Washington Medicare Supplement Plans (Medigap)
Washington Medicare Supplement plans were created to work with Medicare to supplement your Original/Traditional Medicare coverage. These plans were created to provide coverage for what’s not covered by Original Medicare. This includes out of pocket expenses such as deductibles, copayments and coinsurance.
Medigap policies are the same as Medicare Supplement plans, but are offered by private insurance companies. Washington Medicare coverage benefits are broken down into parts and plans.
Washington Medicare Plans & Benefits Explained
Original Medicare Part A offers inpatient hospital care. Through Part B, physician services and some medical equipment is covered. This Federal Medicare coverage is what people are referring to when they say “Original Medicare.”
In Washington, Medicare Advantage plans are available, but keep in mind that all of the plans aren’t available in every Washington county. If you choose a Medicare Advantage plan, you will still need to pay your Medicare Part B premium. There’s also many limits, including network limits, with Advantage plans.
Medicare Part D
Medicare Part D offers the prescription benefits that none of the Medigap plans provide. Private insurance companies offer Medicare Part D Prescription Drug Plans, which are Medicare-approved plans. These stand-alone drug plans are a way to add prescription drug coverage to Original Medicare, Part A, and Part B insurances.
Washington Medicare Supplement Plans
Medicare Supplement plans, also referred to as Medigap plans, cover some out-of-pocket costs such as deductibles and copays that you would experience with an Original Medicare plan. Washington can provide up to 10 Medicare Supplement plans.
These plans are all designated by a letter of the alphabet, A through N. Because these letter designations are standardized by Medicare, it makes for easier comparison shopping. No matter where you purchase the plan, the plans with the same alphabet letter designation will offer the same coverage.
For example, there are 10 companies in Washington that sell Plan C. All offer the same benefits, no matter where you purchase the plan from. There are five companies that offer Plan B, and again, all of these plans will offer the exact same benefits. The only difference is the cost the company chooses to charge you for that letter plan.
Benefits Covered by Washington Medicare Plans
Under Original Medicare, Part A insurance offers hospital coverage that includes:
- hospital stays
- any imaging or diagnostic testing performed
- medications and medical supplies used all while being an inpatient
- skilled nursing facilities
- some home health care
- Hospice care
- doctor visits
- clinic services
- lab work
- preventive care services
- physical and occupational therapy
- care you receive as an outpatient in the ER or an ambulatory service center
- any imaging or diagnostic testing required
- home health care
- durable medical equipment
Both Part A and Part B cover 80% of the costs of the above services. This leaves you to cover the remaining 20% of costs, as well as any out of pocket costs. This is why it’s so important to have a Medigap plan to cover the 20% gap in coverage.
Eligibility for Medigap Insurance in Washington
In order to enroll in Washington Medicare Supplement Plans, you need to be at least 65 years old and enrolled in Medicare Part B. As soon as you’re eligible for Medicare Part B, you should sign up in order to avoid the Part B late penalty. You can read more about the Part B late penalty here.
Medicare Eligibility in Washington When You’re Under 65
In some cases, you can receive Medicare Part A and Part B in Washington before you’ve turned 65. After you receive disability benefits from Social Security, or 24 months’ of certain disability benefits from the Railroad Retirement Benefits, you will automatically receive Medicare Part A and Part B.
Some states require carriers to offer Medicare supplement plans to those on disability under 65. However, Washington isn’t one state with that requirement. However, some carriers may still make the plans available to beneficiaries on disability under the age of 65. Please call for more information on plans available in Washington to those under 65 who are on disability.
How to Enroll in Medicare Supplement/Medigap in Washington
In Washington, your Open Enrollment Period will begin on the first day of the month that you are 65 or older AND your Medicare Part B has become effective.
If you turned 65 on October 31st and your Medicare Part B went into effect on November 7th, then your Open Enrollment Period begins on December 1st. Your Open Enrollment Period will remain effective for 6 months, and you are granted Guaranteed Issue during this time.
Guaranteed Issue is vital because it means that insurance companies can’t turn down your application for a Medigap policy, even if you have pre-existing conditions.
Even if you’ve missed your Open Enrollment Period, you can enroll in a Medigap plan anytime. However, if you’re shopping outside of your Open Enrollment Period and no longer have the protection of Guaranteed Issue, then you will be subject to the guidelines that each insurance company has regarding pre-existing conditions.
