Medicare beneficiaries can enhance their health insurance with a Medicare Advantage plan in Washington State. Medicare Advantage plans must include all coverage offered by Original Medicare, and most include added benefits like prescription drug plans and coverage for dental and vision services. Beneficiaries who want all of their health coverage in one plan for convenience are well suited for a Medicare Advantage plan in Washington State for 2022.
What is Medicare Advantage in Washington State?
Washington State Advantage plans extend Medicare coverage for beneficiaries who want additional benefits like gym memberships, transportation to medical appointments, and vision, hearing, and dental benefits. Original Medicare doesn’t provide those benefits even with the addition of a Medicare Supplement plan.
There are a few things all Medicare beneficiaries should know about Advantage plans before enrollment:
- Many Advantage plans limit you to seeing network providers.
- Some plans allow out-of-network providers at a higher cost.
- Advantage health plans do not minimize out of pocket costs like some Medigap plans but still provide high-quality coverage for health care in your local area.
- You must continue to pay the Part B premium to remain eligible for your Advantage plan.
- Advantage plans are administered by the insurance company rather than the federal government.
- The insurer handles everything from customer service to claims processing.
- You can enroll in an Advantage plan through your insurance agent or online.
What is the Best Medicare Advantage plan in Washington State in 2022?
Best for network freedom: Medicare Advantage PPO
PPO plans offer larger networks than most HMOs and may allow out-of-network providers.
You don’t need a referral to see a specialist, so you have more freedom when seeking medical treatment.
Best for lowest out-of-pocket: Medicare Advantage HMO Plan
HMOs limit out of pocket costs by working with a network of providers who agree to pricing terms.
$0 premium plans are available in most service areas.
Best for low income or health conditions: Medicare Advantage D-SNIP
Special needs plans, also known as SNP, are suitable for low-income beneficiaries or those with special needs. They may provide specialized services needed by beneficiaries with unique healthcare needs and can lower out of pocket expenses for those with limited financial resources.
You can combine Medicare and Medicaid to maximize savings and get the best insurance plans on a limited budget.
What Medicare Advantage plans are available in Washington State?
According to data from the Centers for Medicare and Medicaid Services, there were nearly 160 Medicare Part C plans available in Washington for 2022. $0 premium plans were available to 98% of beneficiaries in the state, and the average cost of a plan was just under $40 per month. That reflects a slight growth in plan options along with a modest decrease in premium rates.
The most popular Washington Medicare Advantage plan options include the following:
How much does Medicare Advantage cost in 2022?
The average monthly premium for a Washington State Medicare Advantage plan was around $40 in 2021 and 2022. There is a downward trend for rates, so that average may decrease in years to come.
Most beneficiaries in Washington have access at least one HMO with no premium. Some areas may also have $0 premium PPO plans available.
There are other expenses that come with an Advantage plan. For instance, you may still need to pay deductibles, copays, and coinsurance when visiting doctors or securing medical equipment. You also need to pay the Part B premium each year.
When can I make changes to my Medicare Advantage plan?
Medicare’s Annual Enrollment Period extends from October 15 to December 7 every year. You can do any of the following during this period:
- Change from one Medicare Advantage plan in Washington to another.
- Switch from Original Medicare to an Advantage plan or vice versa.
Eligibility for special enrollment periods outside of this annual period is limited. If you start out with an Advantage plan that doesn’t include a Part D plan, this period allows you to change plans in the future if you want Medicare Part D included in your monthly health plan premium.
When can you enroll in a Washington State Medicare Advantage plan for 2022?
Initial Enrollment Period
The best time to sign up for a Washington Medicare Advantage plan is during your Initial Enrollment Period. It starts three months prior to the month you turn 65 and lasts for three full months after that birthday month.
This period is your first opportunity to sign up for Original Medicare, which includes Medicare Part A and Medicare Part B. Once signed up, you have the option of adding a Medicare Supplement plan or enrolling in an Advantage plan.
You may face penalties if you fail to enroll in Original Medicare during this period and don’t qualify for a special enrollment period later. Your local Social Security office can help you determine your eligibility for special enrollment at a later date.
Open Enrollment Period – AKA Annual Election Period
The Medicare Open Enrollment Period lasts from October 15 to December 7 every year. It allows you to change plans in order to receive different benefits or lower premiums. You can switch between Advantage plans at this time or go back to Original Medicare if you no longer want to participate in Medicare Part C.
Medicare Advantage Open Enrollment Period
From January 1 through March 31, you can make a one-time change to your Medicare Advantage plan in Washington State. That includes moving to a new plan that may offer better coverage for your needs or lower premiums. You can also use this period to move back to Original Medicare.
