Turning 65 in DC? Let's sort out your Medicare.
Answer a few quick questions. See which path fits you, what it costs, and the deadlines you can't miss.
Everyone picks one of two roads. The questions help you see which one fits.
Takes about 4 minutes. We don't ask your name.
Christine Reavis, BSN, RN | Health policy MPH candidate
Independent community health education project. Not a government website. I don't sell insurance, and nobody pays me to recommend a plan.
Information last reviewed: September 2026
About this project
I'm Christine Reavis. I've been a nurse in DC for nearly 10 years, and I'm now a health policy MPH candidate.
Every year I watch patients make Medicare choices without knowing how the two paths really work day to day, and some of them don't find out until they need care. I built this so people turning 65 in DC can see their options in plain language and know where to get free, unbiased help.
This is an independent project. It isn't run by Medicare, the DC government, or any insurance company. I don't sell insurance or earn anything from any plan. The site doesn't ask your name and doesn't save your answers.
Figures are 2026 national averages from Medicare and DC's Department of Health Care Finance. For advice about your own situation, call DC SHIP at (202) 727-8370. It's free.
Not a U.S. citizen? Medicare rules changed.
A 2025 federal law narrowed which immigrants can have Medicare.
Who can still get Medicare
- U.S. citizens
- Green card holders (lawful permanent residents)
- Certain Cuban and Haitian entrants
- Citizens of Micronesia, the Marshall Islands and Palau living in the U.S.
They still need to meet Medicare's other rules, like work history or years living in the U.S.
Who is losing Medicare
This includes refugees, asylees, people with humanitarian parole, Temporary Protected Status (TPS), T visas, and special immigrant visas, unless they now have a green card.
- Since July 4, 2025, people in these groups can't newly sign up for Medicare.
- People already on Medicare in these groups lose it on January 4, 2027. Social Security is required to send a letter first.
Got a green card since then? You may still qualify. Don't ignore any letter from Social Security. Contact them or get free legal help.
Free help in DC
This is general information, not legal advice. Immigration rules are complicated, so talk with a legal aid lawyer about your situation.
Under 65? You may qualify for Medicare too.
Medicare isn't only for people 65 and older. Some younger people get it because of a disability or a serious illness.
Who can get Medicare before 65
- People on Social Security Disability (SSDI) for 24 months. Medicare starts automatically in month 25. Your card comes in the mail about 3 months before.
- People with ALS (Lou Gehrig's disease). Medicare starts the same month your disability benefits start. There's no 24-month wait.
- People with permanent kidney failure who need dialysis or a transplant. You have to apply. Coverage usually starts in the fourth month of dialysis, sooner for home dialysis or a transplant.
You, your spouse, or in some cases a parent needs enough work history paying Social Security taxes.
SSI isn't the same as SSDI
Supplemental Security Income (SSI) doesn't lead to Medicare on its own. In DC, people on SSI usually get Medicaid instead. Many people get both SSI and SSDI, so check your award letter or ask Social Security which you have.
What's different before 65
- Both roads are open. You can pick Traditional Medicare or a Medicare Advantage plan, just like at 65.
- Medigap is harder to get. DC doesn't require companies to sell Medigap to people under 65. You'll get your guaranteed 6-month window when you turn 65.
- DC may pay your costs. Many people on disability qualify for DC Medicaid or the QMB program, which pays Medicare premiums and the 20%. DC's QMB limit is $4,010 a month for one person.
- Waiting for Medicare during the 24 months? You may be on DC Medicaid in the meantime. The 2027 Medicaid work rules include exemptions for people with disabilities. Check what applies to you at DCMedicaidHelp.org.
Free help
How Medicare works
Medicare is health insurance from the federal government for people 65 and older, and some younger people with disabilities. You helped pay for it through payroll taxes while you worked.
Under 65? You can get Medicare early if you've been on Social Security Disability for 24 months, or have ALS or permanent kidney failure.
Two roads. You pick one.
At 65, everyone chooses how to get their Medicare. You can't be on both roads at once.
Who pays your doctor?
This is the biggest difference between the two roads, and it explains most of the others.
Road 1: Traditional Medicare
Road 2: Medicare Advantage
Example: a $1,000 bill for outpatient care
After you've paid the $283 yearly deductible.
You pay $0.
Your copay is set by your plan. The plan pays only if the provider is in-network and the care was approved when approval was needed.
The pieces, one at a time
Part A: hospital
Usually $0 a month, if you or your spouse worked and paid Medicare taxes for about 10 years.
Part B: doctors and outpatient
$202.90 a month in 2026. You pay this on either road.
Medigap: pays your 20%
Typically $120–$200 a month at 65 for Plan G, the most popular.
Your one guaranteed chance to buy it is your first 6 months.
Medicare Advantage (Part C)
Often $0–$100 a month for the plan, on top of the Part B premium.
Part D: prescriptions
About $34.50 a month on average in 2026. Built into most Advantage plans.
The gap nothing covers: long-term care
No part of Medicare pays for ongoing help with daily living, like bathing, dressing, or a long nursing home stay.
Medicare and Medicaid together
Medicare pays first. Medicaid pays much of the rest, so costs are usually very low. You don't need Medigap, and you get Extra Help with prescriptions automatically.