This Washington Medicare guide will walk you through the basics you need to know so you can make informed decisions about your health insurance.
Use this table of contents to jump to specific sections of the Washington Medicare guide:
There are 1.5 million Washington Medicare beneficiaries, making up 19% of the state’s total population. Most beneficiaries are on Medicare due to age, but about 11% are on Medicare due to disability. 14% of Medicare enrollees also receive Medicaid benefits due to low income and resources. In Washington, 60% of Medicare beneficiaries are on Original Medicare and 40% are on a Medicare Advantage plan.
US citizens 65 and older are eligible for Medicare. Some individuals who are under 65 years old and have certain disabilities like ALS or End-Stage Renal Disease are also eligible.
Most people who age into Medicare enroll in Medicare during their Initial Enrollment Period (IEP). Your IEP is a seven-month period of time that begins three months before the month you turn 65 and ends three months after. Some people choose to delay Part B enrollment because they are still working and receiving employer-linked coverage. If you want to delay Part B enrollment, just make sure you’ll be eligible for a Special Enrollment Period to avoid the Part B late enrollment penalty!
Once you’re enrolled in Original Medicare, you have some options. You can stay on Original Medicare and add a Medicare Supplement plan and/or a prescription drug plan. You can also switch to Medicare Advantage. Each option has its own pros and cons, which we’ll explain more later.
To ensure you get the best value from Medicare, you need to use it! Medicare covers many of preventive services, so make sure to schedule appointments, like your annual wellness visit. Also be sure to share your new insurance info with your pharmacy so you get the right price for your prescriptions.
Each year, during the annual Open Enrollment Period, you should review any changes to your healthcare needs and your healthcare plan to be sure you’re getting the best value. Medicare Advantage and prescription drug plans both change every year. While many people are better off sticking with their plans, some are able to save thousands by switching.
Washington Medicare Beneficiaries have access to 133 Medicare Advantage (MA) plans, but pricing and availability varies by county. For example, King County has 51 MA plans with monthly premiums ranging from $0 to $296. Spokane County has 41 MA plans with premiums ranging from $0 to $99. If you want to explore the plans available in your county, give us a call at (888) 604-0055! We’re happy to help you compare Washington Medicare Advantage plans.
Medicare Advantage plans are popular among Medicare beneficiaries because they offer a bundled approach to Medicare, combining Part A, Part B, and usually Part D benefits. They also generally offer additional health-related benefits, like fitness perks, dental and vision coverage, transportation support, and telehealth. Most Washington Medicare Advantage plans offer these additional benefits at a low (or no) additional cost. While you’re still responsible for your Part B premium (which is commonly misunderstood), more coverage without a significant added cost sounds nice. So, what’s the catch?
As we mentioned before, Medicare Advantage and Original Medicare both have their downsides. The common complaints against Medicare Advantage plans are that they have limited provider networks, often require pre-authorization for covered services, and have much higher out-of-pocket costs (compared to Original Medicare + a Medicare Supplement plan).
Original Medicare doesn’t cover about 80% of costs for covered services. Many Medicare beneficiaries choose to add a Medicare Supplement (Medigap) Plan to help them cover the leftover 20% of costs. Medigap plans can significantly reduce your out-of-pocket costs. With one type of plan (Plan G), your out-of-pocket costs are almost eliminated!
There are ten different Medicare Supplement (Medigap) plans in Washington. Medigap plans are labeled by letters A-N, and each letter plan is identical, regardless of the insurance carrier or price.
Three key benefits of Medigap plans that you don’t get with Medicare Advantage are:
No networks (you can see any doctor who accepts Medicare)
No prior authorization requirements for covered services
Lower out-of-pocket costs and financial predictability
The best time to ennroll in a Medicare Supplement plan is during the first six months that you have Part B coverage. This period of time is called your Medigap Open Enrollment Period. During your Medigap Open Enrollment Period, you are guaranteed acceptance into a Medigap plan. Insurance companies cannot ask you questions about your health history or deny you coverage.
Specifically in Washington, you have more flexibility to change Medigap plans if you’re already on a Medigap plan. If you’re already on a plan from B through N, you can switch to any other plan from B to N at any point. If you’re already on a Plan A, you can switch to another Plan A at any time. In both these instances, you can switch plans without going through medical underwriting (when insurance companies ask you questions about your past and current health).
If you want to enroll in a Medicare Supplement plan and aren’t already on one, you may have trouble outside of your Medigap Open Enrollment Period and a handful of other guaranteed issue periods. Outside of these periods, you will likely need to go through medical underwriting during your application process and could be denied.
Original Medicare doesn’t cover prescriptions. Many Medicare Advantage plans include Part D (prescription) coverage. If your plan doesn’t include prescription coverage or you’re on Original Medicare, you can enroll in a stand-alone Part D plan. Washington has 26 Part D plans. Exact plan pricing and availability vary by county.
Even if you don’t currently need prescription coverage, we recommend enrolling in a lower-cost option to avoid the Part D penalty.
If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Washington Medicare Advisors or give us a call at (888) 604-0055.
The government has three programs that can help Washington Medicare beneficiaries with low income and resources.
Medicaid is a joint federal and state program that’s operated by individual states. Washington’s Health Care Authority established Washington Apple Health as its Medicaid agency.
Washington Apple Health has specific programs for those who are aged and on Medicare. Washington has a program for individuals who are aged, blind, or disabled (commonly called ABD Medicaid). There’s also a Long-Term services program, dental plans, and Medicare Savings Programs. Medicare Savings Programs are offered in every state to help Medicare beneficiaries with low income and resources pay for Medicare-related expenses.
Washington has four types of Medicare Savings Programs
Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI)
Qualified Disabled and Working Individuals (QDWI)
For more information about the eligibility requirements and application process for Apple Health (Medicaid) programs click here.
Extra Help (also called the Part D Low-Income Subsidy, or LIS) helps those with limited incomes and resources pay for expenses related to Part D.
You automatically qualify for Extra Help if you:
Receive full Medicaid coverage from Washington
Washington pays your Part B premium
Are eligible for Supplemental Security Income (SSI)
Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:
You are 65 and older, blind, or have a disability
You have limited income and limited resources