District of Columbia Medicare: Eligibility, 2026 Costs, and Cost Assistance

If you live in Washington, D.C., Medicare eligibility and costs follow the same federal rules as the rest of the country: you qualify at 65 (or earlier with a qualifying disability, ALS, or end-stage renal disease), Part A is usually premium-free, and the standard Part B premium is $202.90 per month in 2026.¹ What sets the District apart is a cost-assistance program that covers residents with incomes up to 300 percent of the federal poverty level and waives the asset test entirely, so a lot of D.C. beneficiaries pay far less than the headline numbers suggest.²

Who Qualifies

Most people become eligible at 65 if they or a spouse paid Medicare taxes for at least 40 calendar quarters, which is roughly ten years of work. Meet that threshold and Part A hospital coverage costs you nothing in monthly premium.¹

If your work history is shorter, you can still buy Part A. In 2026 the premium is $311 a month with 30 to 39 quarters of coverage, and $565 a month with fewer than 30.¹

You can also qualify before 65 in three situations: you’ve received Social Security Disability Insurance for 24 months, you’ve been diagnosed with ALS, or you have end-stage renal disease requiring dialysis or a transplant. The ALS and ESRD paths skip the 24-month waiting period.³

What You’ll Pay in 2026

Part A (Hospital)

Even premium-free Part A has out-of-pocket costs when you use it. The inpatient hospital deductible is $1,736 per benefit period. For a long stay, you pay $434 per day for days 61 through 90 and $868 per day for lifetime reserve days (91 through 150). Skilled nursing facility coinsurance runs $217 per day for days 21 through 100.⁴

Part B (Medical)

The standard Part B premium is $202.90 per month with a $283 annual deductible. After you meet the deductible, you generally pay 20 percent of the Medicare-approved amount for most services, and Original Medicare puts no annual cap on that 20 percent.¹

Higher Premiums at Higher Incomes

If your modified adjusted gross income from two years earlier was above $109,000 single or $218,000 married filing jointly, you’ll pay an income-related monthly adjustment amount (IRMAA) on top of the standard Part B premium, plus a surcharge on Part D. The tiers rise with income, and at the top levels your Part B bill can more than double.¹ If your income has since dropped because you retired or had another qualifying life event, you can ask Social Security to recalculate using a more recent tax year.

Part D Prescription Drugs

Part D has a hard annual out-of-pocket cap in 2026 of $2,100 on covered prescriptions. Once you hit it, you pay nothing more for covered drugs the rest of the calendar year.⁵

Enrollment Windows (and the Penalty for Missing Them)

Your first chance to sign up is the seven-month Initial Enrollment Period: the three months before your 65th birthday month, the month itself, and the three months after. You enroll through the Social Security Administration online, by phone, or in person.⁶

Miss that window for Part B and the price goes up permanently. The late enrollment penalty adds 10 percent to your monthly premium for every full 12 months you could have had Part B but didn’t, and the surcharge stays on your bill for as long as you have Part B.⁷ After the Initial Enrollment Period, your next chance is the General Enrollment Period from January 1 through March 31, with coverage starting the month after you enroll.⁸

If You’re Still Working at 65

Many D.C. residents keep working past 65. If you or your spouse have group health coverage through a current employer, you can delay Part B without penalty. When active employment or that coverage ends (whichever comes first), you get an eight-month Special Enrollment Period to sign up for Part B.⁹ COBRA and retiree plans do not count as employer coverage for this exception, so the clock starts when the job ends, not when the COBRA runs out.

D.C.’s Cost Assistance Is Unusually Generous

The District runs one of the broadest Medicare Savings Programs in the country. The Qualified Medicare Beneficiary (QMB) program pays your Part A and Part B premiums, deductibles, and coinsurance. In most states QMB cuts off at 100 percent of the federal poverty level. D.C. extends it to 300 percent and has eliminated the asset test, so eligibility turns on income alone.²

For 2026, the monthly income limits (including a $20 disregard) are $4,010 for a single person and $5,430 for a couple. Because the District’s threshold is set so high, the separate federal categories for Specified Low-Income Medicare Beneficiary and Qualified Individual effectively fold into the broader QMB structure, with no separate application track.²

QMB status also stops providers from balance billing you. Federal law bars providers and Medicare Advantage plans from charging you any Medicare cost-sharing once you have QMB coverage. If a provider sends you a bill anyway, you can refuse and report it.¹⁰

Extra Help With Drug Costs

Lower-income beneficiaries can also qualify for Extra Help, the federal program that reduces Part D premiums, deductibles, and copays. For 2026, resource limits for the full benefit are $16,590 for a single person and $33,100 for a married couple, with higher limits if you’ve set money aside for burial expenses. D.C. residents who qualify for QMB are automatically considered for Extra Help.¹¹

How to Apply for D.C. Cost Assistance

Apply for the QMB program through the D.C. Department of Health Care Finance. You can mail the completed application to 645 H Street NE, Washington, DC 20002, or bring it in person to a Department of Human Services Income Maintenance Administration Service Center. Locations include Anacostia, Congress Heights, H Street, Fort Davis, and Taylor Street. To find out which Service Center covers your address, call the Income Maintenance Administration at (202) 724-5506.

If you want help figuring out what you qualify for or filling out the paperwork, D.C.’s free Health Insurance Counseling line at (202) 727-8370 will walk you through it at no cost.¹²

Supplementing Original Medicare: Medigap in D.C.

Because Original Medicare has no annual out-of-pocket cap, many beneficiaries buy a Medigap policy to cover the Part A deductible, Part B coinsurance, and other gaps. Plans are standardized by letter (A, B, C, D, F, G, K, L, M, N), so every insurer’s Plan G, for example, covers the same benefits; only price and service differ.

Your best window to buy is the six-month Medigap Open Enrollment Period, which starts the month your Part B coverage begins when you’re 65 or older. During that window, no insurer can deny you a policy, charge more based on health history, or impose preexisting-condition waiting periods. After it closes, underwriting applies.¹³

Two D.C.-specific limits are worth knowing. First, if you join a Medicare Advantage plan and later want to switch back to Original Medicare, the District follows only the federal minimum guaranteed-issue rules, so an insurer can deny you a Medigap policy or price it based on your health unless you fit a narrow federal exception.¹³ Second, D.C. does not require Medigap insurers to sell policies to beneficiaries under 65 who qualify through disability, placing it among a small group of jurisdictions without that protection.¹⁴ Disabled beneficiaries can still enroll in Medicare Advantage, but Medigap availability is not guaranteed.

1
CMS. 2026 Medicare Parts A and B Premiums and Deductibles
2
Department of Health Care Finance – DHCF. Full Duals and Qualified Medicare Beneficiary (QMB) Only
3
HHS.gov. Who’s Eligible for Medicare?
4
CMS. Medicare Deductible, Coinsurance and Premium Rates CY 2026 Update
5
Medicare.gov. Medicare and You Handbook 2026
6
Social Security Administration. Medicare Publication No. 05-10043
7
Medicare.gov. Avoid Late Enrollment Penalties
8
Social Security Administration. When to Sign Up for Medicare
9
Medicare.gov. Working Past 65
10
Department of Aging and Community Living. Qualified Medicare Beneficiaries (QMB) Program
11
CMS. Calendar Year 2026 Resource and Cost-Sharing Limits
12
Department of Aging and Community Living. Health Insurance Counseling
13
Medicare.gov. Get Ready to Buy
14
NAIC. Medigap Open Enrollment: Younger Medicare Beneficiaries Brief Summary