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Medicare Plans in Washington – Coverage and Benefits

Any Washington state resident 65 and older should be enrolling in the federal Medicare program if they have not done so already. With Medicare, you can have most of your healthcare needs met at a relatively affordable price. Between the base parts of the plan, which includes Medicare Parts A and B, you can get coverage for hospital stays, basic doctor care, outpatient procedures, and more.

All enrollees will be expected to pay a yearly deductible and a monthly premium for Medicare Part B. On this page, you can estimate those costs. The good news, however, is that these costs are relatively low and designed to be affordable for those living on a fixed income. Additionally, Part A might be free – assuming you have a long enough employment history. Anything less than a cumulative 10 years (or 40 quarters), however, will require you to pay an additional deductible.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Supplemental Medicare Programs in Washington State

Over one million (1,209,529) Washington citizens are currently enrolled in Medicare right now. Of those, 29% (or 350,763 beneficiaries) have replaced their Traditional Medicare benefits with a Medicare Advantage policy. Another 16% (or 199,318 people) are supplementing their benefits with a Medigap supplement policy. Still, however, there are 665,240 beneficiaries (55% of the total pool) who either have some alternative form of supplement coverage, or no additional coverage at all outside of their Traditional Medicare benefits.

If you think you might want to purchase supplemental coverage, you must first make sure that you are enrolled in Medicare. The process is fairly simple. Learn more about Medicare enrollment here.

Who Do So Many People Choose to Purchase Additional Coverage Beyond Traditional Medicare?

The cost of quality health care is on the rise, and it isn’t going down any time soon. While Medicare Parts A and B are fairly comprehensive, they can’t pay for everything. And the seemingly little things that they don’t pay for can sneak up on you. If you aren’t prepared, they can wreak havoc on your fixed income. You can see some examples of this in the table below:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Supplemental health insurance is a great way to make sure that you don’t end up being a victim of bad luck. There are several different options you can explore for filling your Medicare coverage gaps. Below are some of the most trusted options for managing your Medicare coverage benefits and ensuring you get the most comprehensive plan available.

Coverage Option #1: Medicare Supplement Plans

Most Medicare supplement policies are labeled as “Medigap” policies. If you have a Medicare supplement policy, you can be shielded from unexpected medical expenses incurred from the gaps in Medicare. Right now, there are 10 federally endorsed supplement plans available to the public. Plans A-D, F, G, and K-N are still in effect, but plans E, H, I and J have been weeded out due to the Medicare Modernization Act of 2010. All 10 of the active plans provide for equal forms of coverage, regardless of your state or insurance company. Costs will vary, so make sure you shop around for the best deal.

Below is a detailed explanation of what each plan covers in detail:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $155 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $154 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $159 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $147 $0 $147 Not Covered Not Covered Not Covered Request Info
N $109 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $159 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $96 $1 $147 Not Covered Not Covered Not Covered Request Info
L $96 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $62 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $145 $608 $147 Not Covered 100% Covered 100% Covered Request Info

Option 2: A Medicare Advantage Plan

Medicare Advantage (Medicare Part C) is another Medicare supplement option which is fairly popular. But if you abandon Original Medicare for a Medicare Advantage (MA) plan, your health care will no longer be managed by the US government. A private insurance company will take over. However, you will still have at least the same benefits that Traditional Medicare offers, because your provider is legally required to offer the same deal that you would have access to on the federal level. Some MA plans offer additional benefits as well.

Some of these benefits could include prescription drug plans, vision, or dental (or a combination of benefits). Many MA beneficiaries prefer Part C for the convenience, even though it is highly likely that your plan will force you to enter a very restrictive network. The doctors you are used to seeing might not be available to you after you switch. This is a very important factor to keep in mind when making important decisions about your health care needs.

Before you settle for an Advantage plan, do some research on the PPO and HMO (preferred Provider and Health Maintenance Organizations, respectively) provider networks in your area.

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$936 Group Health Cooperative Clear Care Vital (HMO) Health and Drug $78.00 $310
$1188 Group Health Cooperative Clear Care Basic (HMO) Health Only $99.00 $0
$2484 Group Health Cooperative Clear Care Essential (HMO) Health and Drug $207.00 $250

Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$0 HumanaChoice H6609-070 (PPO) Health Only $0.00 $0
$1080 HumanaChoice H6609-013 (PPO) Health and Drug $90.00 $300
$2460 HumanaChoice H6609-073 (PPO) Health and Drug $205.00 $310

Medigap vs. Medicare Advantage: Which is the Better Deal?

Comparing Medigap and Medicare Advantage can be difficult. Hopefully, this table can clear away some confusion:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Need More Information?

There are a number of variables which will determine whether or not you should supplement your Original Medicare coverage. This article alone can only cover the basics. To make the best possible decisions about your health care, use the contact information below to speak to your local Medicare experts.

Useful Contacts


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Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

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