Get the Coverage You Need with Washington Medicare Advantage Plans

Medicare is a government-run healthcare program for seniors. Known as Original Medicare, the program consists of Part A (hospital insurance) and B (medical insurance). Prescription drug coverage isn’t included. There’s also no cap on your out-of-pocket expenses.

Medicare Part C, also called Medicare Advantage (MA) plans, are offered by private health insurance companies. All MA plans are required to provide the same basic coverage as Original Medicare and most offer additional coverage. Many MA plans include coverage for prescription drugs and cap the amount you’ll pay out-of-pocket for care.

What You Need to Know

Medicare Advantage plans replace Medicare Part A and B while offering the same basic coverage.

Most MA plans provide additional benefits, like prescription drug or dental coverage.

There are two open enrollment periods a year to make changes to your Medicare Advantage plan.

What Types of Medicare Advantage Plans Are Available in Washington?

As a type of private insurance, most Medicare Advantage plans use a network of doctors and healthcare facilities to provide discounts on medical services. Common plans include:

• Health Maintenance Organization (HMO): You’ll need to use an in-network medical facility with this plan. Except in certain emergencies, you risk paying out-of-pocket for care when you use an out-of-network facility. Most HMOs require you to choose a primary care physician (PCP).
• Preferred Provider Organization (PPO): You don’t need to designate a PCP for most PPO plans. You can visit any healthcare facility you want. However, you’ll likely pay less out-of-pocket if you go to an in-network provider.
• Special Needs Plans (SNP): These plans cover specific health conditions.¹
  • Chronic Condition SNP (C-SNP): You’re eligible if you have certain medical conditions, such as diabetes or cancer.
  • Institutional SNP (I-SNP): You qualify if you live in a nursing home or similar institution, or if you need in-home nursing care.
  • Dual-Eligible SNP (D-SNP): You can use this plan if you are eligible for both Medicare and Medicaid.

• Private Fee-for-Service (PFFS): You don’t need to choose a PCP for this plan. The plan decides how much it will pay doctors and medical providers for services, as well as the amount you’ll need to pay.
• Medicare Medical Savings Accounts (MSA): This plan combines a high-deductible insurance plan with an MSA. The MSA helps you pay for out-of-pocket expenses.²

What Are Prescription Drug Options with Medicare Advantage in Washington?

Unlike Original Medicare, most MA plans cover prescription drugs. You won’t need to purchase a separate Medicare Part D plan. 

Consider the medications you take when comparing MA plans, since not all plans cover every brand of prescription drug. Check the plan’s drug formulary, or list of covered medications, to see whether your medications are included. 

How Do You Choose Medicare Advantage Plans in Washington?

To choose a Medicare Advantage plan, you need to compare the costs and benefits of plans to find the right fit. Take a look at:

• Premiums: Your monthly cost to be enrolled in the plan. This cost is in addition to the Medicare Part B premium ($144.60 for most people in 2020). You can choose a zero-premium plan to avoid the monthly cost. However, be aware that zero-premium plans could cost more in other areas like deductibles.
• Deductible: The amount you must pay before your plan starts paying for your medical care.
• Coinsurance: The percentage of a service you need to pay for out-of-pocket.
• Copay: The fixed price of medical services.
• Out-Of-Pocket Maximum: The annual maximum you’ll have to pay out-of-pocket, usually excluding premium costs.
• Plan Benefits
  • Vision: This includes services like eye exams or frames.
  • Dental: This includes services such as checkups or teeth cleaning.
  • Telehealth: This includes remote health services, such as a video office visit or a phone consultation with a specialist.
  • Additional Perks: Most plans have extra benefits, such as transportation services, fitness classes, or reimbursement for a gym membership.

When and How to Enroll in Medicare Advantage in Washington?

You can apply for a Medicare Advantage plan after enrolling in Medicare Part A and B. You’re first eligible to enroll in Original Medicare during your initial enrollment period. This is the three months before you turn 65, your birthday month, and the three months after your birthday.

If you miss your initial enrollment period, you can still sign up during the General Enrollment Period. This annual period runs from January 1 to March 31. Signing up late may trigger late penalties on your Medicare premiums.³

You can sign up for Medicare Part A and B through Social Security online, over the phone or in person at a Social Security office.

After enrolling in Medicare, you’re ready to look for MA plans. Sign up for an MA plan during one of the enrollment periods:

• Initial Enrollment Period: You can sign up for an MA plan during the same period you enroll in Medicare.
• Medicare Annual Election Period: You can join a Medicare Advantage plan each year during open enrollment from October 15 to December 7.
• Medicare Advantage Open Enrollment Period: If you already have an MA plan, you can switch plans or go back to Original Medicare each year from January 1 to March 31.
• Special Enrollment Period: Certain situations allow you to enroll in a plan outside of the normal enrollment periods, including:
  • You get coverage from a union or employer plan.
  • You’re planning to move outside of your plan’s service area.
  • You’re about to become ineligible for your current coverage, such as Medicaid.
  • Medicare is terminating your plan or it’s leaving the Medicare program.
  • You need an SNP after being diagnosed with a medical condition.

How Much Do Medicare Advantage Plans Cost in Washington?

Your Medicare Advantage plan costs will vary due to several factors. Where you live, for example, can change the cost of a plan. The average monthly cost for a 2021 MA plan in Washington is $39.34.⁴

If you sign up for a Medicare Advantage plan in Seattle, you could pay between $0 and $295 per month in premiums. In Spokane, your monthly premium might be between $0 and $223.⁵ Remember to compare costs like deductibles or copays as well.

What If You Want to Change Your Medicare Advantage Plan in Washington?

The easiest time to change your Medicare Advantage plan is during an open enrollment period. To make the change, you’ll need to apply for your new plan. Your old plan is automatically canceled when your new coverage begins.

The easiest time to change your Medicare Advantage plan is during an open enrollment period. To make the change, you’ll need to apply for your new plan. Your old plan is automatically canceled when your new coverage begins.

What Are Alternatives to Medicare Advantage in Washington?

You don’t have to sign up for an MA plan to get coverage. Other types of coverage include:

• Program of All-Inclusive Care for the Elderly (PACE): If you meet eligibility requirements, this program provides community-based medical services.⁶
• Original Medicare: You can opt for Medicare Part A and B if this is enough coverage.
• Medicare Supplement: Another type of private insurance plan, also known as Medigap. This is supplemental insurance to help with costs not covered by Original Medicare.
• Medicare Supplement with Part D: You’ll need to get a separate Medicare Part D plan for prescription drug coverage because it’s not included in Medigap policies.

What Are Medicare Resources in Washington?

• Statewide Health Insurance Benefits Advisors (SHIBA): A free service that provides unbiased counseling to help you enroll in Medicare and choose coverage.⁷
• Office of the Insurance Commissioner for Washington State: Provides resources to get answers to insurance questions, including Medicare questions.⁸
• Medicaid: A federal program that helps cover medical services for those with low income or disabilities.

State Medicare Advantage Data in Washington

Next Steps

If a Medicare Advantage plan will meet your health needs, start comparing plans so you’re prepared when you enroll in Medicare Part A and B.