Who qualifies for Medicare in Washington?
You may qualify for the Medicare program if you fit into one of the following categories:
- You’re 65 or older and you or your spouse paid Medicare tax for at least 10 years.
- You have a qualifying disability.
- You have end-stage renal disease.
- You have Lou Gehrig’s disease.
Is Medicare in Washington free?
Medicare does not provide free health insurance for most beneficiaries. Original Medicare, also known as Medicare Part A and Part B, comes with deductibles, coinsurance, and copayments in addition to other potential out of pocket costs.
Medicare beneficiaries may select Medigap or Advantage plans to offset some of those out of pocket expenses and possibly enhance their health coverage, but these optional plans often come with a monthly premium. There is also a Part B premium, and many beneficiaries pay a premium for their prescription drug Part D plan.
How much is Medicare Part A?
Medicare Part A covers inpatient hospital care and comes with three potential expenses:
- Premium – Most Medicare beneficiaries don’t pay Part A premiums because they paid Medicare taxes for at least 30 quarters prior to enrollment. For those who did not pay enough Medicare taxes, the monthly deductible for Part A is up to $471 in 2021.
- Inpatient Deductibles – There is a deductible for inpatient hospital care coverage. For 2021, that deductible is $1,484 for each benefit period.
- Coinsurance – Beneficiaries are also responsible for coinsurance payments if they spend more than 60 days in the hospital.
How much is Medicare Part B?
Part B offers Medicare benefits for outpatient care. It’s similar to the medical insurance you may have had through an employer before qualifying for Medicare. There are three categories of expenses that you will pay for your Part B coverage:
- Part B Premium – The premium for Part B is $148.50. Beneficiaries with higher incomes may pay more.
- Part B Deductible – The deductible for Part B was $203 in 2021. This is the out-of-pocket amount beneficiaries pay for their outpatient care services each year.
- Part B Coinsurance – Once the deductible is met, beneficiaries pay 20% for most medical services covered by Part B.
How much is a Medicare Part D prescription drug plan?
Medicare Part D premiums and coverage options vary by zip code and insurance company. Some beneficiaries also enroll in Advantage plans that contain prescription drug policies, eliminating the need for a separate Part D insurance plan.
Depending on the plan you select, you may also have coinsurance and copayments to cover out of pocket. Research the Part D plans offered in your service area for a more detailed estimate of potential costs.
What if I choose a “Free” $0 Premium Medicare Advantage Plan?
You will pay your Medicare Part B premium out of pocket every year even when you enroll in a $0 premium Advantage plan. There are some other perks to choosing Medicare Part C, including additional benefits like gym memberships, transportation services, and coverage for hearing, vision, and dental services. Many Advantage plans also include prescription drug coverage.
How much is a Medicare Supplement plan?
Medigap plans are popular with beneficiaries who want to minimize out of pocket health care costs while enjoying comprehensive benefits, but they don’t eliminate all expenses. You can expect the following expenses with a Medicare Supplement plan:
- Monthly Medigap premium
- Annual Part B deductible
- Part D prescription drug plan premium and copays
Some Medicare Supplement plans also require small copays when visiting doctor offices and the emergency room. The more comprehensive the health coverage, the higher the monthly premium.
The rates you pay for a Medigap plan are based on the following factors:
- Zip code
- Tobacco use
- Chosen plan
What Medicare plans are available in Washington?
Best for network freedom: Medicare Supplement
Supplement plans are designed to fill the gaps in the Medicare program. Those gaps include copayments and coinsurance for Medicare Part A and Part B plus the deductible for Part A. There are no network restrictions and no required referrals, so you can see any medical provider accepting Medicare. Some Medigap plans even cover emergency care while traveling abroad.
Best for lowest premiums: Medicare Advantage
Insurance companies charge lower rates for Advantage plans than Medigap plans, but keep in mind that Advantage plans also come with more out of pocket costs. It’s important to consider all of your potential expenses for both plan types before deciding what works best for your finances and your health and wellness needs.
HMO plans will offer the lowest premiums. Most beneficiaries have access to $0 premium HMO policies, and some service areas offer no-premium PPO plans as well.
Best for low income or health conditions: Medicare Advantage D-SNIP
There are two ways to qualify for these specialized Medicare Advantage health care plans:
- Qualify through a chronic disability or medical condition.
- Qualify as a low-income beneficiary.
There are SNP policies for beneficiaries with End-Stage Renal Disease, diabetes, cancer, and many other conditions that require special treatment. Not all insurance companies will offer plans for low-income or special needs beneficiaries in all areas. An insurance agent or one of our Policy Guides can help you explore your options if you have a qualifying condition.
Washington Medicare FAQs:
What is the income limit for Medicare in Washington?
The income limit only applies to Medicare’s Part B premium. If an individual earns more than a specified amount based on their tax return two years prior to calculation, they will pay an amount higher than the standard premium.
For example, in 2021, the standard Part B premium was $148.50. Individuals earning more than $88,000 or couples filing jointly and earning more than $176,000 were required to pay higher premiums. You can check with the Centers for Medicare & Medicaid Services to learn the income limits for following years.
How do I apply for Medicare in Washington?
If you started receiving Social Security before turning 65, the government will automatically enroll you in Medicare Part A and Part B. If you did not start collecting Social Security prior to your Medicare eligibility, you can manually apply through your local Social Security office or online.
You may also enroll through an insurance agent familiar with Medicare. Our Policy Guides are also available to help you select between Original Medicare, Medicare Supplement plans, and Medicare Advantage plans.
You will need the following information when applying for Medicare benefits:
- Date and place of birth
- Medicaid number
- Medicaid start and end dates
- Current medical insurance start and end dates
- Names, birth dates, and social security numbers for current and past spouses
- Place of marriage plus marriage and divorce dates for current and past marriages
- Names and birth dates of children
- Service dates for military enlistment
- Employment details going back two years
- Bank account numbers for direct deposit
When can I apply for Medicare in Washington?
Your eligibility for Medicare enrollment starts three months before the month you turn 65 and lasts for seven months. If you enroll during the three months prior to your birthday month, your coverage will start the first day of your birthday month. If you apply during the three months following your birth month, your Medicare benefits will start the first day of the following month.
If you qualify for early Medicare due to a disability or end-stage renal disease, you will have an immediate enrollment period.
If you don’t sign up during your initial enrollment period, you may have penalties for late enrollment. Qualifying for a special period of Medicare enrollment may allow you to avoid penalties without limiting your coverage options.
What should I bring when applying for Medicare?
You will need the following documentation to complete your Medicare enrollment:
- Birth certificate
- Social Security card
- Health insurance information
- Proof of citizenship or legal residency in the U.S.
- W-2 or other tax documentation
- Military service records
These documents are required by the federal government to verify your eligibility for Medicare.
Is enrollment in Medicare mandatory at age 65?
If you receive Social Security benefits, you are required to enroll in Medicare Part A when you turn 65. If you have health insurance through an employer or another credible source, you can delay enrollment in Medicare Parts B and D.
Ready to learn more?
If you’re a beneficiary of Medicare in California or if you’re going to be signing up soon, we can help you compare insurance plans and look for the best rates. Call us today to talk to one of our licensed insurance agents so that we can explain your plan options and help you choose a company with a 5-star rating.
- In Washington, Medicare Advantage & Medicare Supplement plans are the most popular choices.
- Your initial Medicare enrollment period begins three months before your 65th birthday and includes the entire month.
- In Washington, apply for Medicare online, by phone or at a Social Security office in your service area.