Medicare in Washington

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Overview of Medicare in Washington

Are you one of the more than 1.7 million Medicare beneficiaries residing in Washington and curious (or perhaps even a little overwhelmed) about how Medicare coverage works? As a Medicare beneficiary, you can choose from a variety of Medicare coverage options in Washington.

To start, there’s Original Medicare, Part A and Part B, coverage. Original Medicare is the health insurance program administered by the federal government. Regardless of where you live in the United States, you’re eligible for Medicare if you’re 65 or older and either an American citizen or a permanent legal resident who has lived here at least five continuous years. You may also be eligible for Medicare if you are younger than 65 because of a disability or certain health conditions, such as end stage renal disease (permanent kidney failure requiring a kidney transplant or continuous dialysis treatments) or amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

Typically, most people get Medicare Part A without a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes; otherwise, you may owe a premium for your Part A coverage. Most Medicare beneficiaries pay a premium for Part B coverage, along with any deductibles, copayments, and coinsurance costs that come with Medicare Part A and Part B coverage.

Original Medicare is made up of two parts: Part A and Part B.

  • Medicare Part A covers inpatient hospital stays, post-hospitalization skilled nursing facility care, some post-hospitalization home health care, and hospice care.
  • Medicare Part B covers outpatient services, including doctor visits, certain disease prevention screenings and exams, lab tests and X-rays, durable medical equipment, physical therapy and some home health care services.

If you are already enrolled in Original Medicare, you are probably aware that it does not cover all of the services you may need. For example, Original Medicare does not cover:

  • Most prescription drugs you may take at home
  • Custodial long-term care and services in a nursing home
  • Health-care services or items you receive outside the United States
  • Routine dental care and dental items, such as dentures
  • Routine vision care and eye wear, such as glasses.

You may have also noticed that deductibles and coinsurance amounts can be fairly steep, especially if you experience a prolonged stay in the hospital or skilled nursing facility or multiple hospitalizations during the year.

If you stay with Original Medicare, you may want to explore the option of applying for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. You can find out more about private insurance companies that offer Medigap policies by using the eHealth Plan Finder located on this webpage.

You may also be interested in getting Medicare Part D prescription drug Coverage as a complement to your Original Medicare (Part A and Part B) coverage. In Washington, as in the rest of the country, Original Medicare beneficiaries have the option of enrolling in a stand-alone Medicare Part D Prescription Drug Plan (PDP) to help pay for their prescription drug costs. These are separate Medicare plans, available through Medicare-approved private insurance companies, which can work alongside your Original Medicare coverage. Or, as another way to get your Medicare Part D coverage, you can instead choose to enroll in a Medicare Advantage plan that includes prescription drug coverage. You can find Medicare plan options that cover prescription drugs where you live by using the e-Health plan finder.

As an alternative to receiving your Original Medicare coverage, you may have access to a Medicare Advantage plan (Medicare Part C) in Washington. Private insurance companies approved by Medicare offer Medicare Advantage plans. Medicare requires Medicare Advantage plans to provide at least the same level of coverage as Original Medicare. However, many Medicare Advantage plans cover more than Original Medicare, which makes them an attractive option to many beneficiaries.

Additional benefits offered by many Medicare Advantage plans may include routine dental and vision care, hearing devices, wellness programs, and prescription drug coverage. Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug (MA-PD) plans; these plans can provide you the convenience of having your Medicare medical and prescription drug benefits through one plan.

Medicare also requires that Medicare Advantage plans limit the annual out-of-pocket costs enrollees must pay for Medicare covered services. Once this cap is reached, the Medicare Advantage plan pays 100% of the cost for most Medicare-covered services for the rest of the year.

If you’re interested in enrolling in a Medicare Advantage plan, you must:

  • Have Medicare Part A and Part B.
  • Live in the Medicare Advantage plan’s service area.
  • Not have end-stage renal disease (unless you meet certain exceptions).

Keep in mind that, generally, Medicare Advantage members must continue to pay their Medicare Part B premium and may also be required to pay an additional premium directly to their Medicare Advantage plan.

If you’re ready to compare Medicare plan options where you live, the eHealth plan finder tool makes it easy to do so. Simply type your zip code into the tool on this webpage to get started.

Medicare resources in Washington

Washington Aging and Long-Term Support Administration: Washington has established the Aging and Long-Term Support Administration (ALTSA) to serve the aging population and disabled adults who live in the state. With their strategic planning and direction, they oversee programs and services to help improve the health-care services to those with chronic illnesses and conditions. Aging adults enrolled in Medicare can benefit from the Medicare/Medicaid Integration Project in Washington, which helps improve the quality of care and reduces waste and expenses. A few of the programs sponsored by ALTSA include:

  • Adult Day Health Program
  • Family Caregiver Support Program
  • Specialized Dementia Care Program

King County Aging and Disability Services: Washington Medicare beneficiaries living in Seattle and the surrounding area can find help from the King County Aging and Disability Services (ADS), which also acts as the Area Agency on Aging (AAA). The ADS works to foster a community that provides better health-care choices, promotes independence, and endorses a better quality of life for seniors. The ADS focuses on meeting the needs of the aging and disabled through planning and developing new programs, providing direct services, and even promoting new health legislation.

Statewide Health Insurance Benefits Advisors (SHIBA): The Statewide Health Insurance Benefits Advisors (SHIBA) is part of the Washington State Insurance Commissioner’s consumer protection services. SHIBA offers free, unbiased, and confidential counseling services to Washington Medicare beneficiaries. Counseling is provided by highly trained volunteers, who are typically seniors who have are enrolled in Medicare plans themselves. SHIBA can help Washington Medicare beneficiaries understand their coverage, plan options, and rights when it comes to Medicare. Counselors can offer advice if fraud or abuse is suspected.

Medicare statistical trends in Washington

If you’re a beneficiary in Washington, you may be wondering about current Medicare trends in your state. Here is some statistical information on Medicare coverage in 2015, according to the Centers for Medicare & Medicaid Services*:

  • 819,681 Washington beneficiaries were enrolled in Medicare Part A and/or Part B.
  • There were 356,870 Washington beneficiaries enrolled in a Medicare Advantage plan.
  • 735,723 beneficiaries enrolled in Medicare Part D prescription drug coverage in Washington.
  • Of those who had Medicare Part D, 427,326 beneficiaries enrolled in a stand-alone Medicare Prescription Drug Plan, while 308,397 beneficiaries got Part D coverage through a Medicare Advantage Prescription Drug plan.

Please note the following interesting facts about Medicare coverage in the state of Washington in 2016*:

  • There are 83 Medicare Advantage plans available in Washington.
  • 95.3% of Medicare beneficiaries residing in Washington have access to at least one Medicare Advantage plan.
  • There are 26 Medicare Prescription Drug Plans available in Washington.
  • 84% of people with Medicare Part D have access to a plan with a lower premium than what they paid in 2015.
  • The lowest monthly premium for a Medicare Prescription Drug Plan is $18.40.
  • 29% of beneficiaries in Washington with Medicare Part D get Extra Help (also called the low-income subsidy, or LIS)

*Sources Used:
Statistical data from the Centers for Medicare & Medicaid Services, “On its 50th anniversary, more than 55 million Americans covered by Medicare” as of July 28, 2015; and “2016 MA Part D Landscape State-by-State Fact Sheet” as of September 21, 2015.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.


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