Medicare plays a key role in providing health and financial security to beneficiaries residing in Washington. With more than 1.3 million Washington beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Washington. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Washington?

Medicare covers most Washington residents who are 65 or older, and it also covers disabled Washington residents. In general, Medicare enrollment in Washington works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Washington Medicare Enrollments

882,369

Original Medicare Plans
(Part A and B)

506,037

Medicare Advantage & Other Health Plans

479,431

Stand-alone Medicare
Part D (Drug plans)

1,388,406

Total Medicare Beneficiaries
in Washington

Washington Medicare Advantage Plans (Part C)

More than 34% of Washington Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Washington who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 506,037 beneficiaries enrolled in Medicare Advantage and other plans in Washington. More than 34% of Washington Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 140 Medicare Advantage plans are available in Washington. The average monthly Medicare Advantage premium changed from $48.56 in 2019 to $42.48 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Washington. In 2020, 30 of Washington’s 39 counties have Medicare Advantage plans available for purchase. Depending on the county, Medicare Advantage plan availability ranges from just one plan to 43 plans.

Washington Medicare Supplement (Medigap) Insurance Plans

Washington’s pre-ACA high-risk pool WSHIP provides opportunities for beneficiaries who are unable to qualify for Medigap plans and who don’t have access to Medicare Advantage.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

There are currently 25 insurers licensed to sell Medigap plans throughout Washington. Washington is one of eight states where Medigap insurers are required to use community rating for beneficiaries 65 and older (see Washington statute RCW 48.66.045).

Along with community-rating requirements, Washington state law also provides Medigap beneficiaries the option to switch to a different Medigap plan at any time, guaranteed-issue. Washington also enacted legislation that limits the pre-existing condition waiting period for Medigap beneficiaries.

Since there are nine counties in Washington where there aren’t Medicare Advantage plans available at all, WSHIP, or the Washington State Health Insurance Pool, serves as an option for disabled Medicare beneficiaries.

Washington Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 479,431 Medicare beneficiaries in Washington enrolled in stand-alone Part D prescription drug plans and 451,994 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in Washington, with premiums ranging from about $15 to $117 per month. About 26% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS). When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Washington

  • Washington’s SHIBA program provides free, unbiased, and confidential help with Medicare and health care choices to people of all ages and backgrounds. The volunteer advisors, located around the state, can help you: Assess health care coverage needs; determine general eligibility for health care coverage programs; evaluate and compare health insurance plans and programs; provide enrollment help with Medicare; speak with 1-800 Medicare on your behalf; make referrals to other agencies and programs, and collect and report possible fraud complaints.
    Contact: Call 1-800-562-6900 or email the organization. You can also consult this list of local SHIBA offices.

  • The Washington State Health Advocacy Association (WASHAA) is a nonprofit organization made up of healthcare professionals, patients, community members, and many others, who are dedicated to promoting health advocacy in Washington State, empowering patients and improving healthcare outcomes.
    Contact: Locate your local health advocate or call the organization at 1-206-377-3000.

  • The Washington Office of the Insurance Commissioner serves as an advocate for Medicare beneficiaries and educates the public about access to insurance and medical care. Through this resource, seniors can learn how health insurance works, get information regarding their coverage options and out-of-pocket costs, and receive free, unbiased Medicare counseling in their area.
    Contact: Call 1-360-725-7080 or 1-800-562-6900 on weekdays during normal business hours. You can also send a message through the office’s website.

  • AdvoConnection Directory provides access to independent health and patient advocates, care managers, elder care advocates, medical billing advocates, legal and other forms of independent guidance to help you or your loved ones manage those many health care challenges.
    Contact: To locate an advocate near you, visit the AdvoConnection website, and provide your zip code and the services you need. Once the results are provided, you can review their options and contact advocates directly for more information.

  • The Washington Association of Area Agencies on Aging (W4A) is a membership organization made up of the leadership from the thirteen Area Agencies on Aging in the State of Washington. W4A’s mission is to advocate at the local, state, and federal level for services and supports that enhance the lives of seniors and adults living with disabilities. The association works to further the effectiveness of each local AAA by working with community partners in order to strengthen advocacy efforts, share information, and enhance the work of staff and caregivers in supporting clients to live independently in their homes.
    Contact: Call 1-360-485-9761 or email w4a@agingwashington.org.

  • The National Aging and Disability Resource Center Program (ADRC), is a collaborative effort of the Administration for Community Living (ACL), the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health Administration (VHA), and is designed to streamline access to home and community supports and services for consumers of all ages, incomes, and disabilities, and their families. ADRC’s local centers increase awareness of the options that are available to seniors, including insurance programs like Medicare Advantage.
    Contact: Services through ADRCs are provided at the county level. To find the service providers for your county, consult the state’s DSHS resources page.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Washington. Our process makes it easier for you to access your Medicare eligibility in Washington so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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