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 29% 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

Medicare Advantage plans can be tailored to your specific needs. One of the ways providers accomplish this is by offering different provider networks. Some networks give you a great deal of choice when it comes to doctors and hospitals. These plans, however, tend to be pretty expensive. Other plans are more affordable, but have limited provider networks and more stringent restrictions.

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.

Doctor/Providers List

Drug, Vision and Dental Coverage

Unlike many Medicare supplements, which protect your from coverage gaps but function as a separate entity from Traditional Medicare, you can bundle all of your health care benefits under a single Medicare Advantage policy. That includes your basic Medicare benefits, gap coverage, and even ancillary benefits such as dental, vision, or prescription drugs (MAPD plans). These plans are sometimes a little more costly, but many seniors believe that the convenience is worth the expense.

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?

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