If you’re considering Medicare, there are a few options that you should become familiar with. Understanding your choices will help you find the right plan for you. Benzinga has put together this guide to Medicare options in Washington to get you started.
The Best Medicare in Washington State:
- Best Overall in Washington: Kaiser Foundation Health Plan of Washington
- Most Affordable in Washington: Humana
- Best for Low Drug Costs: Aetna
- Best for Over-the-Counter Drug Benefits: WellCare
- Best for Travel Coverage: UnitedHealthcare
What is Medicare?
Medicare is a federally-offered health insurance program. You may qualify for Medicare insurance if:
- You are 65 or older.
- You suffer from a disability.
- You suffer from end-stage renal disease and need a transplant.
Medicare offers insurance in 4 separate parts:
Part A: Part A of Medicare is your hospital insurance. This part of your Medicare insurance covers inpatient hospital stays, hospice care, care in a nursing facility and some forms of home health care.
Part B: Part B of Medicare insures your other medical needs. This part covers outpatient care, medical supplies, preventive services and other types of doctor’s office services.
Part C: Part C of Medicare is also known as Medicare Advantage plans. These plans offer an alternative option to Original Medicare and are offered by private Medicare-approved companies.
Part D: Part D of Medicare is prescription drug coverage. This part of Medicare can be added to your Medicare plan(s) as a supplemental coverage option.
Legalities of Medicare in Washington
Before choosing a Medicare option, it’s important to understand the difference between Medicare and Medicare Advantage. Medicare is a health insurance plan that is controlled by the federal government. This type of coverage may also be called Original Medicare. When you shop for an Original Medicare plan, you can be assured that your plan is held to the standards set by the federal government. You will also be able to see any doctor that accepts Medicare insurance plans.
Medicare Advantage is offered by private insurance companies. While the companies must be approved by Medicare to offer a Medicare Advantage plan, these plans may not be held to the same standards as Original Medicare. The provider of your Medicare Advantage plan can restrict the doctors and specialists that are covered by your plan. These insurance providers also reserve the right to change your insurance premiums at their will.
You may need to get a referral from your primary care doctor before your Medicare Advantage plan covers any visits with a specialist. Your prescription drug coverage may also be restricted by your Medicare Advantage plan. Some plans require you to use generic drug treatments and only cover brand-name options if the generic drug did not work for you.
If you have a Medicare Advantage plan, you are prohibited from also carrying Medicare Supplemental Insurance. This supplemental plan — known as Medigap policies — is designed to fill gaps in your Medicare coverage. It is also offered by private insurance companies.
Types of Medicare Advantage Plans
When shopping for a Medicare Advantage plan in Washington, you should recognize the different types of insurance plans that may be offered. Most often you will see HMO and PPO plans.
HMO: Health maintenance organization (HMO) Medicare Advantage plans include both Part A and Part B Medicare insurance. This means that you are able to combine your hospital and medical insurance needs into one plan. It usually includes Medicare Part D plans to cover your prescription drug needs. You may also find that the Medicare Advantage HMO option includes vision, hearing and dental coverage.
The most important thing to understand about a Medicare Advantage HMO plan is that it does have requirements attached to its coverage. Your visits with doctors and hospitals are only covered if the provider is within your plan’s network. You will only receive coverage for out-of-network providers in emergency situations. These plans may also require a referral from your primary care doctor before it covers any specialist visits.
PPO: Preferred provider organization (PPO) Medicare Advantage plans also combine Part A and Part B of Medicare insurance. PPO plans also likely include your Part D prescription drug coverage. Similar to HMO plans, you may also find PPO plans that offer coverage for vision, hearing and dental services.
PPO plans handle in-network coverage differently than HMO plans. PPO plans do have a network of participating doctors and hospitals. However, you are not restricted to visiting only these doctors with a PPO plan. If you visit a provider that is not within your plan’s network, you can expect to pay more than you would if you visit an in-network provider. These plans usually do not require a referral from your primary care doctor to receive coverage for specialist visits.
To select the best coverage option for you, you should become familiar with a few key insurance-related terms:
Deductible: Every plan you see will have a deductible listed. Your deductible is the amount of money you must pay out-of-pocket before your health insurance contributes toward your medical costs. After you have met your deductible, your health insurance company will begin paying for your visits. To have your costs counted toward your deductible, you will need to present your insurance card each time you visit a doctor or hospital. You may also be able to submit a claim to your insurance company.
Coinsurance: After you’ve met your deductible, you will begin sharing the costs of your medical services with your health insurance company. If the plan you’re looking at lists a coinsurance, this means that you pay a percentage of each visit after you’ve met your deductible. The actual monetary cost you pay will depend on the total cost of your bill.