Some companies have no pre-existing condition limitations. While others may require you to wait for up to six months before you can receive coverage for your condition.
Premiums for Washington Medicare Supplement Plans
There are many factors that affect the premiums for Washington Medicare plans. Insurance companies all sell the same plans, but the costs of those plans will vary from company to company. Because these rates vary from company to company, you will need to call around in order to find the best rates.
There are other variables that can cause your premiums to increase, including your age, sex, and location. For instance, a plan in Seattle, Washington will not cost the same as a plan in Spokane, Washington.
To determine premiums, each insurance carrier uses 1 of 3 rating systems. These include community rated, issue age rated, and attained age rated systems. You can read more about them here.
The Best Medicare Supplement Plans in Washington
- Plan F: Plan F tends to be a more popular plan, as it includes coverage for your Medicare Part A & B deductibles, copayments, and coinsurance. If you travel, this plan also offers foreign travel emergency coverage. Other benefits include skilled nursing care and coverage for Medicare Part B excess charges.
- Plan N: Plan N is another popular Medigap plan in Washington. Plan N offers the same coverage as Plan F, except for covering the Medicare Part B deductible. This plan also won’t cover any excess charges. Be aware that some office visits and emergency room visits will require a small copay.
- Plan G: Almost as popular as Plan F, Plan G offers the same coverage but doesn’t cover your Medicare Part B deductible. However, Plan F does cover any Part B excess charges that you may incur.
Remember that all of these plan benefits will be the same, regardless of which carrier you purchase your coverage from. The only difference in the plans is the cost that the carrier charges you.
In other words, Plan N in Seattle, Washington, can cost more or less compared to the same plan in Spokane, Washington, but the benefits offered by the plans will be the same.
Washington Medicare Advantage Plans
Medicare Advantage plans in Washington are offered through private insurers. A Medicare Advantage plan covers both Medicare Part A and Part B. However, there are some limitations to be aware of.
Limitations such as restrictions on in-network doctors, cancellation restrictions, and coverage limitations negate some of the apparent advantages of purchasing a Medicare Advantage plan.
If you have an Advantage plan, you can’t sign up for a Medigap plan, and will have higher out-of-pocket costs with the Advantage plan in the end.
Washington Medicare Part D Prescription Plans
Because Original Medicare and Washington Medicare Supplement Plans don’t offer drug prescription coverage, it’s recommended that you purchase a Medicare Part D prescription plan.
This policy covers most medications that your doctor will prescribe, except for any medications that are over-the-counter. By combining Original Medicare, a Medigap policy, and a Prescription Drug Plan, you will have comprehensive coverage to cover most of your health care costs.
You should enroll in a Medicare Part D plan as soon as you are enrolled in Medicare. If you wait, you may incur a Part D penalty, which is based on the number of months that you did not have coverage.
If you are enrolled in Medicare, you need to consider how you’ll pay for health care costs that your Original Medicare plan doesn’t cover. Remember, if you just have Original Medicare, then 20% of your costs will not be covered.
Signing up for a Washington Medicare Supplement plan and Part D PDP plan can give you the additional coverage you need to know that your costs will be covered.
It’s peace of mind for you and your family. It means that you’ll be able to get the health care that you need and deserve.
In order to enroll in Washington Medicare Supplement Plans, to compare rates, or to get more help, please fill out the form on this site or call the number above.
Medicare Resources in Washington
Washington has a Medicare Savings Program which helps Medicare beneficiaries to cover the high cost of health care. Washington also has a SHIP center, which can provide residents with counseling on healthcare insurance policies and benefits.
State Specific FAQs:
- Can you use Medicare for oral surgery in Seattle Washington? While Medicare doesn’t cover routine dental care, you can supplement it with a separate dental insurance policy so you have coverage for oral surgery.
- Where can I compare Medicare Supplement plans in Washington? You’ve already come to the right place. We are happy to help you compare Medicare Supplement plans. Please fill out the form on this site or call us at the number above for help understanding the different plans.
- Does the Washington state health exchange offer Medicare Supplement plans? The Washington state health exchange helps people to shop for the insurance plans that are right for them.