Medicare Advantage plans are becoming more and more popular, and with the variety of benefits and plan offerings, it makes sense. Here is what you need to know about Medicare Advantage plans in Washington.

What is Medicare Advantage in Washington?

Medicare Advantage, or Medicare Part C, are Medicare plans offered by private insurers. All MA plans offer at least the same level of coverage as Original Medicare (Part A and Part B). Part A covers inpatient services and Part B covers outpatient services. Note that Original Medicare does not cover prescription drugs, those benefits come from Medicare Part D.

However, most Medicare Advantage plans offer comprehensive benefits in addition to those offered by Original Medicare, such as dental, vision, and prescription drug coverage.

Washington Medicare Advantage plans with prescription drug coverage

Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug (MA-PD) plans. They are also referred to as "all-in-one" policies, since they combine Parts A, B, and D in a single policy.

MA plans often include fitness programs, hearing aids, and other benefits in addition to the standard Medicare offerings. It is important to note that Medicare Advantage plans are provided by private insurance companies, so benefits and costs will vary.

How do you qualify for Medicare Advantage in Washington?

Once you have enrolled in Medicare Part A and Part B, you qualify for Medicare Advantage. All American citizens and permanent residents 65 and older may enroll in Medicare. You are automatically enrolled if you began collecting Social Security benefits at least 4 months before your 65th birthday. If you qualify for Medicare due to disability or collect Railroad Retirement Board (RRB) benefits, you are automatically enrolled in your 25th month of collection benefits.

When can you sign up for a Medicare Advantage plan in Washington?

You can sign up for Medicare during the following periods:

  • Initial Enrollment Period (IEP): Everyone's IEP is unique to them, and starts three months before the month of your 65th birthday and lasts the following three months for a total seven-month period.
  • General Enrollment Period (GEP): You can sign up for Original Medicare during this time, between January 1 and March 31. After, from April 1 through June 30, you can join Medicare Part C.
  • Annual Enrollment Period (AEP): Between October 15 and December 7, current Medicare enrollees can make a number of coverage changes, including switching to an MA plan.
  • Medicare Advantage Open Enrollment Period (OEP): If you already have Medicare Part C, from January 1 to March 31 you can switch to Original Medicare or join a different MA plan.

To sign up if you miss these time frames, you would need to qualify for a Special Enrollment Period (SEP). You can see a full list of special circumstances here.

Types of Medicare Advantage plans in Washington

Washington has four types of Medicare Advantage plans:

  • Health maintenance organizations (HMO): These plans have a provider network and often require you to pay the full cost of any out-of-network non-emergency visits. They also typically require people to pick a primary care physician and get referrals for any specialist visits.
  • Preferred provider organizations (PPO): Though PPO plans also have a provider network, out-of-network visits usually only require a higher copay. These plans do not require choosing a primary care physician or specialist referrals.
  • Private fee-for service (PFFS): These plans have set costs for any covered services. They also generally have a provider network, but members can go out-of-network for a higher cost.
  • Special needs plans (SNP): As the name suggests, SNPs are for those that meet certain criteria. Having a chronic condition (i.e, diabetes), requiring in-home care, or having dual eligibility for Medicare and Medicaid are all qualifying circumstances.

How to choose a Medicare Advantage Plan in Washington

There are four main things to consider when looking for a Medicare Advantage plan:

  • Cost: Look at your total out-of-pocket costs, such as annual deductibles, copays, and monthly premiums
  • Network: Check which hospitals, labs, and physicians are in a plan's network
  • Ratings: Every fall, Medicare publishes plan ratings to help people compare their options
  • Scope of coverage: Benefits vary based on plan and provider, so be sure to thoroughly compare options. Always check the formulary for an MA-PD plan

The easiest way to compare Medicare Advantage plans in Washington is with our Find a Plan tool. Simply enter your location information to start looking at plans in your area.

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