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Medicare Advantage Plans in Washington State

These days, a beneficiary has so many choices that it may be hard to select the best Medicare Advantage plans in Washington State or even to know if a Washington Medicare Advantage plan will offer the best solution. Almost 400,000 people in this state have chosen to enroll in Medicare Part C in WA instead of only relying upon being enrolled in Medicare Part A and Part B. Learn more about how this kind of Medicare insurance can help reduce the coinsurance, copayments, and deductibles associated with Original Medicare and how different types of Medicare Advantage plans work.

Timing Enrollment in Medicare Advantage Plans in Washington State

The primary qualification people need for a Medicare Advantage plan in Washington State is to have enrolled in Medicare Part A and Part B. Also, typical Medicare Part C plans in Washington State won’t accept a Medicare beneficiary who has End Stage Renal Disease ESRD.

Otherwise, it’s just important to pay attention to these important enrollment dates:

  • Initial Coverage Election Period: For three months before, the month of, and three months after enrolling in Original Medicare, a beneficiary can choose to enroll in a Medicare Advantage plan.
  • Annual Election Period: This is the annual Open Enrollment that offers people a chance to review and switch Washington State Medicare Advantage plans.
  • Special Election Periods: You may get a Special Election Period to switch your Medicare Advantage plan in Washington State if you lose coverage, move away, or have other special circumstances.
  • Medicare Advantage Disenrollment Period: For a few weeks at the beginning of each year, you can drop your Medicare Part C plan and resume coverage from Medicare Part A and Part B. You can also join a Part D plan if you need to.

Once you have completed your enrollment in a Medicare Part C plan in Washington, the insurance company should mail or email you a new enrollment card. You will typically use this new card instead of the card you got when you joined Medicare Part A and Part B.

Popular Types of Medicare Advantage Plans in Washington State

You should understand that you have a variety of Medicare Advantage plans Washington State to choose from. It’s important to compare them to find the ones that will work best for you. To get started, you can read this brief summary of the most common kinds of Medicare Part C choices in Washington State:

  • Health Maintenance Organization HMO plans: While an HMO will have the strictest network restrictions, it’s also more likely to have cheap or $0 premium rates and low out-of-pocket costs. About 86 percent of MA enrollment has been in HMOs.
  • Preferred Provider Organization PPO plans: About 14 percent of enrollment goes to Medicare Advantage PPOs in Washington. These may cost somewhat more, but they will offer more flexibility to choose an out-of-network hospital or doctor.
  • Special Needs Plans SNPs: People in nursing homes or who have to manage other institutional conditions and chronic health conditions may find an insurance company that offers them Special Needs Plans.
  • Dual-Eligible: If you are a Medicare beneficiary who has Original Medicare and Medicaid, you may find a Dual-Eligible HMO to suit your needs.

Enrollment Statistics for Medicare Advantage Plans in Washington State

These enrollment statistics are for Washington State Medicare Advantage plans:

  • Most common Washington MA plan: HMO
  • Percent of MA Members in a Washington HMO: 86 percent
  • Number of Washington Medicare Advantage plan members: 382,571

How Medicare Advantage Plans in Washington State Cover Prescriptions

Medicare Part A and Part B only cover prescriptions in a few circumstances, but Medicare Advantage Prescription Drug plans bundle medical and drug insurance together. Since a Medicare Advantage plan may charge modest rates or even a $0 premium, this can offer some beneficiaries a very good value over getting drug benefits from a stand-alone Part D plan.

While premiums are important to many people with Medicare, it’s also important to research the way that the Medicare Advantage plan in Washington State pays for prescriptions. A couple of important things to compare include the formulary, or list of covered medicines, and the Prescription Drug tiers, such as generics and brand names.

Network Restrictions for Medicare Advantage Plans in Washington State

Medicare Part A and Part B don’t use plan networks. With Original Medicare, you may want to find providers who accept Medicare Assignment to make sure you can reduce your out-of-pocket costs. Otherwise, most providers in the U.S. will accept Medicare Part A and Part B.

If you’re accustomed to Original Medicare benefits, it’s important to take a moment to make certain that you understand the network rules of an HMO or PPO you might consider. Keep this brief summary in mind:

  • HMO: With this kind of Medicare Advantage plan in Washington State, you almost always will need to get covered services from an in-network doctor, hospital, or another provider. They will make exceptions for emergencies and a very few special circumstances. You must also choose a primary care doctor, called a PCP, to give you referrals to specialists and some other services.
  • PPO: With these kinds of plans, you will pay less if you choose in-network providers. You also don’t need to get referrals to visit specialists.

If you move away from your Medicare Advantage plan network, you will probably trigger a Special Election Period. You will have about two months to enroll in a Medicare Advantage plan that includes your new city or town.

Washington State Medicare Resources

Medicare beneficiaries may find these resources helpful:

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