Are you one of the numerous Medicare beneficiaries in Washington who wants to learn more about how the program functions? You typically have a selection of Medicare coverage alternatives in Washington as a beneficiary of Medicare. Let’s check out your options for Medicare plans in Washington.
Overview of Washington’s Medicare program
First, there is Original Medicare, which consists of Parts A and B. The federal government’s health insurance program is called Original Medicare.
Part A and Part B are the two components of Original Medicare.
- Inpatient hospital stays, post-hospitalization care in skill nursing facilities, some post-hospitalization home health care, and hospice care are all under Medicare Part A coverage.
- Doctor visits, some home health care services, lab work, X-rays, durable medical equipment, and a few screenings and exams for disease prevention are all included in Medicare Part B’s list of outpatient services.
Original Medicare does not cover all of the services you might require is probably already known to you if you have signed up for it. For instance, Original Medicare excludes coverage for
- You can take most prescription medications at home.
- Nursing home long-term care and services that are custodial
- Medical supplies or services you obtain outside of the United States
- Typical dental care and dental products, like dentures
- Typical eye exams and eyewear, such as glasses.
Who in Washington is eligible for Medicare?
If you are sixty-five (65) years of age or older, an American citizen, or a permanent resident who has been in the nation for at least five continuous years, you may be eligible for this benefit. If so, you are qualified for Medicare regardless of your place of residence. Suppose you have a disability, or medical condition, such as end-stage renal disease, amyotrophic lateral sclerosis, or Lou Gehrig’s disease. In that instance, even if you are under the age of 65, you may be eligible for Medicare.
Options for Medicare in Washington
In addition to hospice care and hospital stays, Medicare Part A also provides some home healthcare services and care in skilled nursing facilities. The CMS determines the cost of Medicare Part A each year.
Medicare Part B provides outpatient treatment, including physician visits, vaccinations, yearly wellness exams, and some durable medical equipment costs.
Washington’s Medicare Advantage Program
You can choose to purchase Medicare Advantage (Part C) insurance separately from the original Medicare. Medicare enters into a contract with private insurance providers to provide equivalent benefits to sections A and B. Additional information regarding Medicare Advantage programs is provided below:
The following businesses provide Medicare Advantage plans in Washington State:
- Medicare Aetna
- Washington’s Kaiser Foundation Health Plan
- The Premera Blue Cross
- BlueShield by Regence
Because not all plans are offered in every county, your choice of plans may vary based on where you live.
Medicare Advantage Plan Enrollment and Eligibility in Washington
When you turn sixty-five or if you are younger and have a qualifying disability, you are eligible for Medicare. A qualifying disability is one that meets at least one of the criteria below:
- You have been receiving Railroad Board Disability Annuity or Social Security Disability Insurance for 24 months.
- You have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis).
- You have advanced kidney disease.
You can enroll in these plans after you are eligible for the program. You can register for a Medicare Advantage Plan for the first time during two particular periods of the year: your Initial Enrollment Period and the Open Enrollment Period.
Initial Enrollment Period
Your IEP runs for three months prior to the month you turn 65 and for the period of three months following that month. You can register for a Medicare Advantage Plan during this time. Your coverage will begin the first day of the month you turn 65 if you enroll before that month.
If your IEP is missed, you can enroll in Medicare from January 1 through March 31 during the General Enrollment Period.
Open Enrollment Period
During the annual Medicare Open Enrollment Period (OEP), which runs from October 15 to December 7 each year, you have the opportunity to sign up for a Medicare Advantage Plan or make modifications to your current coverage. You have the option during this time to change from Original Medicare to Medicare Advantage, select a new Medicare Advantage Plan, or switch between Original Medicare and Medicare Advantage many times.
Open Enrollment for Medicare Advantage takes place every year between January 1 and March 31. Only beneficiaries who currently have a Medicare Advantage Plan are eligible during this time to switch plans or enroll in Original Medicare. During Medicare Advantage Open Enrollment, you are not permitted to change from Original Medicare to Medicare Advantage.
Special Enrollment Period
Special Enrollment Periods are exclusions to these enrollment windows. Move beyond the coverage area of your current plan or to a place with new plan alternatives that you didn’t have before, for example. You might be qualified to switch your Medicare Advantage Plan outside of the open enrollment periods. Call 1-800-MEDICARE and describe your circumstances if you believe you could be eligible for a Special Enrollment Period.
Washington Medicare supplemental insurance plans
Medigap plans can help cover out-of-pocket expenditures, such as copayments, deductibles, and coinsurance because Original Medicare does not impose an annual limit on these costs.
Only those with original Medicare can purchase Medigap policies from private insurance providers. Medicare Advantage plan holders are not eligible for Medigap.
Numerous insurance providers in Washington provide Medigap coverage. Some of the businesses providing Medigap policies in Washington for 2022 include:
- UnitedHealthcare and AARP
- State of Garden
- Washington’s Premera BlueCross BlueShield
- Security Sentinel
- The State Farm
If you reside in Washington, you have a total of 12 Medigap plans to choose from this year (including high-deductible variants of plans F and G).
