Medicare Advantage Plans in Washington

Washingtonians have many options when it’s time to choose a Medicare Advantage plan. A Medicare Advantage plan in Washington provides Part A and Part B benefits administered by a private insurance company. Most Medicare Advantage plans in Washington provide more than Part A and Part B benefits, including prescription drug coverage (Part D), dental, vision and hearing. Medicare Advantage plans and the cost of each vary across Washington. Medicare Advantage plans in Washington cover everything Original Medicare covers, plus additional services like dental care and hearing aids.

Anyone age 65 and older or eligible for Medicare based on disability has the option to choose a Medicare Advantage plan to receive Part A and Part B benefits. In 2023, 159 Medicare Advantage plans are being offered in Washington. However, not every plan is available in every part of the state. Availability depends on the insurance company offering the plan and where you live.

Part A and Part B benefits cover most of your inpatient and outpatient medical care. This can include wellness visits, examinations in your doctor’s office or therapy sessions. Medicare Parts A and B cover these general areas of care, but a prescription medication plan (Part D) is an optional add-on. However, Medicare Advantage plans may include Part D coverage and other services, including:

• Dental care
• Hearing aids
• Medical transportation
• Lab testing
• Home medical equipment and supplies

The federal Centers for Medicare & Medicaid Services set rules on who is eligible and what Medicare Advantage plans include, but different states may have additional rules, too.

The average cost of a Medicare Advantage plan in Washington 2023 is $30.50 per month, but 98% of residents have access to a plan with a $0 premium.

The cost of Medicare Advantage plans in Washington varies based on where you live and the type of coverage you need. You can find plans in your area by entering your zip code at Medicare.gov, or you can contact a licensed insurance agent like those at GoHealth to help you find the right plan for your needs.

Your costs will also depend on rules set by your individual plan. For example, Medicare Advantage plans in Washington use a designated provider network to deliver healthcare services within a specific area. If you have Part A and pay a Part B premium, you have the option to enroll in a Medicare Advantage plan. In most cases, you have a choice of plans available that fit a variety of needs and budgets.

To be eligible to enroll in Medicare Advantage, you must meet the general Medicare eligibility requirements. Also, you must be enrolled in Part A and Part B before you can enroll in a Medicare Advantage plan.

Medicare is available to:

• people who are over age 65
• people with end-stage renal disease (ESRD)
• people with amyotrophic lateral sclerosis (ALS)
• people with disabilities who qualify for Social Security

Medicare has specific enrollment periods to add or switch coverage. If you’re new to Medicare, you can sign up for Medicare in the three months before or after your 65th birthday or after you have been receiving disability benefits from the Social Security Administration for at least 24 months.

If you are interested in enrolling in a Medicare Advantage plan, it may be best to consider this option when you first enroll in Medicare. Whether you opt to enroll in Original Medicare and add a Part D prescription plan, or choose a Medicare Advantage plan with prescription coverage, it’s usually a good idea to start prescription drug coverage immediately.

If you wait to sign up for a Part D plan, a late enrollment penalty will be added to your Medicare premium for the rest of your life, and this penalty is based on how long you were eligible for a prescription plan but chose not to enroll.

To avoid penalties and get the most from Medicare benefits, here are important dates to remember for Medicare Advantage enrollment:

• Medicare’s Open Enrollment Period for all Medicare coverage: October 15 to December 7
• Medicare Advantage Open Enrollment Period only for Medicare Advantage enrollees: January 1 to March 31

Special enrollment periods are also available based on certain circumstances, like a new disability, changes to your eligibility, or a move to an area where your current plan isn’t offered.

Yes. Most Medicare Advantage plans offer prescription drug coverage (Part D). Similar to the provider network, Medicare Advantage Part D plans are part of a pharmacy network specific to the plan you choose. Whether or not you include prescription drug coverage in your Medicare Advantage plan is up to you. Most states offer options with and without drug coverage.

Without a Part D plan added to your Medicare Advantage coverage, you should expect to pay the entire cost of your outpatient prescription medications. You may add Part D coverage to your plan at any time, but if you don’t sign up when you are first eligible, you will have to pay a penalty for the rest of your life. This penalty will be added to your regular monthly premium.