Medicare in Washington

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Washington Medicare Plans

Medicare in Washington just like any other states is a federal health insurance program that helps individuals pay for a variety of health care expenses. Medicare plan is designed especially for people age 65 and older and people under 65 who are either on Social Security Disability Income or diagnosed with diseases like End-Stage Renal Disease (ESRD) and Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis or ALS). In Washington, around 14 % of Medicare beneficiaries are eligible due to disability. Individuals who are receiving retirement or disability benefits are automatically enrolled in Medicare. More than 1.3 million people are enrolled in Medicare in Washington. The annual Medicare open enrollment period in Washington as well as other states runs from October 15 to December 7.

Some of the Medicare Plan Options in Washington include:

Original Medicare

Original Medicare which include Medicare Part A and Part B, coverage is the health insurance program introduced by the federal government that pays for variety of health care expenses. Permanent legal residents of Washington along with other states are eligible for Original Medicare if they have lived here for at least five continuous years. The benefits, price and eligibility for Original Medicare are same in all the states of the United States. Original Medicare comprises of two parts, Medicare Part A and Medicare Part B, where Part A covers inpatient hospital stays and Part B covers outpatient services.


People younger than 65 years of age are also eligible for Original medicare if they have disability or certain health conditions such as end-stage renal disease or amyotrophic lateral sclerosis. Most of the people get automatically enrolled in Medicare Part A without any premium if they have worked for at least ten years and paid their Medicare taxes otherwise they have to pay a premium for Medicare Part A coverage along with the deductible, co-payments, and coinsurance costs.


Medicare Part A coverage includes inpatient hospital care, skilled nursing facility care, some post-hospitalization home health care, and hospice care. Beneficiaries benefit period for hospitalization starts the day they receive inpatient service in a qualified hospital and ends when they have been out of a hospital for 60 days in a row. Typically Medicare Part A covers services such as semi-private room, nursing services, meals, medications that are part of inpatient treatment, and other hospital services and supplies. Medicare Part B coverage include outpatient services such as doctor visits, preventive screenings and exams, x-rays and lab tests along with durable medical equipment, physical therapy, and home health care services. Medicare Part B covers medically necessary services or supplies essential to diagnose and treat medical condition along with preventive services like health care to prevent illness like flu. Part B coverage also include clinical research, ambulance services, durable medical equipment, mental health and limited outpatient prescription drugs.

Medicare Part C or Advantage Plan in Washington

Medicare Part C also known as Medicare Advantage plans is an alternative way to receive Original Medicare benefits. This plan is offered by private insurance companies, as the private insurance carriers are paid by Medicare to manage Original Medicare. More than 32% of Medicare beneficiaries in Washington are enrolled in Medicare Advantage plan, which has been steadily increasing for more than a decade. Different types of Medicare Advantage Plan are available in Washington and residents can choose the plan that best fit their healthcare needs.


Irrespective of the type of Medicare Advantage plan individuals choose, they should first enroll in Medicare Part A and Part B to be eligible for enrolling in Medicare Part C plan. They also need to continue paying their Part B premium along with the premium of Advantage plan and they should live within the plan’s service area. People having end-stage renal disease are not be eligible for Medicare Advantage plans except for a Special Needs Plan.


The Medicare Advantage plan pays for all medically necessary care that are covered under Original Medicare. Besides Original Medicare benefits, Part C plan also include some additional benefits. Medicare Advantage plans go beyond the Original Medicare benefits and provide additional benefits like routine dental and vision services, hearing devices, wellness programs, fitness programs, and prescription drug coverage.

Types of Medicare Advantage Plans

In Washington there are several types of Medicare Advantage plans available just like any other states. Medicare Advantage plan is available only in 30 counties of Washington out of 39 counties and the plan availability ranges from from just one plan in Whitman County to 43 plans in King County. Some of the Advantage plans available in Washington include:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Special Needs Plans (SNPs), designed for beneficiaries with specific illnesses or conditions
  • Private Fee-for-Service Plan
  • Medical Savings Account

Medicare Advantage Prescription Drug Plans

Many Medicare Advantage plans in Washington come included with prescription drug coverage and are known as Medicare Advantage Prescription Drug plans. These plans combine health and prescription drug coverage into a single plan. However, individuals enrolled in a Medicare Advantage Prescription Drug plan will continue to be enrolled in Original Medicare and they will also need to pay their Medicare Part B premiums to not lose their health coverage. These plans are offered by private insurance companies having contract with Medicare to Provide Part A, Part B and Part D benefits.

