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Medicare in Washington

October 6, 2016

Medicare beneficiaries in the state of Washington may be eligible for a number of important health benefits under Original Medicare, Part A and Part B, including medical insurance and hospital insurance. In Washington, as in other U.S. states, Medicare beneficiaries may have other choices beyond Original Medicare. These Medicare plan options are discussed below. Please be aware that not every plan may be available in every part of Washington.

As a Medicare beneficiary in Washington, you may be interested in taking a quick look at the kinds of Medicare coverage that may be available to you.

Original Medicare for Washington beneficiaries

Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). To qualify for Original Medicare, you must be a citizen of the United States, or a legal resident of at least 5 years in a row, and be 65 years or older. Some people under 65 may also qualify for Medicare if they receive Social Security or certain Railroad Retirement Board disability benefits.

In Washington, as in other states, you’re generally enrolled in Medicare Part A and Part B automatically if you’re receiving Social Security or Railroad Retirement Board benefits when you turn 65.

If you’re not automatically enrolled, you can sign up for Original Medicare during the seven-month period that generally begins three months before the month you turn 65, including the month you turn 65 and ending three months after the month you turn 65.This is the seven-month Medicare Initial Enrollment Period (IEP). If you qualify for Medicare because of a disability, your IEP may start three months before your 25th month of receiving disability benefits, and last for three months after that month.

If you don’t sign for up Original Medicare during your IEP, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late-enrollment penalty in the form of higher premiums.

In general, enrollment in Medicare Part A costs nothing for qualifying people who worked at least 10 years (40 quarters) and paid Medicare taxes during that time (or whose spouses did), but others may have to pay a premium. As a Medicare beneficiary in Washington, you’re generally eligible for the following benefits under Medicare Part A:

  • Hospital care
  • Skilled nursing facility (SNF) care
  • Nursing home care (non-custodial)
  • Hospice care
  • Home health services

Medicare Part B is medical insurance, and most people have to pay a monthly premium for it. You may also have to pay an income-related monthly adjustment fee if your income is higher than a certain limit. Medicare beneficiaries in Washington, like Medicare beneficiaries in other states, may receive benefits under Medicare Part B such as the following (this is not a complete list):

  • Ambulance services
  • Durable medical equipment
  • Mental health services (inpatient, outpatient, and partial hospitalization)
  • A second opinion before surgery
  • Limited outpatient prescription drugs

Please note that coverage of these items and services is subject to Medicare approval, and limitations and restrictions may apply.

Medicare plan options in Washington

You may have a few different options as a Medicare beneficiary in Washington.

You may be able to receive your Original Medicare (Part A and Part B) benefits through a Medicare Advantage plan. Offered by private, Medicare-approved insurance companies, Medicare Advantage plans cover the same hospitalization and medical benefits offered by Original Medicare, except for hospice care, which Part A still covers. Some Medicare Advantage plans offer additional benefits such as routine vision, hearing, and dental coverage.

Many Medicare Advantage plans in Washington also include prescription drug coverage. These plans, known as Medicare Advantage Prescription Drug plans (MA-PDs), combine health and prescription drug coverage into one insurance plan. You still need to pay your monthly Part B premium, in addition to any premium your Medicare Advantage plan may charge.

If you decide to stay with Original Medicare, another option you may have is to sign up 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.

If you’re seeking prescription drug coverage, you may want to consider a stand-alone Medicare Part D Prescription Drug Plan. Available from private health insurance companies that contract with Medicare, these plans are designed to help Medicare beneficiaries cover prescription drug costs. Availability and costs for each Medicare Prescription Drug Plan in Washington may vary; your plan may require you to a pay a monthly premium, annual deductible, and copayment or coinsurance.

A resident of Seattle in King County may have different Medicare plan offerings than a resident of Spokane in Spokane County, so you may want to customize your search for Medicare plans based on your individual health and prescription needs. You’re welcome to enter your zip code where indicated on this page to start comparing plans.

Washington resources for Medicare beneficiaries

There are a number of resources designed to help Washington Medicare beneficiaries with Medicare-related issues and concerns. Here are some resources that may be helpful:

Learn more about how Medicare plans work in Washington including:

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