Special Enrollment Periods – Special Circumstances
Special enrollment periods are extended to individual beneficiaries due to unique circumstances. For instance, if you move out of the service area for your current plan, you can notify your plan provider and move to a new plan within two months of the move. You may also qualify for special enrollment if you lose a job that previously provided your health care insurance.
5-Star Special Enrollment Period
Medicare awards rankings for insurance companies in the form of stars. 5-star insurers offer the best coverage and receive the highest satisfaction ratings from beneficiaries in Medicare surveys. If you want to move to a 5-star plan in your service area, you can do so one time between December 8 and November 30.
Special Enrollment Periods if you get “Extra Help”
If you receive Extra Help, you may change your Medicare drug coverage in Washington one time during each of the following three periods:
- January – March
- April – June
- July – September
You cannot change your Advantage plan or move back to Original Medicare due to Extra Help qualification. This pertains to Part D prescription drug coverage only.
Are Medicare Advantage plans in Washington State “bad”?
Medicare Advantage plans are not bad in Washington or any other state. While they may not fit the financial and health needs of every Medicare beneficiary, they do provide high-value coverage options for many. For instance, they often provide wellness benefits that aren’t available through Original Medicare alone or Medigap.
From 2016 to 2021, participation in Advantage plans nationwide increased by more than 40%. While enrollment in Original Medicare has seen a decline in recent years, Advantage plans continue to grow. Most states have more Part C plans available every year due to increasing demand.
Frequently Asked Questions about Medicare Advantage in Washington State
What's the downside to Medicare Advantage plans?
There are many benefits to enrolling in Part C in Washington for 2022, but it’s important to highlight some of the potential downsides as well:
- Not all insurance providers have a high star rating. If you enroll in the cheapest plans available in your service area without paying attention to that rating, you may end up unsatisfied with your coverage.
- That’s a reflection on the plan rather than Medicare Advantage plans in general.
- Advantage plans may limit your options for healthcare providers due to network restrictions.
- You may pay more out of pocket with an Advantage plan than you would with Medigap. Supplement plans are designed to limit out of pocket costs, but Advantage plans reduce monthly premiums with more out of pocket expenses.
- There are some maintenance duties required when you choose an Advantage plan. For instance, you need to make sure your providers are all within your network, do some research to decide if you want to change plans each year, and keep up with copayments, coinsurance, and other bills.
- Benefits, premiums, and other details can change every year. Small changes like updates to the covered drug list can have significant impact on your health and wellness.
What are 4 types of Medicare Advantage plans in Washington State?
- HMO Plans – Health Maintenance Organizations often offer the lowest premiums but have the most restrictive provider networks.
- PPO Plans – Preferred Provider Organizations have larger provider networks and may allow out-of-network services, which means more options when selecting a primary care physician or seeking other medical services.
- PFFS Plans – Private Fee-for-Service plans allow you to select any medical provider as long as they agree to the plan’s payment terms. Not all Medicare doctors will agree to the terms of every PFFS.
- SNP Plans – Special Needs Plans are reserved for beneficiaries with special health needs or limited income. Each plan is dedicated to beneficiaries with one specific special need. For instance, one plan may only enroll beneficiaries with end-stage renal disease while another caters to those with diabetes.
What are the top 3 Medicare Advantage plans?
In 2020, there were just over 24 million beneficiaries enrolled in Medicare Advantage plans. Approximately 26% were enrolled in plans offered by United Healthcare, 18% were enrolled in Humana plans, and 15% were enrolled in Blue Cross Blue Shield plans.
The best Medicare Advantage plan in Washington State for 2022 is the one that fits your healthcare needs and budget. It’s important to compare premiums and out of pocket costs like the premium for Medicare Part A or Part B. You may also want to compare prices for Medigap plans to ensure you find the best plan for your needs. Our Policy Guides can help you do the research if needed.
What Are Medicare Special Needs Plans?
Special needs plans, also known as SNP, are Medicare Advantage plans that limit participation to beneficiaries with a specific need. Many plans are reserved for beneficiaries with chronic health conditions like cancer or diabetes while others cater to those with limited income.
There are HMO and PPO special needs plans. The basic cover is often similar to other plans, but they will also include special services or discounts that are relevant to the covered special need. Beneficiaries will still pay the deductible for Part B out of pocket even if the plan has no monthly premium.
Does Medicare Advantage cover drugs?
Some Advantage plans are Medicare Advantage Prescription Drug plans, which are otherwise known as MAPD. They include medical coverage plus a prescription drug plan with one monthly premium. Check the benefits carefully because not all Advantage plans include Part D coverage.
Do Medicare Advantage plans use the SilverSneakers program in Washington?
The SilverSneakers program and other extra benefits are offered through many Medicare Advantage plans. Some insurance companies also provide discount gym memberships and other additional coverage to all Advantage customers.
Washington Medicare Resources
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