Medicare is a health insurance program offered by the federal government. It is available to anyone who is age 65 or older, and to some people under age 65 who meet certain medical criteria.
There are two options to choose from when deciding on Medicare plans in Washington state:
- Original Medicare. This includes Part A and Part B, but you can also add Part D and optional Medicare supplemental insurance (Medigap) coverage.
- Medicare Advantage. This is also called Part C. These plans bundle the benefits of parts A, B, and sometimes D into a single plan through a private insurance carrier.
Continue reading to find out what each of these parts and plans cover for residents of Washington.
- free monthly premium if you or your spouse meet qualifications by having worked in a job where you paid Medicare taxes for at least 10 years
- paid premium options for those who have worked less than 40 quarters (10 years) in total
- deductible of $1,408 each time you are admitted to the hospital
Medicare Part B covers outpatient care, such as doctors’ visits, preventive screenings, vaccines, annual wellness visits, and some durable medical equipment. Costs for Part B in 2020 include:
- monthly premium of $144.60 for most people
- annual deductible of $198
- 20 percent coinsurance for most items and services after you pay the deductible
Medicare Part D covers prescription drug costs and can be purchased through private insurance carriers. Costs and coverage vary based on your plan.
Original Medicare doesn’t have an out-of-pocket maximum each year, so Medigap plans can help pay these, including deductibles, copays, and coinsurance.
Medigap plans are purchased through private insurance companies and are only available if you have original Medicare. People with Medicare Advantage plans don’t qualify for Medigap.
Costs and coverage vary based on your plan.
Medicare Advantage (Part C) plans are those you can choose to purchase separate from original Medicare. Private insurance carriers contract with Medicare to offer the same benefits as parts A and B. Here are some additional facts to know about Medicare Advantage plans:
- Many plans also include prescription drug coverage.
- Most plans have networks of providers or facilities where you must go for your care to be covered.
- Some offer benefits not available in original Medicare, such as dental or vision care, home meal delivery, wellness perks, and medical transportation.
- These plans are required to have a maximum out-of-pocket amount of $6,700 (or less, depending on the plan). Once you reach the maximum, your plan pays any additional costs for the rest of the year.
Medicare Advantage plans in Washington state are available from:
- Kaiser Foundation Health Plan of Washington
- Arcadian Health Plan
- UnitedHealthcare Insurance
- Premera Blue Cross
- Regence BlueShield
- Aetna Better Health of Washington
- Community Health Plan of Washington
- Health Alliance Northwest Health Plan
- Humana Insurance
- Sierra Health and Life Insurance
- Molina Healthcare of Washington
- Providence Health Assurance
- AmeriGroup Washington
- Health Net Life Insurance
- Anthem Insurance Companies
- PacificSource Community Health Plans
Your choice of plans will vary depending on where you live, as not all plans are available in every county.
If you choose a Medicare Advantage plan, you can select from four different types:
Health Maintenance Organization (HMO)
HMOs offer coverage from providers within the plan’s network and have specific rules you must follow to get your care covered.
- You choose a primary care provider (PCP) who is in charge of coordinating your care.
- Your PCP must provide a referral to see a specialist.
- Most out-of-network care is not covered, except in an emergency.
HMO Point-of-Service (POS)
An HMO-POS offers care within an HMO plan’s network, with an option to get some POS care outside the network.
- The same rules for HMO plans apply to HMO-POS.
- Care is available at some out-of-network providers as POS care.
- POS care may cost more than in-network care.
Preferred Provider Organization (PPO)
In a PPO, care is provided by doctors and facilities within a plan’s network.
- You don’t need a referral to see a specialist.
- You should still have a PCP to oversee your care.
- Care outside the network may cost more or may not be covered.
Special Needs Plans (SNPs)
SNPs are available if you have chronic health conditions and require more coordinated care. They are also available if you are dual eligible for Medicare and Medicaid in Washington state. These plans are not open to everyone, since you must meet eligibility requirements.
U.S. citizens and legal residents for 5 or more years are eligible for Medicare when you turn 65 years old. You may also be eligible before age 65 if:
- You’ve received Railroad Retirement or Social Security Disability benefits for 24 months.
- You had a kidney transplant.
- You have end stage renal disease (ESRD or permanent kidney failure).
- You have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
If you’re not sure whether you qualify, use Medicare’s eligibility tool to check.
It’s important to sign up for Medicare during the correct enrollment period for your situation.
Initial enrollment period
- It starts 3 months before you turn 65 and continues for 3 months after your 65th birthday.
- Signing up before your birthday means coverage begins the first day of your birthday month.
- Signing up during your birthday month or after means a delay in your coverage start date.
- Sign up for parts A, B, C, and D plans and Medigap during initial enrollment.
Medicare open enrollment
- It takes place October 15 through December 7.
- You can make changes to your original Medicare coverage.
- You can change plans or sign up for Part D.
- You can switch between original Medicare and Medicare Advantage plans.
Medicare general enrollment
- It takes place January 1 through March 31.
- You can sign up for original Medicare and Part D if you missed your initial enrollment period.
- Coverage begins July 1.
- You may owe a penalty for signing up late.
Medicare Advantage open enrollment
- It takes place January 1 through March 31.
- You can change your Medicare Advantage plan if you already have one of these plans.
- You can switch back to original Medicare (and sign up for Part D).
Special enrollment periods
- These allow you to sign up for Medicare outside of normal enrollment windows if you lose coverage for a qualifying reason.
- The length and timing of special enrollment periods vary based on the reason you lost coverage.
Before you decide which plan is right for you:
- Consider whether you want original Medicare or if you prefer a Medicare Advantage plan.
- If you choose original Medicare, make sure you purchase a separate prescription drug coverage (Part D) plan and a Medigap policy, if you need them.
- If you choose Medicare Advantage, look for a plan that gets high ratings for quality care and patient satisfaction.
You can find answers to your Medicare Washington state questions and get help with enrollment by using the following resources:
- Washington State Department of Social and Health Services (800-865-7801)
- Washington State Office of the Insurance Commissioner (800-562-6900)
- State Health Insurance Benefits Advisors (800-562-6900)
- General Medicare information
- Help paying for Medicare
- Medicare Advantage plans by county for 2020
- Medicare.gov (800-633-4227)
When you are ready to sign up for Medicare plans in Washington state:
- Review your healthcare needs and projected costs and figure out the best plan, as well as any additional coverage you might need (such as Medigap or Part D).
- If you choose a Medicare Advantage plan, check if it includes prescription drug coverage and make sure the doctors and hospitals you prefer are part of the plan’s network.
- Mark your calendar for the correct enrollment periods so you don’t miss them and owe a late sign-up penalty.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.