Medicare in Washington - Compare Plan Options
Residents of Washington who are either 65 years old or have a qualifying disability are eligible to receive medical insurance through Medicare, a federal program. The coverage provided by Medicare benefits over 1.4 million individuals in Washington.
Medicare Plans in Washington
In Washington, Medicare plans offer different coverage levels based on your health needs and lifestyle. Original Medicare may not cover all expenses for those with multiple health conditions or disabilities, resulting in higher out-of-pocket costs. Medicare Advantage provides comprehensive care, while a Medigap plan can fill the remaining gaps for maximum coverage.
Here are the five types of Medicare plans in Washington:
Original Medicare (Parts A & B)
Washington’s Medicare program builds upon the foundation of Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance). Part A is generally premium-free to individuals who have worked and contributed to Medicare taxes for at least ten years. On the other hand, Part B requires a monthly premium determined by income. While Original Medicare covers a wide range of healthcare services, it does not include certain benefits, such as prescription drug coverage.
Medicare Advantage (Part C)
Medicare Advantage (MA) plans in Washington, approved by Medicare, are offered by private insurers. These plans provide the same benefits as Original Medicare and may offer additional coverage for prescription drugs, vision, dental, and hearing. MA plans generally have lower out-of-pocket costs compared to Original Medicare. There is an extensive selection of Medicare Advantage plans in Washington, so it’s important to thoroughly compare the available options and select the one that best meets your needs.
Medicare Supplement Insurance (Medigap)
Private insurers offer Medigap plans in Washington to fill the coverage gaps left by Original Medicare. These plans provide coverage for deductibles, co-payments, and coinsurance. Ten standardized Medigap plans are available, ranging from Plan A to Plan N. Among beneficiaries, Medigap Plan G is the popular choice. The government ensures that the benefits of every plan are standardized, regardless of the insurance company chosen. Along with the premium for your Original Medicare, you must also pay a monthly premium for a Medigap policy.
Medicare Prescription Drug Plans (Part D)
Residents of Washington covered under Original Medicare do not have prescription drug coverage. However, they can enroll in a standalone Medicare prescription drug plan offered by approved private insurers to obtain this coverage. These plans come with a formulary, which is essentially a list of drugs that are covered. Choosing a plan carefully is essential, ensuring it includes your required medications. Please note that formulary changes may take place on an annual basis.
Special Needs Plans (SNPs)
In Washington, there are Medicare Advantage plans known as Special Needs Plans (SNPs) specifically designed to cater to individuals with specific chronic conditions or those requiring specialized care, such as those with Medicare and Medicaid. SNPs are available in three types: Chronic Condition SNPs, Dual Eligible SNPs, and Institutional SNPs. It’s important to note that the availability of SNPs may vary by location in Washington, and not everyone is eligible for these plans.
Medicare Eligibility in Washington
In Washington, Medicare benefits are available to individuals aged 65 and older, younger individuals with disabilities, and those diagnosed with End-Stage Renal Disease (ESRD.
To qualify for Medicare in Washington, you need to meet the national standards set by the Social Social Security Administration (SSA). This includes working in jobs with Medicare tax requirements for at least ten years as a U.S. citizen or permanent resident. Once you turn 65, you can apply for Medicare benefits. You must have lived in the United States for five consecutive years before applying.
Individuals younger than 65 may be eligible if they have received Social Security disability benefits for at least 24 months or have ESRD. Individuals with ESRD must also meet residency requirements to be eligible.
In addition to meeting specific eligibility requirements, applicants must apply for Medicare coverage before their 65th birthday or within three months after their disability begins to avoid late enrollment penalties. Applicants can use the Social Security website or visit a local office for assistance and advice.
About cost, if you are not eligible for automatic qualification for Part A, you might have to pay as much as $506 per month (as of 2023). The Part B standard premium is $164.90 monthly (as of 2023), but your premium could be higher if you have a higher income.
How Do I Apply for Medicare in Washington?
Applying for Medicare in Washington is an easy process. You can apply online or by phone.
If you apply online, you must visit the Social Security Administration website and complete an application. The website includes a helpful tutorial that walks you through the process step-by-step. Once your application has been submitted, completing the process typically takes less than 10 minutes.
If you prefer to apply over the phone, call 1-800-772-1213 (TTY users should call 1-800-325-0778).
As you can see, each plan type has unique features and benefits. Although choosing the right plan may seem overwhelming, take the time to do some research, ask questions, and determine which plan aligns with your healthcare needs and budget.
Washington Medicare Resources
Residents of Washington are encouraged to explore the Medicare options available to them. The state offers a variety of resources for seniors and caregivers, such as Area Agencies on Aging, local public health agencies, and nonprofit groups. These organizations provide valuable information and programs to enhance the well-being of seniors.