Enrolment in Medicare in Washington
When you turn sixty-five (65), you become eligible for Medicare if you have been a US citizen or legal/permanent resident for five years or longer. Prior to turning 65, you might also be qualified if:
- You’re receiving Social Security Disability or Railroad Retirement payments for 24 months.
- You underwent kidney transplantation.
- You suffer from advanced renal disease
- You have Lou Gehrig’s disease.
Enrolling in Medicare during the appropriate enrollment period for your circumstances is crucial.
Initial enrollment period
- It begins three months before you reach 65 and lasts for another three months after you turn 65.
- If you enroll before your birthday, your coverage will start on the first day of the month you turn that age.
- If you sign up after your birthday or during it, your coverage won’t begin until the following month.
- During first registration, sign up for Parts A, B, C, and D plans as well as Medigap.
Medicare enrollment season
- It occurs between October 15 and December 7.
- Your original Medicare coverage can be modified.
- You can enroll in Part D or modify your coverage.
- You can move between Medicare Advantage and Original Medicare coverage.
Medicare general enrolment period
- The period runs from January 1 – March 31.
- If you missed the initial enrollment period, you could still enroll in original Medicare and Part D.
- Coverage starts on July 1.
- If you wait to sign up, you can be charged a fee.
Medicare Advantage enrollment is now available.
- The period runs from January 1 – March 31.
- If you currently have a plan of these plans, you can change your Medicare Advantage plan.
- You may revert to your old Medicare (and sign up for Part D).
Special enrollment period
- If you lose coverage due to a qualified reason, you can use these to enroll in Medicare outside of the regular enrollment periods.
- Special enrollment periods’ duration and timing may change depending on why you lost coverage.
Medicare Trends in Washington in 2022
In Washington, there are roughly 1,427,600 Medicare beneficiaries. Nationally, Medicare Advantage prices are anticipated to drop by more than 10% starting in 2021, but the variety of plans and benefits keeps rising. Here are a few Washington Medicare trends for 2022:
- In 2022, 159 Medicare Advantage Plans will be offered.
- In 2022, the typical monthly Medicare Advantage premium will be $34.45
- The cheapest Medicare Advantage plan monthly premium is $0.
- Medicare Advantage plans are available to 99 percent of beneficiaries.
- Medicare Advantage plans will be available to 98 percent of beneficiaries with no monthly premiums.
- In Washington, there will be 23 stand-alone Medicare prescription medication plans accessible in 2022.
- Seven stand-alone Medicare prescription drug plans and eighty Medicare Advantage plans with prescription drug coverage provide decreased out-of-pocket insulin expenditures through the Part D Senior Savings Model.
- All individuals who have stand-alone Medicare coverage for prescription drugs are eligible for a plan that has a monthly premium that is lower than what they paid in 2021.
- Extra Help is used by 24% of those having stand-alone Medicare prescription drug coverage.
- The cheapest stand-alone Medicare prescription medication plan monthly premium is $7.70.
Resources for Medicare in Washington
The Aging and Long-Term Support Administration, or ALTSA, was found in Washington to assist the state’s elderly population and its resident persons with disabilities. The Washington Medicare/Medicaid Integration Project, which helps enhance service quality and cut costs, is beneficial to older persons enrolled in Medicare.
A few of the initiatives supported by ALTSA are:
- Adult Day Health Program
- Specialized Dementia Care program
- Family Caregiver Support program
King County Aging and Disability Services: It also serves as the Area Agency on Aging (AAA), and assists Washington Medicare beneficiaries residing in Seattle and the surrounding areas.
The ADS focuses on delivering direct services, advocating for new health legislation, and planning and implementing new programs to address the needs of the elderly and disabled.
The Statewide Health Insurance Benefits Advisors (SHIBA) is a division of the consumer protection services provided by the Washington State Insurance Commissioner. SHIBA provides Washington Medicare recipients with free, objective, and private counseling services. Seniors who are often enroll in Medicare programs themselves provide counseling as volunteers. SHIBA can assist the recipients in Washington in understanding their rights, plan alternatives, and coverage under Medicare. Counselors can offer guidance if fraud or abuse is thought to have occurred.
Who in Washington offers the finest Medicare Supplement?
The type of plan letter determines which Medigap provider is ideal. With a NewMedicare rating of 90 out of 100 in Washington, Cigna was rated as having the best Plan F, G, and N options.
In Washington, how much do Medicare Supplement plans cost?
Depending on the plan you select, Medicare Supplement expenses change. G, N, and F are the most comprehensive plans; their rates vary. Washington’s average monthly expenditures for Plans G, F, and N are $158.50, $184.30, and $164.70, respectively.
What distinguishes Original Medicare from Medicare Advantage?
The majority of Medicare Advantage plans include coverage for the cost of prescription drugs (Part D). Hearing aids, exercise perks, and dental and vision care coverage are just some of the extras that may be covered in certain Medicare Advantage plans. Original Medicare covers everything that is covered by Medicare Advantage. Various plans offer different supplemental benefits and coverages.
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