Plan Formulary

Each Medicare Advantage Prescription Drug plan has its own list of prescription medications that it covers, which is called a formulary. Medicare Advantage prescription drug plan generally offer two or more medications within each category, like two medications from antidepressant, and two medications from antibiotic category. The formulary includes at least two drugs in all the commonly prescribed categories and classes. This is basically done to ensure that people with different medical conditions can find prescription drugs as per their need. Therefore, before enrolling in a Medicare Advantage Prescription Drug plan, individuals are advised to make sure that their current prescriptions are included in the plan’s formulary, since covered medications vary from plan to plan.


Medicare Advantage Prescription Drug plans include all the benefits that are covered under Original Medicare with the only exception of hospice care, which is covered under Medicare Part A. In addition to prescription drug coverage, many of Medicare Advantage Prescription Drug plans include some additional benefits too such as routine vision and dental, hearing, health and wellness programs, and hearing devices etc.

Medicare Part D Plans in Washington

Original Medicare beneficiaries in Washington have the option to enroll in a stand-alone Medicare Part D or Prescription Drug Plan that helps them pay for their prescription drug costs. Medicare Part D is a separate plan available through Medicare-approved private insurance companies that work alongside Original Medicare coverage. Medicare Part D plans were designed and established to help cover the prescription drug costs, which is not covered under Original Medicare except in limited situations.


Medicare beneficiaries who are either enrolled or eligible to enroll in Original Medicare can sign up for Medicare Part D plan. Beneficiaries must permanently live in the service area of plan in order to sign-up for Medicare Part D plan. Though, Medicare Part D coverage is optional, but if beneficiaries do not enroll in Part D as soon as they become eligible, then they may have to pay a late-enrollment penalty. Individuals enrolled in this plan still need to pay there Medicare Part B premium along with the premium of their Part D Plan.

Medicare Part D Plan Formulary

Each Medicare Part D plan have a list of drugs that it covers and is called the plan’s formulary. The plan’s formulary list the name of drugs covered by the plan, the amount which the insured have to pay for each drug and if there are restrictions on the insured ability to get a drug. The formulary include both generic and brand name drugs included in the plan. Some of the drugs are mandated by the Medicare, so these drugs are on every plan’s formulary. Medicare Part D plan formulary has at least two drugs from every popular category like Antipsychotics, Antidepressants, Anticonvulsants, Antiiretrovirals, Immunosuppressants, and Antineoplastics. Precsription drug plans plans also cover vaccines that are must for preventing illness.

Medicare Supplement Plans in Washington

Medicare Supplement plans are designed for enrollees so that they maintain some form of supplemental coverage. Since half of Original Medicare beneficiaries do not get their supplemental coverage through an-employer sponsored plan so they prefer to enroll in a Medicare Supplement plan. Since Original Medicare plan comes with out-of-pocket costs so beneficiaries can save money with the help of medicare Supplement insurance plan. Supplement plans help to pay out-of-pocket costs such as deductibles, coinsurance and co-payment.

Benefits of Medicare Supplement Plans

It is a fact that each Medicare Supplement plan offers a different level of benefits but each supplement plan include the same standardized benefits irrespective of the insurance company and the location. Like Medicare Supplement Plan D in Washington will have the same basic benefits as Plan D in Virginia. Medicare Supplement plans in Washington should cover some of the basic benefits such as Medicare Part A coinsurance costs for additional 365 days after Medicare benefits have been exhausted. Besides, these plans also include Medicare Part A hospice care coinsurance or co-payment. Coinsurance or co-payment of Medicare Part B and cost of first three pints of blood used in a medical procedure.

Types of Medigap Plan

The Washington federal government has allowed sale of ten standardized Medicare Supplement insurance plans. Each of the Medigap plan is labeled with a letter such as A, B, C, D, F, G, K,L, M, and N. Plan with the same letter, irrespective of the insurance company offering this plan, offers the same set of standard benefits.

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