Introduction to Medicare Part C in Washington (Medicare Advantage)

Did you know about the potentially expensive coverage gaps inherent in Medicare Parts A & B? Were you aware that a Medicare Advantage policy could help protect you from these gaps? Medicare Advantage (Medicare Part C) is a “replacement” policy which swaps out your federal Medicare benefits with a private insurance policy. It comes with several different options for adding additional coverage, many of which will help protect you from Medicare Coverage gaps.

Federal Regulations for Medicare Advantage

Because Medicare Advantage aims to replace your federal benefits with a private policy, there are laws in place to protect you (the consumer). The Advantage policy you subscribe to will have to offer you at least the same coverage you would get with Traditional Medicare. But the majority of plans will offer you more, including coverage for extended hospital stays and co-insurance fees, which Traditional Medicare alone will not pay for.

Medicare Advantage Enrollment In Washington

Medicare Advantage is fairly popular in Washington – a full 30% of all Medicare-qualified retirees have an Advantage plan. But not all Advantage plans are crafted in exactly the same way. There is a great deal of variance, and you can see with the chart below which ones are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Your age, your city and/or county, and your current health status will all be factored together when your provider calculates your monthly rate for a Medicare Advantage plan. Below are estimated prices for seniors in your area. But remember that your personal circumstances may render you a higher or lower rate:

Most Popular Medicare Advantage Plans in Washington

When choosing a Medicare Advantage plan, there are several factors you need to look at. Is the company financially stable? Do they have a good reputation for customer service and care management? Can you get all of this for an affordable monthly premium? We make it easy for you to find answers to those questions by assigning each plan a ranking based on a five-star system. The more stars they earn, the better the plan.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Provider networks (and their associated restrictions) can be difficult to deal with at times. Start by asking your doctor if they belong to any specific networks before you begin shopping around – unless you don’t mind changing doctors, that is. The cheaper plans, such as HMO plans, will be more difficult to manage than PPOs or PFFS plans. These more expensive plans have larger provider networks and fewer restrictions on where, when, and how you can receive your medical care.

  • HMO Plans – HMO private health insurance tends to be on the less expensive side. You pick a primary care physician (or one is picked for you), you see them once or twice a year for wellness visits, and if you require additional medical care, they will refer you to another doctor or facility in-network. You have to stay within your – albeit limited – medical network or else your insurance company will not help you cover your costs. The only time you can go out of network is if you require immediate, emergency care and cannot get to an in-network hospital.
  • PPO Plans – PPO stands for “Preferred Provider Organization”. You aren’t restricted to only those care providers who belong to your medical network like you would be with an HMO. Just remember that if you go out-of-network, your insurance company will compensate you for a smaller fraction of the shared costs than it would if you got your care from a preferred provider. The monthly premiums on these plans also tend to be a little bit more expensive than HMOs.
  • PFFS Plans – PFFS plans let you visit any doctor or facility you like without restricting you to a specific network. However, it’s not necessarily as simple as it seems. In order to get care, the care provider you choose and your insurance company have to agree to specific payment terms. When they don’t agree, you don’t get care (or you don’t get your costs partially covered by your insurance company). And these agreements are renegotiated for every single appointment; so you may get covered for a wellness visit, but if you have to go back and get a specific condition treated by the same doctor, they may not agree. It’s all done on a case-by-case basis.
  • Special Needs Plans – Special Needs Plans are special in that you can’t simply buy one; you have to qualify for it based on medical need (such as chronic diseases like ESRD) and financial need. Once you qualify, you can expect it to work the same way an HMO plan does. You have a limited pool of lower-cost health care providers to choose from, and you can only see them if your primary care doctor gives you a referral. The only times you can go out of network are in the event of a medical emergency or if you negotiate for out-of-network, specialized care with your insurance provider. But these negotiations will rarely work out in your favor.

