEHB coverage face separate coordination rules, so check with the Office of Personnel Management first.
What is the difference between an HMO and a PPO in Washington, D.C. Medicare Advantage?
HMOs (8 of Washington, D.C.'s 20 plans) require in-network providers and usually a referral to see a specialist, with lower premiums around $12/month; Kaiser Permanente and Cigna are the district's HMO carriers. PPOs (9 plans) let you see out-of-network providers, including specialists in Maryland and Virginia, without referrals, but charge higher premiums around $35/month. Choose HMO for lower cost within a defined network; choose PPO if your specialists practice outside D.C. proper.
Does Medicare Advantage cover prescription drugs in Washington, D.C.?
Most Washington, D.C. Medicare Advantage plans include Part D drug coverage built in, making them MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans, set by the Inflation Reduction Act, and insulin is capped at $35 per month. Always check the plan's formulary to confirm your D.C.-area pharmacy and medications are covered, and at what tier.
Are dental, vision, and hearing covered by Medicare Advantage in Washington, D.C.?
Most Washington, D.C. Medicare Advantage plans include some dental, vision, and hearing benefits, which Original Medicare does not cover. Coverage varies across the district's 20 plans: some cover only cleanings and exams, while others cover crowns, hearing aids, and prescription eyewear. Always check the plan's Evidence of Coverage for annual dollar limits and network restrictions.
What is a Special Needs Plan (SNP) and who qualifies in Washington, D.C.?
A Special Needs Plan (SNP) is a Medicare Advantage plan designed for people with specific needs. Washington, D.C. offers 3 SNP plans in 2026, mostly Dual Special Needs Plans (D-SNPs) for residents who qualify for both DC Medicaid and Medicare. Some states also offer Chronic Condition SNPs (C-SNPs) for diabetes or heart failure, and Institutional SNPs (I-SNPs) for nursing home residents. Check the DC Department of Health Care Finance or medicare.gov to confirm which SNP types apply to you.
