TSM Life & Health is an independent, licensed agency helping Washington, D.C. residents compare Medicare Advantage, life insurance, final expense and annuity options in plain language. For 2026, CMS lists 11 Medicare Advantage (MA-PD) plans in the District of Columbia from 6 carriers, 3 of them at a $0 monthly plan premium, with an average in-network out-of-pocket maximum of about $6,714. The District runs its own ACA exchange, DC Health Link, so Marketplace shoppers enroll there. We help you compare, at no cost and no pressure.
The District of Columbia is a single jurisdiction — its county-equivalent is the District of Columbia (ZIP anchors 20001, 20002, 20009). The figures below are for all Medicare Advantage plans with drug coverage (MA-PD) CMS lists in the District for contract year 2026, pulled live from the CMS Landscape file.
Every figure below is for a non-SNP Medicare Advantage plan with prescription drug coverage (MA-PD) available in the District of Columbia for contract year 2026. The monthly premium shown is the consolidated Part C + Part D plan premium; the in-network maximum out-of-pocket (MOOP) is the most you would pay for covered Part A and Part B services in a year. Ordered by monthly premium.
| Plan | Type | Monthly premium | In-network MOOP | Part D deductible | Overall star |
|---|---|---|---|---|---|
| Kaiser Permanente MA Value DC | HMO-POS | $0.00 | $7,500 | $0 | 4.5★ |
| HealthSpring Preferred | HMO | $0.00 | $4,250 | $0 | 3.0★ |
| HumanaChoice (H5216-383) | PPO | $0.00 | $6,750 | $615 | 3.5★ |
| HumanaChoice (H5216-389) | PPO | $16.20 | $6,750 | $615 | 3.5★ |
| HealthSpring True Choice Plus | PPO | $21.00 | $6,500 | $615 | 3.0★ |
| Kaiser Permanente MA Standard DC | HMO-POS | $36.00 | $7,400 | $0 | 4.5★ |
| CareFirst BCBS Advantage Complete | PPO | $42.00 | $7,300 | $0 | 3.5★ |
| AARP MA from UnitedHealthcare (DC-0002) | PPO | $46.00 | $6,700 | $600 | 4.0★ |
| Aetna Medicare Enhanced Plus | HMO-POS | $63.00 | $7,500 | $615 | 3.0★ |
| Aetna Medicare Premier | PPO | $70.00 | $7,500 | $615 | 4.5★ |
| Kaiser Permanente MA High DC | HMO-POS | $105.00 | $5,700 | $0 | 4.5★ |
A $0 plan premium does not mean $0 cost — you still pay your Medicare Part B premium and any plan copays or coinsurance. Once you reach a plan’s in-network MOOP, it pays 100% of covered in-network Part A and Part B services for the rest of the year. Carriers offering MA-PD plans in the District for 2026 include Aetna, CareFirst BlueCross BlueShield, Humana, HealthSpring, Kaiser Permanente and UnitedHealthcare.
Unlike most states, the District of Columbia does not use the federal HealthCare.gov Marketplace. D.C. runs its own state-based exchange, DC Health Link, where residents and small businesses shop for and enroll in individual, family and SHOP health plans, and where income-based premium tax credits are applied. Because plan listings and enrollment for the District live on that exchange, we don’t publish federal Marketplace plan tables here.
If you need an ACA plan, start at DCHealthLink.com. We can still help you understand how a Marketplace plan fits alongside Medicare, life insurance or retirement coverage — just reach out.
TSM Life & Health is an independent, licensed insurance agency (founder Keith McLiverty, National Producer Number 3481853). We are licensed in Washington, D.C. and work with District residents by phone and video, so you get the same plain-spoken, no-pressure guidance whether you live on Capitol Hill, in Georgetown, Columbia Heights, Anacostia or anywhere across the District’s four quadrants. Because we are independent, we help you compare options across carriers — we do not work for any one insurance company.
Yes. We are an independent, licensed insurance agency serving Washington, D.C. residents. We help you compare Medicare Advantage, life insurance, final expense and annuity options by phone and video, at no cost to you.
For 2026, CMS lists 11 Medicare Advantage plans with drug coverage (MA-PD) in the District of Columbia, offered by 6 carriers. Three carry a $0 monthly plan premium, and 5 of the 11 hold a CMS Overall Star Rating of 4 stars or higher. Tell us your doctors and prescriptions and we will help you compare.
The District runs its own exchange, DC Health Link, instead of the federal HealthCare.gov Marketplace. D.C. residents shop and enroll in individual and family ACA plans at DCHealthLink.com. We can help you understand how a Marketplace plan fits with your other coverage.
Medicare has an Annual Enrollment Period from October 15 to December 7, plus Initial and Special Enrollment Periods tied to your situation. DC Health Link sets its own Open Enrollment window for ACA plans, generally beginning November 1. We can help you find the window that applies to you.
No. There is no cost to you to compare plans with us. We are compensated by the carriers when you enroll, and we present your options neutrally so you can choose what fits.
Sources. Medicare Advantage plan list, plan types, monthly consolidated (Part C+D) premiums, in-network out-of-pocket maximums, annual Part D deductibles and CMS Overall Star Ratings come from the CMS Medicare Advantage / Part D Landscape for contract year 2026 (cms.gov) for the District of Columbia (ZIP 20001, county-equivalent District of Columbia), covering all 11 non-SNP MA-PD plans; the averages shown are computed across those 11 plans. ACA Marketplace coverage for the District is administered by DC Health Link (dchealthlink.com), the District’s state-based exchange, not the federal HealthCare.gov Marketplace, so no federal Marketplace table is shown. Data accessed via The Brain (Ambrose) MCP on July 31, 2026. For all of your options, see medicare.gov or ssa.gov.
