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 plans cover for residents of Washington.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Washington for the 2021 plan year:
- A total of 1,398,832 Washington residents were enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in Washington compared to last year — from $42.69 in 2020 down to $39.34 in 2021.
- There are 157 Medicare Advantage plans available in Washington for 2021, compared to 140 plans in 2020.
- Approximately 98 percent of Washington residents have access to buy a Medicare Advantage plan, and 96 percent have access to plans with $0 premiums.
- There are 29 stand-alone Medicare Part D plans available in Washington for 2021, compared to 28 plans in 2020.
- All Washington residents with a stand-alone Part D plan have access to a plan with a lower monthly premium than they paid in 2020.
- There are 12 different Medigap plans offered in Washington for 2021.
Medicare Part A covers hospital stays and hospice, as well as limited home healthcare and care at skilled nursing facilities. The costs of Medicare Part A are set each year by the Centers for Medicare and Medicaid Services (CMS).
Medicare Part B covers outpatient care, such as doctors’ visits, preventive screenings, vaccines, annual wellness visits, and some durable medical equipment.
Medicare Advantage in Washington
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:
Some of the companies that sell Medicare Advantage plans in Washington state include:
- Aetna Medicare
- Clear Springs Health
- Health Net
- Kaiser Foundation Health Plan of Washington
- Mutual of Omaha Rx
- Premera Blue Cross
- Regence BlueShield
Your choice of plans will vary depending on where you live, as not all plans are available in every county.
Medicare supplement plans in Washington
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.
In Washington, many insurance companies offer Medigap plans. As of 2021, some of the companies offering Medigap plans in Washington include:
- AARP – UnitedHealthcare
- Garden State
- Premera BlueCross BlueShield of Washington
- Priority Health
- Sentinel Security
- State Farm
- United of Omaha
In total, you have 12 different Medigap plans (including high-deductible versions of plans F and G) that are available to choose from this year if you live in Washington.
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’ve had a kidney transplant
- you have end stage renal disease (ESRD)
- you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
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 age 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.
Tips for enrolling in Medicare in Washington
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.gov (800-633-4227)
What should I do next?
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.
- Almost 1.4 million people in Washington were enrolled in Medicare in 2020.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans in Washington.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in Washington.
- There are also several Medigap plan options if you live in Washington and are looking for additional coverage.