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Medicare Advantage Plans in Washington
With more benefits and plan offerings than ever before, Medicare Advantage (MA) continues to grow. In fact, over one-third of Medicare beneficiaries had an Advantage plan in 2019. This page describes Medicare Advantage plans in Washington and how to compare your options.
What Is Medicare Advantage in Washington?
Also known as Medicare Part C, Medicare Advantage plans are similar to the group health plans offered by private insurance companies and many employers.
Every Advantage plan offers at least the same coverage as Original Medicare. There are two parts:
- Medicare Part A covers inpatient services, such as hospital and skilled nursing facility (SNF) care
- Medicare Part B covers outpatient services, such as doctor visits, lab work, and durable medical equipment (DME)
Original Medicare does not cover prescriptions. Medicare Part D provides those benefits.
Most Medicare Advantage plans offer more comprehensive coverage than just Parts A and B. For example, around 90 percent cover prescription medications.
Washington Medicare Advantage Plans with Prescription Drug Coverage
All-in-one policies that combine your Medicare Parts A, B, and D benefits are known as Medicare Advantage Prescription Drug plans (MA-PD).
Other benefits you may get with an Advantage plan include:
- Fitness programs
- Hearing aids
- Routine dental and vision care
Private insurance companies provide Medicare Advantage plans, which is why benefits and costs vary.
How Do You Qualify for Medicare Advantage in Washington?
You qualify for Medicare Advantage in Washington as soon as you enroll in both Parts A and B.
American citizens and permanent legal residents aged 65 or older are eligible for Medicare when they turn 65. If you started collecting Social Security benefits at least 4 months before your 65th birthday, you will be enrolled automatically.
You also qualify for Medicare if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. In this case, enrollment occurs automatically in month 25.
When Can You Sign Up for a Medicare Advantage Plan in Washington?
You may join a Medicare Advantage plan in Washington during any of the following enrollment periods.
Your Initial Enrollment Period (IEP) lasts for 7 months and starts 3 months before you qualify for Medicare. So, if your 65th birthday or 25th month of collecting disability occurs in April, your IEP starts on January 1 and ends July 31.
If you didn't sign up for Part A and/or Part B during your IEP, you can during the General Enrollment Period (January 1 through March 31). You then have from April 1 until June 30 to join a Medicare Advantage plan.
Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7 and allows current beneficiaries to make a wide array of coverage changes. This includes joining an Advantage plan.
If you already have Medicare Part C, you may either join a different MA plan or return to Original Medicare during the Medicare Advantage Open Enrollment Period. It lasts from January 1 through March 31.
Beneficiaries who experience certain life changes can sign up for Medicare Part C during a Special Enrollment Period. Medicare.gov has the full list of qualifying special circumstances.
Types of Medicare Advantage Plans in Washington
There are four types of Medicare Advantage plans in Washington.
- Health maintenance organizations: HMO plans have a provider network. If you go out-of-network and it's not an emergency, you'll probably have to pay the entire cost. HMOs also require members to choose a primary care doctor and obtain referrals before seeing a specialist.
- Preferred provider organizations: PPO plans also have provider networks. However, members may visit out-of-network providers for a higher copay. PPO plans also don't require members to choose a primary doctor or get referrals.
- Private fee-for service: PFFS plans set costs for covered services. Most also use a provider network but, as with PPOs, members can use an out-of-network provider for a higher cost.
- Special needs plans: SNPs limit enrollment to people who meet certain criteria. This means one of the following: qualifying for both Medicare and Medicaid (dual eligible), having a chronic condition (e.g. diabetes, HIV/AIDS, ESRD), or living in an institution or requiring in-home healthcare.
How to Choose a Medicare Advantage Plan in Washington
To ensure you get the best Medicare Advantage plan for your unique needs and budget, consider these four metrics:
- Costs: May include a yearly deductible, monthly premium, and copayments.
- Coverage: Benefits vary from plan to plan. Don't forget to review the drug formulary for MA-PD plans.
- Network: May include doctors, hospitals, labs, durable medical equipment providers (DME), and more.
- Ratings: Medicare publishes plan ratings every fall to help members compare their options during AEP.
It's easy to compare Medicare Advantage plans in Washington with our Find a Plan tool. Just enter your location information and coverage start date to review the Medicare plan options in your area.
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