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Medicare in Washington

Washington residents 65 and older are eligible for affordable insurance

Reviewed by: Eboni Onayo, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • U.S. citizens age 65 or older qualify for Medicare in Washington.

  • The state’s Medicaid program assists residents facing financial need or a disability regardless of their age. It’s possible to be on Medicaid and Medicare in Washington at the same time.

  • GoHealth licensed insurance agents are licensed in the state of Washington to help you navigate Medicare resources.

 

I cannot tell a lie: Washington is the only state named for a U.S. President, and it produces more cherries than any other state.

But while the myth of George Washington chopping down a cherry tree in his youth isn’t dangerous, Medicare myths can be hazardous to your health.

GoHealth is here to make sure your understanding of Medicare in Washington is beyond reproach.

How do I apply for Medicare in WA?

If you are a U.S. citizen approaching age 65 or already there, you are eligible to apply for Medicare coverage:

  • You can apply for Medicare in Washington online with the Social Security Administration [1] , by visiting a Social Security office in Washington [2] or by calling 1-800-772-1213 (TTY: 1-800-325-0778).

So how exactly do you enroll in Medicare?

 

Original Medicare

The starting point for health insurance at 65 is Original Medicare, featuring Part A (“hospital insurance”) and Part B (“medical insurance”). If you enroll in both parts, you can choose to enroll in Part D, which is drug coverage administered by private insurance companies under federal guidance. Medigap also is an option; it is supplemental insurance, also issued by private companies, that helps control out-of-pocket costs for people with Parts A and B.

 

Medicare Advantage

Medicare Advantage is private insurance approved by Medicare to meet all of the needs mentioned above while also offering things like dental and vision coverage.

Who Qualifies for Medicaid in Washington State?

Each state has its own plan for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need and/or disability regardless of age.

Washington’s robust program, administered by the Washington State Health Care Authority, also includes oversight of Medicare Savings Programs in the state and includes coverage options for various groups like noncitizens and foster parents along with a variety of eligibility rules and income limits. [3]

Is Washington Apple Health covered by Medicare?

Apple Health is the name given to the Medicaid program administered by the state of Washington.

While Medicare and Medicaid cover similar things, Medicare is primarily designed for Americans age 65 and older, while Medicaid is mostly for those facing financial hardships or a disability regardless of age. That being said, it is possible for residents researching Medicare plans in Washington to be dually eligible for Medicare and Medicaid.

What is the Income Limit for Medicaid in Washington State?

Different programs offered by Medicaid in Washington feature different income limits for eligibility.

One of the most common situations involves Medicaid coverage for long-term care assistance when a person’s financial resources begin to dwindle. The American Council on Aging offers detailed information regarding Washingtonians’ eligibility in varying situations related to Medicaid and long-term care. [4]

What are the Different Medicare Plans Available?

If you’re talking about Original Medicare in Washington, there’s only one plan — Parts A and B, which does open the option to add Part D and Medigap coverage from private insurance companies.

If you’re talking about Medicare Advantage in Washington — also known as Part C — there are many plans.

  • Some Medicare Advantage plans mirror Original Medicare but are more affordable.
  • Some Medicare Advantage plans include options for dental, vision and hearing coverage.
  • Some Medicare Advantage plans offer assistance with transportation costs or over-the-counter needs.
  • Some offer all of the above.

Original Medicare is simple. Medicare Advantage offers a variety that can be overwhelming. Still, it’s simple for a dedicated GoHealth licensed insurance agent to review your situation and figure out what Medicare Advantage plan is the right fit for your specific situation.

Which Company has the best Medicare Advantage Plan?

The Centers for Medicare & Medicaid Services has a Medicare Star Rating system that assigns a rating of up to five stars to individual Medicare Advantage plans, and Medicare Advantage beneficiaries even are offered the opportunity to switch once a year to a five-star plan.

While the rating system can shed light on Medicare Advantage plans’ performance, it’s not as easy as just picking the highest-rated plan. A GoHealth licensed insurance agent, without obligation, can help you compare plans and find the one that’s the right fit for you, all things considered.

Medicare in Washington by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,233,069 people are enrolled in Medicare in Washington. The total number of beneficiaries enrolled in Medicare Advantage in Washington is 447,669. The previous year, 413,042 enrolled in Medicare Advantage. Medicare Advantage participation in Washington went from 34.52% to 36.31% year over year. If you’d like to dive deeper into how Medicare in Washington breaks down across the state, we provide a glance at who is using Medicare, and how.

1,233,069
Beneficiaries with Part A & Part B
447,669
Medicare Advantage Beneficiaries
36.31%
Medicare Advantage Participation Rate
53.33%
% Female
46.67%
% Male
0.91
Average HCC Score
$9,006.04
Actual Per Capita Costs
17.33%
% Eligible for Medicaid
29.50%
% of Beneficiaries with an Emergency Department Visit
15.67%
Hospital Readmission Rate
85.46%
% Non-Hispanic White
2.35%
% African American
3.80%
% Hispanic
8.39%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Washington Medicare Resources & Contacts

Beneficiaries spend an average of $9,006.04 each year on Medicare in Washington. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Washington-based resources, like these, may be able to help:

Statewide Health Insurance Benefits Advisors (SHIBA)

1-800-562-6900

https://www.insurance.wa.gov/about-shiba-services

What should I know about SHIBA?

The renowned branch of the Office of the Insurance Commissioner offers free and confidential Medicare advice to all ages.

Washington State Department of Social and Health Services (DSHS)

1-877-501-2233
Phone lines open M-F, 8 a.m. to 5 p.m.

https://www.dshs.wa.gov/node/71

What should I know about the Washington State DSHS?

The state agency’s services include assisting Washingtonians apply for Medicare Savings Programs.

Washington State Health Care Authority (HCA)

1-800-562-3022 (Medicaid questions), 1-855-923-4663 (to apply)

https://www.hca.wa.gov/hca-closes-lobby-and-person-customer-services-olympia-office

What should I know about HCA?

Administers the state’s Medicaid program, called Apple Health, for Washingtonians.

Washington State Department of Veterans Affairs (WDVA)

1-800-562-2308

https://www.dva.wa.gov/about-wdva

What should I know about WDVA?

Washington veterans and their families can turn to the state agency for assistance with their healthcare benefits earned through military service.

Nationwide Resources

Speak with an insurance agent that is licensed in Washington about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in WA, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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