Medicare Advantage Plans in Washington

Fact Checked
Published: June 11, 2021

Medicare Advantage Plans, or Medicare Part C, are Medicare plans offered by Medicare-approved private insurance companies. These plans must contain the same coverage as Original Medicare Part A (home health care, hospice, hospitalizations, and nursing home care) and Part B (doctor’s visits, durable medical equipment, ambulance services, and mental health care). Currently, about 890,000 seniors in Washington are enrolled in Original Medicare. Medicare Advantage Plans offer additional benefits, such as dental, hearing, vision, and fitness programs, and some plans also offer prescription drug coverage.

  • In 2019, there were 106 Medicare Advantage Plans available in Washington.
  • 31% of the total Medicare population in Oregon is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,163 per beneficiary in Oregon which is 19% lower than the national average.
  • Available Medicare Advantage Plans range from one to 53 across Oregon’s 39 counties.

When you’re ready to enroll in Medicare, you can decide between Original Medicare or a Medicare Advantage Plan. However, you can only select a Medicare Advantage Plan that’s available in your service area.

Types of Medicare Advantage Plans

Washington’s Medicare Advantage program has four types of plans, including HMOs, PPOs, PFFSs, and SNPs. Each plan has its the seven months surrounding your 65th birthday. This period begins three months before your birthday, includes your birth month, and continues for the three months following your birthday.

  • Open Enrollment This period runs from October 15th to December 7th. During this period, you can switch from Original Medicare to a Medicare Advantage Plan or return to Original Medicare. You can also change Medicare Advantage Plans.
  • Medicare Advantage Open Enrollment Open enrollment runs from January 1st to March 31st. During this period, you can switch Medicare Advantage Plans or return to Original Medicare. However, you cannot move from Original Medicare to a Medicare Advantage Plan. If you have not previously signed up for Medicare Part B, you can do so during this period and then select a Medicare Advantage Plan from April 1st to June 30th. Your coverage will start on July 1st.

You may qualify for a special enrollment period if you lose your current coverage, move, or become eligible for an SNP. If you’re still on a regular health insurance plan, either through an employer or your spouse, you don’t need to sign up for any form of Medicare when you turn 65. You’ll have eight months after this insurance ends to select your Medicare option.

Prescription drug coverage

Many HMO and PPO Medicare Advantage Plans include prescription drug coverage. While some plans include it in their premiums, others may charge for it separately. If your HMO or PPO plan doesn’t include prescription drug coverage, you can’t sign up for a separate Medicare Part D plan. If you do, the insurance companies will expel you from your Medicare Advantage Plan and return you to Original Medicare. Most PFFS plans include prescription drug coverage, but if yours doesn’t, you can sign up for a separate Medicare Part D plan. All SNPs are legally required to provide prescription drug coverage.

Medicare Advantage Resources in Washington

Selecting a Medicare Advantage Plan may seem confusing and frustrating. As you get closer to the start of your initial enrollment period, you may find your mailbox filling up with flyers and advertisements from different companies, which can make it even harder to make a decision. Deciding whether to join an available Medicare Advantage Plan or remain with Original Medicare requires some consideration. Fortunately, several resources in Washington can help you make the right decision for your health care needs.

Washington Association of Area Agencies on Aging (W4A)

The 13 offices of the Washington Association of Area Agencies on Aging, scattered throughout the state, work to promote the interests of seniors and the disabled. The Association’s mission is to advocate for services and resources at the local, state, and federal levels to improve the lives of Washington seniors. The W4A offices also work with local community groups to deliver some of these services, including nutritious meals for seniors, transportation to medical appointments, and free and unbiased counseling on health care issues, such as Medicaid, Medicare, and Medicare Advantage Plans.

Contact Information: Website | 360-485-9761

Washington Senior Medicare Patrol (SMP)

The goal of the Washington Senior Medical Patrol is to educate and inform you about how you can detect, report, and stop Medicare fraud. Many seniors who fall victim to Medicare and Medicare Advantage scams experience long-term negative consequences that impact their finances and health. The SMP shows you how to detect errors in Medicare billing and how to spot fraudulent claims made by organizations that say their services are covered by Medicare or Medicare Advantage Plans. SMP counselors are available to give one-on-one sessions to you, your family, or your caregiver about Medicare fraud.

Contact Information: Website | 800-562-6900

Statewide Health Insurance Benefits Advisors (SHIBA)

SHIBA provides free, confidential, and unbiased help with all aspects of Medicare to Washington seniors. SHIBA’s counselors can help you assess your health care needs, evaluate and compare Medicare plans and programs, and report possible Medicare fraud. The trained counselors are volunteers, and none of them are employed by a health care company. Counselors are available to speak with you, family members, or caregivers about your Medicare options.

Contact Information: Website| 800-562-6900

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