Medicare Plans in Washington

Medicare Plans in Washington

The good news is that there are Medicare options for Washingtonians to choose from. But, sorting through all of the options to find the right coverage can be overwhelming. We don’t think it has to be! We’ve created this guide to help navigate you through the Medicare plans in Washington so that you find the coverage you need.

Who’s eligible for a Medicare Plans in Washington?

Medicare is a federal health insurance program available to American citizens and permanent residents who qualify, by either age or disability.

If you’re 65 or older, you may qualify for Medicare if:

  • You are a citizen or permanent resident (having lived in the US for at least 5 years), and
  • You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.

If you’re under 65, you may qualify for Medicare if you have:

  • Been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
  • Received Social Security Disability Insurance (SSDI) for at least 24 months

We can help you determine your eligibility for Medicare plans in Washington or help you prepare for your upcoming eligibility. View plans in your area online or talk to a licensed insurance agent now by calling us.

What are the Medicare Plans in Washington?

Orginial Medicare Part A & Part B

Original Medicare is made up of two parts:

Part A (Hospital Insurance) covers inpatient services, like hospital care, care received at a skilled nursing facility, and hospice care.

Part B (Medical Insurance) covers outpatient medical services and supplies that are considered medically necessary. Part B also covers some preventive care, like flu shots and cardiovascular screenings.

It’s important to recognize that Original Medicare does not cover everything. For example, it generally does not cover prescription medications, hearing exams/hearing aids, long term care, dental care, or eyeglasses. That’s why there is a wide variety of different types of Medicare plans available, to help obtain a more comprehensive coverage.

Medicare Advantage Plans   (Part C)

Medicare Advantage plans are provided by Medicare-approved private insurance companies and work as an alternative to Original Medicare (Parts A and B). These plans must provide the same coverage as Original Medicare (with the exception of hospice care, which remains covered by Part A). They can also provide additional benefits, such as dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.

To enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Premiums for these plans can start at $0, increasing with the level of coverage selected. You’ll need to continue paying your Part B premium in addition to your Part C premium.

Read more about Medicare Advantage plans here »

Medicare Prescription Drug Plans (Part D)

Prescription Drug coverage is generally not covered by Original Medicare or Medigap Plans. Stand-alone Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare (Parts A and B) to add prescription drug coverage. With these plans, a tier system is used to grade medications, and copays/coinsurance for each medication are set in accordance with their tiers. Drugs graded in the lowest tiers have the lowest copays/coinsurance, and vice versa. Each plan provides a drug formulary for you to see which tier(s) your medications fall into. This allows you to compare plans and select one with the best overall value for your specific prescription needs.

Read more about Medicare Prescription Drug Plans here »

Medicare Supplement Plans (Medigap)

Medicare Supplement plans add an additional layer of coverage to your Original Medicare by filling in coverage gaps. Medigap plans are provided by Medicare-approved private insurance companies and work alongside your Original Medicare to help reduce your out-of-pocket costs by paying certain healthcare costs, like copayments, coinsurance, and deductibles.

Learn more about Medicare Supplement Plans here »

When Can I Enroll In A Plan?

Medicare Advantage and Medicare Prescription Drug Plans

The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month period begins at the start of your 65th birthday month, assuming you’ve enrolled in Medicare Part B. Otherwise, your Medigap Open Enrollment Period would start the same month as your Medicare Part B coverage.

Important Note: You are guaranteed the Medigap plan of your choice if you enroll during this period. But if you don’t enroll within this period, you could be charged higher premiums or be denied coverage entirely.

Medicare Initial Enrollment Period

7-Month Initial Enrollment Period  |  Begins 3 months before the month you turn 65

*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.

KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.

Medicare Supplement Plans

Once you’ve enrolled in both Medicare Part A and B, you can select the Medigap plan of your choice during your Medigap Open Enrollment Period. The enrollment period is a 6-month period that begins the month you are both 65 or older and enrolled in Medicare Part B.

Important Note: If you fail to enroll in a Medigap plan during your Medigap Open Enrollment Period, you’re subject to higher premiums or denial of coverage entirely.

Special Enrollment Periods

Some major life changes, like moving into a new coverage area or transferring to or from a care facility, are qualifying life events for a Special Enrollment Period (SEP). A Special Enrollment Period allows you to enroll or make changes to your coverage outside of the standard enrollment times. Our licensed insurance agents can help determine your eligibility for a Special Enrollment Period.

How Can I Compare Plans?

MedicareMatchup provides a convenient way to explore the many Medicare plans available in Maryland to find the coverage you need. By working with trusted partners, we’ll help you find coverage that best suits your particular needs.

If you’re unsure about your eligibility or will be turning 65 within six months, we can give you some guidance and help you prepare for enrollment. Give us a call today or get plan information online using our simple form below.

Additional Medicare Resources in Washington

The Statewide Health Insurance Benefits Advisors (SHIBA) is part of the insurance commissioner’s consumer protection services. SHIBA provides free, unbiased, and confidential assistance with Medicare and health care choices.

Washington’s Medicare Savings Program is available to Medicare beneficiaries in Washington that have little or no income to help pay for Medical expenses, like premiums and deductibles.

Sources: Medicare.gov; www.insurance.wa.govwww.dshs.wa.gov