Medicare Plan Options

When deciding on a Medicare option, consider your state of health. If you’re in good health, Original Medicare may be your best option. If you have concerns about issues like your vision or hearing, Medicaid Advantage Plans can help. If you have Original Medicare but want some extra coverage, look at Medicare Supplemental Insurance Plans. If you require many medications, you’ll want to investigate a Medicare Part D plan.

Original Medicare

Original Medicare is composed of two parts: Part A, which provides coverage for hospitalization, home health care, nursing care, and hospice; and Part B, which covers doctors’ visits, ambulance services, mental health care, and durable medical equipment. Part A can cost as much as $471 a month, although you may not pay anything. It depends on the Medicare taxes you’ve paid in the past. Part B has a premium of $148.50 a month, which is normally taken out of your monthly Social Security payment. After deductibles, you’ll pay about 20% of the cost of Medicare-approved medical procedures. Original Medicare has no limits on out-of-pocket costs.

Medicare Advantage Plans

A Medicare Advantage Plan is a Medicare plan provided by private companies which are approved by Medicare. There are four kinds of Medicare Advantage Plans: HMOs, PPOs, Private Fee-For-Service Plans (PFFS), and Special Needs Plans (SNP). Regardless of the type of Medicare Advantage Plan, they all provide Original Medicare’s Parts A and B. They also offer extra benefits like vision, dental, hearing, and fitness programs. Many Medicare Advantage Plans will bundle prescription drug coverage into their offerings. However, you can only select a Medicare Advantage Plan that is available in your county in Washington.

Medicare Prescription Drug Coverage Plans

If you require numerous prescription drugs, you’ll want a Medicare Part D plan. If you select Original Medicare, you’ll need to purchase a Part D plan separately. Several factors affect this cost, including a drug’s tier, financial assistance available from drug companies to help purchase their products, and which drugstore you use. Prescription drug coverage is often provided in Medicare Advantage Plans, although not in all plans. If you chose not to select a Part D plan when you initially enrolled in Medicare or don’t receive coverage through a Medicare Advantage Plan, you can enroll later but may have to pay a penalty.

Medicare Supplement Insurance Plans

Sometimes, when you select Original Medicare, you’ll find gaps in your coverage that can prove expensive over time. Consider a Medicare Supplemental Insurance Plan, also known as Medigap. These plans help plug those gaps. They cover co-pays, coinsurance, and deductibles. However, they won’t help with long-term care, vision, hearing, dental, or Part B’s $148.50 monthly premium. Medigap can also be helpful if you need to travel outside the country and want medical coverage. However, if you have chosen a Medicare Advantage Plan, you cannot use Medigap, as the two plans do not work together.

Medicare in Washington by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
887,064 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$7,816 -19%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Washington

If you’ve relied on health coverage from an employer or through your spouse in the past, it can be daunting when the time comes for you to select a Medicare option. There are important questions to consider. Will Original Medicare give me enough coverage? Can I find a good Medicare Advantage Plan in my county? Navigating your way through these questions can be frustrating. In Washington, however, you have access to free, unbiased, and confidential counseling about your Medicare choices from several statewide organizations.

Washington Senior Medicare Patrol (SMP)

When you’re a senior, you always need to be on the lookout for scams. This includes Medicare scams and abuse. The mission of the SMP in Washington is to teach you how to detect and report Medicare errors, scams, and abuse. They can show you how to spot errors in your Medicare billing. They can also help you learn how to detect fraud when companies falsely claim that Medicare covers their products or services. SMP regularly holds outreach sessions around the state, but, you can arrange an in-person session if you, your family, or your caregivers suspect Medicare fraud.

Contact Information: Website | 800-562-6900

Washington Association of Area Agencies on Aging (W4A)

The Washington Association of Area Agencies on Aging promote the interests of seniors and the disabled across the state. The 13 W4A offices work with local community groups and senior centers to provide services like delivering meals if you are needy or homebound, congregate meals that allow you to enjoy a nutritious lunch and associate with other seniors, transportation to your medical appointments, and counseling on issues such as Medicaid, Medicare, and Medicaid Advantage programs.

Contact Information: Website | 360-485-9761

Statewide Health Insurance Benefits Advisors (SHIBA)

The trained volunteers of SHIBA are available to counsel you about your Medicare options. They provide free, confidential, and unbiased counseling about Medicare, Medicare Advantage Plans, long-term health care options, Part D prescription drug coverage, and Medicaid. All counselors are volunteers, and no counselor will ever try to sell you a particular plan. You can reach a counselor by phone, or you can arrange a one-on-one session to talk about how to choose the plan that suits you the best.

Contact Information: Website| 800-562-6900

Learn More from Our Sources