Medicare in Washington
- Discover more about Medicare in Washington state, what plans you can choose from and whether or not you need to apply for coverage.
What Washington Medicare Plans Are Available?
The Medicare program provides invaluable assistance to those that are able to utilize it. While the program is highly effective, it is also somewhat complex. Understanding the ins and outs of Medicare in Washington state can help you figure out which portion of the program is applicable for your circumstances.
Medicare offers several key components as part of the larger program construct. They are labeled as "parts."
Part A of the Medicare program is the original element of the larger plan and generally covers active, inpatient care. This includes care provided to patients in a hospital, surgical center, skilled nursing facility or hospice. It also covers home health care and some of the cost of lab work.
There are no premiums associated with Part A for those who paid into the Medicare system through payroll taxes for enough years. Those that did not pay into the system may be able to purchase it as a standalone plan.
Part B is more like traditional medical insurance in that enrollees pay a monthly premium, which is largely based on personal income. This portion of the program covers primary care visits, specialist visits, preventative care, some home health care and some types of medical equipment.
Enrollees must sign up when eligible or face a penalty of 10% for every 12 months that passes without doing so. Exceptions include those who had coverage, either through their own policy or a spouse's, that suddenly ended.
Medicare Part C is also known as Medicare Advantage Plan. This is a replacement for Parts A and B, not in addition to those parts. Medicare Advantage plans are provided by private companies. This means that the coverage spread is different; for instance, Medicare Advantage plans often cover vision and dental as well, whereas Parts A and B do not.
Medicare Advantage plans may be administered through a health maintenance organization (HMO) or preferred provider organization (PPO), and they sometimes can come in other types as well. These are the constructs to which those who have had employer-sponsored coverage are most accustomed. Medical savings accounts (MSAs) are also available through some Medicare Advantage plans.
Part D of the Medicare program is the prescription drug benefit. Similar to Part B, there is a monthly premium attached to this coverage. Penalties are also levied for late enrollment in this program, barring the same exceptions as those mentioned for Part B coverage.
All of the plans provided via Part D are from private entities.
Medigap is also known as Medicare Supplement Insurance and may provide coverage that fills in any gaps left by Parts A and B coverage. This includes helping pay for out-of-pocket Medicare costs such as Medicare coinsurance or even in-office copays. Enrollment in Parts A and B is required to be eligible for Medigap.
There are 20 companies offering Medigap coverage in Washington state, with two offering options for those under the age of 65. The state has stringent consumer protections for Medigap enrollees, such as preventing companies from implementing lengthy waiting periods based on pre-existing conditions.
Washington has also instituted community ratings that let consumers know more about the companies they choose within this program.
Who Is Eligible for Washington Medicare?
Citizens aged 65 and older are automatically eligible for Medicare coverage, as long as they have paid long enough into the system via payroll taxes. However, age is not the only factor for enrollment. The program also covers some younger individuals with disabilities and/or chronic/terminal conditions. These determinations are made by the Social Security Administration.
Social Security Administration beneficiaries are automatically enrolled as part of their larger benefits package roughly 4 months before their 65th birthdays.
How Do I Enroll in Medicare in Washington?
The enrollment period for new signups is the period that starts 3 months before the individual turns 65 and extends 3 months after their birthday. While enrollment is allowable outside of this period, enrollees may have to pay a penalty based on their personal circumstances.
General enrollment for Parts A and B runs from January 1 through March 31, with coverage starting July 1. Special enrollment periods are available as well. Traditional Medicare enrollees can sign up for a Medicare Advantage plan or Part D plan when a five-star plan becomes available. This special enrollment option can only be used one time between December 8 and November 30.
Medicare also has a fall enrollment period from October 15 to December 7, with a coverage start date of January 1. Those who suddenly lost employer-sponsored healthcare may also take advantage of special enrollment options.
Enrollees can sign up via the Social Security Administration's website at www.SocialSecurity.gov. Enrollees can also sign up via phone by calling (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m. or visiting a local Social Security office for in-person assistance.
Contact Information for Washington Medicare, Medicaid and Insurance Help
To learn more about Medicare, Medicaid and insurance options in Washington state, visit the Office of the Insurance Commissioner's website at https://www.insurance.wa.gov/learn-how-medicare-works.
The Statewide Health Insurance Benefits Advisors (SHIBA) resource is another option to learn more about the plans available for consumers. This group also provides unbiased advice about plan choices and advocates that can assist with sign-up or claims. To reach a SHIBA representative, consumers can call (800) 562-6900.