Doctor/Providers List

  • HMO Plans – If you don’t mind the restrictions set by most HMO networks and want an affordable way of managing your health care through private insurance company, then you should definitely look into a Medicare Advantage HMO plan. Because you’re getting government help, you can purchase a private HMO plan under Medicare Advantage at a fraction of the price that are regular private plan would normally cost. And you’ll have all the same rules that most HMO plans follow – just more benefits in the form of Medicare.
  • PPO Plans – Combining Medicare Advantage and a PPO network can help make better healthcare more affordable for aging seniors. You’ll have to pay a little more for it then you would a Medicare Advantage HMO, but you’ll have greater access to different doctors and facilities and you’ll have the potential to get better care. And the fact that you have financial assistance through the Medicare program will make it that much easier for you.
  • PFFS Plans – Many people report that PFFS plans get a little more predictable under Medicare Advantage. It’s never 100% foolproof, but it’s likely that there will be more agreements made between your Medicare Advantage insurance provider and your chosen doctors. This can make it much easier to get the care you need when you need it.
  • Special Needs Plans – If your healthcare needs require or qualify you for a Special Needs Plan, you can get a more affordable one if you purchase it through Medicare Advantage. You may even find that the medical network of doctors and facilities you can choose from are a little bit better quality then a regular, private health insurance plan. Just keep in mind you still have to stick to your primary care physician and do everything you can to stay in network in order to keep your costs as affordable as possible.

If you already have a doctor that you would like to keep seeing, there are ways to search online and make sure that they will be a part of whatever Medicare Advantage plan you decide to purchase. Or if you know a doctor or specialist you would like to make sure is in your future plan, you can use the Physician Search Tool to search for them, too.

Drug, Vision and Dental Coverage

Most people’s vision and eye health naturally declines over time. Unfortunately, Original Medicare and most Medicare supplements don’t provide vision coverage. You’ll have to go outside of your Medicare benefits and purchase separate vision insurance from a private company. Or you can purchase a Medicare Advantage plan and ask them to add vision coverage to your policy. But this may not be available from all Medicare Advantage providers in all areas, so check with your insurance company first.

Most Medicare Advantage plans also give you the option to purchase dental insurance. But like with vision coverage, it might not be available everywhere. Also, like vision coverage, you can’t get it through Original Medicare or through a Medicare supplement. Adding it to a Medicare Advantage policy makes it a little more convenient because you get to manage all of your health care needs through the same insurance provider.

Enrollment Options & Best Time To Enroll

As long as you enroll during your IEP (Initial Enrollment Period), you shouldn’t have trouble finding affordable coverage under a Medicare Advantage plan. However, the longer you wait, the more difficult it may be to find coverage. Private insurance companies have the right to ask you about your health status and reject you based on pre-existing conditions, such as End Stage Renal Disease. For more information on getting coverage outside of your IEP, you can contact your local insurance agent or inquire at your state department of insurance. You can also look at our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: For best results, try to enroll in a Medicare Advantage plan within your first 6 months of Medicare enrollment.
  • Annual Enrollment Period (AEP): You have the option of changing or cancelling your Medicare Advantage and Part D drug plan between October 15th and December 7th every year.
  • Special Enrollment Period (SEP): If you lose your employer plan coverage, move out of your coverage area, or lose coverage from your provider, you could qualify for an SEP.

What Medicare Advantage Plan Is Best For Me?

Most seniors are so worried about choosing a good plan before their enrollment period expires that they end up with a Medicare supplement plan that’s too expensive. Or maybe it doesn’t have all the benefits they want, or they find out much later that it’s managed by a company that isn’t financially stable or reliable. Don’t let any of these mistakes happen to you.

You can find a good Medicare supplement provider at the right price who offers the right benefits. And you can do it within your enrollment period, too. But you’re going to need our help. We’ll be happy to assist you in comparing plans and companies, along with comparing quotes So that you can find a good plan at the right price. Just reach out to us and answer a few simple questions, and you’ll have your Medicare benefits supplemented in no time.

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