Medicare Advantage plans in Washington State 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 a Medicare Advantage plan through your insurance agent or online.
Best Medicare Advantage plan types in Washington State
Best for network freedom: Medicare Advantage PPO
PPO plans offer more extensive 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 price 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.
According to data from the Centers for Medicare and Medicaid Services, nearly 160 Medicare Part C plans were available in Washington for 2022. In addition, $0 premium plans were available to 98% of the state’s beneficiaries, and a plan’s average cost was just under $40 per month. That reflects a slight growth in plan options and a modest decrease in premium rates.
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. However, there is a downward trend for rates, so the average may decrease in years to come.
Most beneficiaries in Washington have access to at least one HMO with no premium. In addition, some areas may also have $0 premium PPO plans available.
Other expenses 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 enroll in a Medicare Advantage plan in Washington State?
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 before the month you turn 65 and lasts for three whole 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 can add a Medicare Supplement plan or enroll 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 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 the Extra Help qualification. This pertains to Part D prescription drug coverage only.
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. However, if you start 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.
Ready to Learn More?
Medicare can be very confusing; if you need help with plan selection or getting more detailed information, please reach out to us for additional assistance; we are here to guide you!
Washington Medicare Resources
Washington Medicare State Links
- Washington State Medicare Extra Help Savings
- Help for the Aged, Blind, and Disabled in Washington State
- CMS: Centers for Medicare and Medicaid Services