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Medicare in Washington

Medicare beneficiaries in the state of Washington are eligible for a number of important health benefits under Original Medicare, Part A and Part B, including medical insurance and hospital insurance. In addition, in Washington, as in other U.S. states, Medicare beneficiaries may enroll in a private health insurance plan of their choosing under Medicare Advantage (Medicare Part C) and may receive prescription drug coverage through a private company under Medicare Part D. Remember that Medicare Advantage is required by law to offer at least the same benefits as Original Medicare. Like residents of other states, Washington residents enrolled in Medicare Advantage are covered through their individual health plan and not through Original Medicare.

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 and be 65 years or older. Some people under 65 may also qualify for Medicare if they have certain disabilities.

In Washington, as in other states, you can sign up for Original Medicare during the seven-month period that 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 don’t sign for up Original Medicare during your IEP, you can still join 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 is free 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 Washington Medicare beneficiary, you’re eligible for the following benefits under Medicare Part A:

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

Medicare Part B is medical insurance, and most people have to pay a monthly premium upon enrollment. You may also have to pay an income-related monthly adjustment fee if your income is higher than a certain limit set by Medicare. Washington Medicare beneficiaries, like Medicare beneficiaries in other states, receive the following benefits under Medicare Part B:

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

Medicare private insurance in Washington

Washington Medicare beneficiaries can sign up for Medicare Advantage plans as an alternative to their Original Medicare coverage. Offered by private insurance companies in Washington, Medicare Advantage plans cover the same hospitalization and medical benefits offered by Original Medicare. Washington Medicare Advantage plans can offer additional benefits such as vision, hearing, and dental coverage.

Many Washington Medicare Advantage plans also include prescription drug coverage. These plans, known as Medicare Advantage Prescription Drug plans (MA-PDs), combine health and prescription drug coverage into one private insurance plan.

As a Washington state resident, you also have the option to sign up for a Medicare Supplement plan (also known as Medigap plan). Medigap plans are available through private insurance companies, and they’re designed to help pay for costs you incur under Original Medicare, like copayments, coinsurance, and deductibles.

If you’re seeking a standalone prescription drug plan, you may want to consider a Medicare Prescription Drug Plan, which is private health insurance designed to help Medicare beneficiaries cover prescription drug costs. Costs for each Medicare Prescription Drug Plan in Washington vary, but most 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 it’s important for Washington Medicare beneficiaries to customize their search for Medicare plans based on their individual health and prescription needs, as well as on the county in which they reside.

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:

  • State Department of Insurance: 1-800-342-3736, website.
  • State Health Departments: 1-800-525-0127, TTY users 711, representatives available Monday to Friday, 8AM to 5PM PT, website.
  • State Health Insurance Assistance Program (SHIP): 1-800-562-6900, TTY users 1-360-586-0241, representatives available Monday to Friday, 8AM to 5PM PT, website.
  • State Hospice Organization: 1-253-661-3739, website.
  • State Medical Assistance Office: 1-800-562-3022, TTY users 711, representatives available Monday to Friday, 8AM to 5PM PT, website.

Learn more about how Medicare plans work in Washington including: