Medicare in Washington

Resources for Washington Medicare Beneficiaries 

Researching Medicare’s many features, enrollment windows, and advice on selecting a Medicare plan? Check out Healthpilot’s Medicare resources. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Guidance is helpful when deciding on Medicare coverage options. The State Health Insurance Program (SHIP), also known as Washington’s Statewide Health Insurance Benefits Advisors (SHIBA), is one of the many services available to you as a resident of Washington. Across the state of Washington, SHIBA has consultants working in tandem with non-profits, government agencies, and Area Agencies on Aging (AAA) to disseminate Medicare education and information. 

Medicare Plan Options in Washington  

Washingtonians have multiple Medicare plan options. Original Medicare is for persons 65+ or with a qualifying disability. If you need more comprehensive coverage, you may look at choosing a Medicare Advantage plan. You may also want to consider prescription drug coverage and/or Medicare Supplement Insurance for your Medicare coverage. 

Original Medicare (Parts A & B)  

Original Medicare is the core program of Medicare. It has two parts: Medicare Part A, which covers hospital insurance, and Medicare Part B, which covers medical insurance. Part A of Medicare covers hospital stays, stays in skilled nursing facilities, home health care, and care for people in hospice. Medicare Part B covers doctor visits, outpatient care, lab tests, and preventive services like cancer screenings, flu shots, and a wellness visit once a year.  

Things to keep in mind if you want to keep Original Medicare: 

• Original Medicare in Washington is a great choice if you want to be able to choose doctors and hospitals anywhere in the U.S. that accept Medicare. 
• There are no networks, copays, waiting periods, or restrictions based on pre-existing conditions. 

Medicare Advantage (Part C)  

Medicare Part C, also known as Medicare Advantage plans, is a private insurance company-provided alternative to Original Medicare coverage. These plans cover, at a minimum, what Medicare Parts A and B would, and they frequently include additional benefits. Most services are administered by a network of providers, which may require you to have a primary care physician, a referral to see a specialist, and prior approval for certain services, treatments, and medications, similar to a Health Maintenance Organization (HMO) plan. Other insurance products available include a Preferred Provider Organization (PPO), HMO-POS (a hybrid model of an HMO and a PPO), and a Private Fee for Service (PFFS) plan. 

Medicare Advantage plans in Washington often provide more comprehensive coverage. Explore our Medicare Part C Resource Page to learn more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

The advantage about Medicare Part D, AKA prescription medication coverage, is that you can find it in some, if not most, Medicare Advantage (Part C) plans. And if it’s not currently included, you may add a stand-alone Prescription Drug Plan (PDP) to your Original Medicare (or a Medicare Supplement Insurance policy). Private Medicare-approved insurers companies offer Part D coverage. Each covered prescription may have a deductible, copay, or coinsurance, depending on the plan’s formulary.  

Medicare Supplement Insurance (Medigap)  

Some Medicare-eligible Washington residents purchase Medigap, also known as Medicare Supplement Insurance. The purpose of these plans is to supplement gaps in Original Medicare coverage. For instance, coverage for deductibles, co-insurance for Medicare Parts A and B, and coverage for medical care outside the U.S. are examples of these “gaps”. 

Because Original Medicare does not cover all of your medical expenses, the Office of the Insurance Commissioner in Washington state provides guidelines on how Medicare Supplement Insurance coverage may reduce out-of-pocket costs. 

Be aware that Medicare Advantage is not covered by Medigap. You cannot enroll in both a Medicare Advantage Plan and a Medigap plan concurrently. If you already have a Medicare Advantage plan and wish to purchase a Medigap policy, your Medigap policy’s effective date must begin the day following the Medicare Advantage plan’s termination date.  

Medicaid 

Medicaid was established in 1965 as a government-run health care insurance program. Medicaid is jointly funded by the state and federal governments. Each state is responsible for administering its own Medicaid program in accordance with federal guidelines. This means that requirements for participation and available benefits under Medicaid can and do differ significantly between states. Children, parents, pregnant women, the elderly, and the disabled benefit from this program if qualified to make it easier for them to afford medical treatment. 

How and when to sign up for Medicare in Washington

Most Americans can sign up for Medicare once they reach the age of 65. The following events also trigger Medicare eligibility: 

• You are under the age of 65 and have received Social Security disability benefits for at least 24 months. In another case, you may be eligible for Railroad Retirement Board if you were a railroad employee. 
• You’ve been diagnosed with End-Stage Renal Disease (ESRD). 
• You’ve been diagnosed with Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Washington and nationwide  

Here is a quick overview of the Medicare enrollment periods and enrollment timeframes in which you can elect or change your Medicare Advantage plan.  

Never fear, Washingtonians. We’re almost finished. Healthpilot understands that navigating Medicare can be difficult and that adding enrollment deadlines can add stress. 

What is the most exciting news you will hear today? We’re here to sort out all of the time-consuming tasks for you. We will recommend our best plan recommendation tailored for you after you answer a few questions telling us about your healthcare needs, and you can enroll quickly and securely online. 

We will take care of this for you every year as long as you are a Healthpilot customer. Enrollment periods do not need to be kept track of when you have Healthpilot on your side. 

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Key Stats

Some facts about Medicare coverage in Washington:    

• 1,398,937 people in Washington use Medicare. This means that 18% of people have Medicare, which is just below the average of 19% for the country. 
• About 42% of Medicare recipients in Washington are enrolled in a private Medicare Advantage program. This is just below the national average of 45%. 
• In Washington, the average monthly premium for a Medicare Advantage plan went from $33.56 in 2022 to $30.50 in 2023. This means that the average premium price has decreased by 9.1%. 
• The cheapest premium for a stand-alone Medicare prescription drug plan in Washington costs $1.60 per month. 
• What’s a cool thing about Washington? There are still a few strange laws in place. Did you know it’s against the law to spit on a bus, paint polka dots on the American flag, pretend that your parents are rich, or in Everett it’s illegal to put a hypnotized person in a store window? Oh, Washington! 

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