TSM Life & Health is an independent, licensed insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program (SHIP) to get information on all of your options. We are not connected with or endorsed by the U.S. government, the federal Medicare program, or CMS. Figures are estimates for education only, not quotes or guarantees of coverage or savings. Verify current plan details with a licensed agent before enrolling.
Medicare in the District of Columbia works the same way it does across the country. Most people choose one of three paths, and you can compare them side by side. As an independent agency, we help you weigh the trade-offs — and we do not offer every plan available in your area.
| Path | What it covers |
|---|---|
| Original Medicare | Part A (hospital) plus Part B (medical). Covers the essentials, but not everything — there is no built-in prescription drug coverage and no annual out-of-pocket cap. |
| Medicare Advantage (Part C) | A private plan that bundles Part A and Part B, usually with Part D drug coverage built in. Often adds extra benefits and a yearly out-of-pocket cap, and uses a provider network. |
| Medicare Part D | Prescription drug coverage from a private plan. Pair it with Original Medicare as a stand-alone plan, or get it built into a Medicare Advantage plan. |
Timing matters. These are the standard Medicare enrollment windows set by CMS — they apply to District residents just as they do nationwide.
| Enrollment period | When | What it is for |
|---|---|---|
| Initial Enrollment Period (IEP) | The 7 months around your 65th birthday — the 3 months before, your birthday month, and the 3 months after. | When most people first sign up for Medicare Part A and Part B. |
| General Enrollment Period (GEP) | January 1 – March 31 each year. | For people who missed their IEP; coverage starts the month after you sign up. |
| Annual Enrollment Period (AEP) | October 15 – December 7 each year. | Join, switch or drop a Medicare Advantage or Part D plan for the coming year. |
| Medicare Advantage Open Enrollment | January 1 – March 31 each year. | If you are already in a Medicare Advantage plan, make a one-time change. |
Special Enrollment Periods (SEPs) can also apply after qualifying life events — for example, losing employer coverage or moving.
You generally qualify for Medicare if you:
A quick snapshot of Medicare in the District of Columbia, using the latest CMS figures. Plan counts and the average premium are for contract year 2026; the beneficiary total is the 2025 annual figure.
We do not offer every plan available in your area.
There is no cost or pressure — just clear guidance. Here is how we help D.C. residents get it right:
These independent, government and nonprofit resources can help D.C. residents understand their options at no cost:
Medicare is usually the reason people call, but it’s rarely the only thing on the kitchen table. We’re an independent agency, so we compare across carriers rather than representing one — and a fair number of these conversations end with us telling someone that what they already have is the right fit.
Not sure which of these applies to you? That’s a normal place to start. Book a free consultation or call 203-951-0339 and ask one question — that is allowed.
You will probably recognize yourself in one of these. Each one starts in a different place, so each one gets a different first conversation.
There are three shopping bags of mail on the table, every plan claims to be free, and you’d like to keep your cardiologist. We start with your doctors and your prescriptions, then look at the plans — not the other way around.
Start with MedicareYou’re the one reading small print at 11pm, wondering whether the postcard that looks like a Medicare card is a scam. Bring us the mail. We’ll tell you what’s real, and you can put us on speakerphone with your mother.
See how we workCOBRA quoted more than the mortgage payment and you’ve got a few years to get to Medicare. We help you think through the income estimate the Marketplace runs on, and set the calendar so you land on Medicare at 65 without a gap or a penalty.
Read the ACA guideSize it before you shop it — debt, income to replace, mortgage, education, minus what you already have. Then match the tool: term for the years with a mortgage and children in the house, a smaller permanent policy for what never expires.
See life insuranceNone of these are dramatic enough to notice in the mail. All three show up later — at the pharmacy counter, at the front desk, or in a monthly check that can’t be changed.
Working past 65 does not always let you delay Medicare. Whether you can wait depends on the size of your employer and whether the coverage counts as creditable. Nothing that arrives in the mail tells you which case you’re in, and the penalties for guessing wrong are added to your premium for as long as you hold the coverage. Here is how the enrollment windows actually work.
The higher earner’s Social Security decision is really the survivor’s decision. When one spouse dies, the survivor keeps the larger of the two checks — not both. So the higher earner’s claiming age sets the income the widow or widower lives on, potentially for decades. It’s the single most expensive thing to get wrong, and the easiest to miss. We walk through 62 versus 67 versus 70 here.
“Keep what I have” is one of the options being compared, not the default. Plans change every year — premiums, formularies, networks, the out-of-pocket maximum — and so does your life. Once a year we re-run your drug list and your doctors against the plans we offer in your area. If the plan you have is still the right one, that’s what we tell you, and it costs nothing either way. That yearly review is the part of the relationship that matters most.
Happy to look at any of this with you, at your pace. Our office is at 479 New Haven Avenue in Milford, Connecticut, and a real person answers the phone Monday to Friday 9–6 and Saturday 10–2. Get in touch.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP), to get information on all of your options. TSM Life & Health is a licensed independent insurance agency and is not connected with, affiliated with, or endorsed by the U.S. government, the federal Medicare program, the Social Security Administration, or the Centers for Medicare & Medicaid Services (CMS). This is a solicitation for insurance; a licensed insurance agent may contact you. Product availability and benefits vary by state and carrier, and all guarantees are backed solely by the claims-paying ability of the issuing insurance company. This page is general educational information only and is not insurance, tax, legal, or investment advice.
Tell us your doctors and your prescriptions, and we will help you match a plan — at no cost and no pressure.