Medicare Advantage is private insurance that expands on the essential services offered as part of Original Medicare .
Medicare Advantage plans in Washington state must offer the same services as Medicare Parts A and B, but additional covered services can vary.
The cost of your Medicare Advantage plan in Washington will depend on the services you choose and where you live.
Washingtonians have many options when it’s time to choose a Medicare Advantage plan.
A Medicare Advantage plan provides Part A and Part B benefits administered by a private insurance company. Most plans provide additional benefits, including prescription drug coverage (Part D), dental, vision and hearing. Medicare Advantage plan availability and cost vary across Washington, so it’s important to learn about your choices before enrolling.
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Anyone age 65 and older or eligible for Medicare based on disability has the option to choose a Medicare Advantage, also called Part C, plan as a substitute for Original Medicare. In 2024, private insurance carriers offered 152 Medicare Advantage plans in Washington. Availability of specific plans depends on where you live, but everyone in the state with Medicare has access to a Part C plan.
Original Medicare, which consists of Part A and Part B, covers most of your inpatient and outpatient medical care. This can include wellness visits, examinations in your doctor’s office, or therapy sessions. A prescription medication plan (Part D) is an optional add-on administered by private insurers.
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 average monthly premium for a Medicare Advantage plan in Washington was $29.62 in 2024, but 100% 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 your individual plan. Medicare Advantage plans generally use a designated provider network to deliver healthcare services within a specific area. To take full advantage of your benefits, you will need to see providers in your plan network. Medicare Advantage plans also establish out-of-pocket maximums which may help you save on your annual healthcare expenses.
In most cases, you have a choice of plans available that fit a variety of needs and budgets.
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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
- Have end-stage renal disease (ESRD)
- Have amyotrophic lateral sclerosis (ALS)
- Have disabilities and 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 received 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.
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.
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.
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