Copay: Some insurance companies have you make a copayment after meeting your deductible. If you have a copay listed on your insurance plan, this is the amount of money you will pay for each visit after you’ve met your deductible. Copays offer a more reliable option because the amount you pay does not depend on the total cost of your bill.
Most health insurance plans choose either a coinsurance or copay model. Once you’ve met your deductible, your health insurance company will cover the remaining cost of your covered services.
How to Sign Up for Medicare in Washington
There are 3 ways you can sign up for Original Medicare (Part A and Part B) in Washington:
- Enroll online.
- Call Social Security anytime Monday through Friday from 7 a.m. to 7 p.m. at 800-772-1213.
- Visit a Social Security office near you.
If you’d like to look at Medicare Advantage plans, you should first compare the plans that are available in your area. Be sure to enter your home ZIP code when you compare plans because the plans offered can vary by county.
If you find a Medicare Advantage plan that you would like to enroll in, you have 3 options:
- Visit the company’s website to see if you can enroll in the plan online.
- Contact the company to require a paper enrollment form.
- Call 800-MEDICARE (800-633-4227).
Average Cost of Medicare Advantage Plans in Washington
When exploring your Medicare Advantage plan options, you will find that the costs can vary widely among the company and plan. When comparing plans, pay close attention to each plan’s deductibles as well as the coinsurance or copay amounts. You may also want to check each company’s network to see if your doctors participate in the plan you are considering.
| Plan Name | Company | Plan Type | Health & Drug Costs |
|---|---|---|---|
| Kaiser Permanente Medicare Advantage Key | Kaiser Foundation Health Plan of Washington | HMO | $0 |
| AARP Medicare Advantage Plan 2 | UnitedHealthcare | HMO | $48 |
| Humana Honor | Humana | PPO | $13.52 |
| Regence MedAdvantage Basic | Regence BlueShield | PPO | $22.12 |
| Aetna Medicare Value Plan | Aetna Medicare | HMO | $40 |
Best Medicare Insurance Providers in Washington
If you’re considering a Medicare Advantage plan, you might be wondering which companies can offer you a plan. Below are some of the best Medicare Advantage insurance providers in Washington.
1. Best Overall in Washington: Kaiser Foundation Health Plan of Washington
This insurance provider offers a plan that received Medicare’s highest rating of 5 stars. The rating is based on a number of categories, including preventive care, care for chronic conditions and member satisfaction.
This provider offers its members access to a fully-integrated system of primary and specialty care, lab, radiology, pharmacy and other service providers. With this provider’s Medicare Advantage plan, you can expect low copays and deductibles.
- Medicare Advantage Plans
2. Most Affordable in Washington: Humana
Humana is a long-time provider of Medicare Advantage plans. This provider has been able to build its network and establish relationships with many valued doctors and hospitals nationwide.
If you travel often, this can be a valuable asset to have. Humana offers affordable Medicare Advantage plans with health plan deductibles as low as $0. You can also expect low drug deductibles with Humana’s Medicare Advantage plan.
- Member support
3. Best for Low Drug Costs: Aetna
Aetna is one of the most widely-available health insurance providers in the country. It offers both HMO and PPO plans with a deductible as low as $0. You can expect low copays with Aetna plans, as well as vision, dental and hearing benefits. Your Aetna Medicare Advantage plan may also offer fitness benefits.
Aetna’s large network of pharmacies makes getting your prescriptions an easy and accessible process. You can expect most preferred generic drugs to cost as little as $1 with an Aetna plan.
- Medicare Prescription Drug Plans
4. Best for Over-the-Counter Drug Benefits: WellCare
WellCare is among the higher-rated providers of Medicare Advantage plans. It offers deductibles and premiums as low as $0. You can also receive dental, hearing and vision coverage. WellCare also offers additional benefits to its members. One of its unique benefits is an over-the-counter credit.
This allows you to choose from health and wellness items such as allergy and cold medicine, first aid items, vitamins, toothbrushes and more. You can place an order up to the amount of your over-the-counter credit each month.
- Same day coverage available
5. Best for Travel Coverage: UnitedHealthcare
If you travel often, you may want to select a Medicare Advantage plan that can help you in case you need medical services while you’re away from home. UnitedHealthcare offers the option for travel insurance in addition to its other benefits.
These plans can offer video doctor visits as well as nurse hotlines to its members. Both of these options can be helpful if you run into a nonlife-threatening medical concern when you’re away from home.
What’s the Best Medicare Option?
There is no one Medicare option that is better than another. The best Washington Medicare option is the one that can offer you the coverage that you need. To find the best option for you, take your time to carefully evaluate and compare the options available in your area.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.