Speak to a Licensed Sales Agent
Call Now 1-888-992-0738 TTY: 711
M-F 9am-8pm EST
Customer ID

Washington State FlagMedicare Part D Plans in Washington

In 1965, President Johnson signed legislation that created the Medicare program. However, it did not include prescription drug coverage until 2006, thanks to the passage of the Medicare Modernization Act (MMA). This legislation introduced both Medicare Advantage (Part C) and prescription drug coverage (Part D). This page explains Medicare Part D in Washington.

How Can You Get Medicare Part D in Washington?

You have two Medicare Part D options in Washington, a standalone Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug plan (MA-PD).

Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Medicare Advantage plans provide the same benefits as Original Medicare, but most MA plans also offer additional coverage. The most common add-ons are fitness programs, prescription drug coverage, and routine vision and dental care.

You may add a standalone Part D plan to either Original Medicare or an MA plan that does not cover prescription drugs. (Only around 10 percent of MA plans do not include Part D benefits.)

Medicare Advantage Prescription Drug plans combine your Original Medicare and Part D benefits into a single policy often referred to as an all-in-one plan.

You cannot combine a standalone Part D plan with an MA-PD plan.

Who Is Eligible for Medicare Part D in Washington?

As long as you have Medicare Part A and/or Part B, you are eligible for Medicare Part D in Washington. Most Part D plans also require beneficiaries to live in the plan's service area.

As long as you are a U.S. citizen or permanent legal resident, you will become eligible for Medicare when you turn 65. However, enrollment in Parts A and B is not automatic unless you begin receiving Social Security benefits at least 4 months before your 65th birthday. If you haven't retired yet, you'll have to apply for Medicare through Social Security.

You may qualify for Medicare before turning 65 if you collect Social Security disability benefits for 24 months. In this case, you will be automatically enrolled in Parts A and B during your 25th month.

Nobody is automatically enrolled in a Medicare Part D prescription drug plan, even if they receive Social Security benefits.

When Can You Join in a Prescription Drug Plan in Washington?

You may join a Part D prescription drug plan in Washington during certain times known as enrollment periods.

  • Initial Enrollment Period: Your IEP starts 3 months before the month you become eligible for Medicare and lasts for a full 7 months. So, if month 25 of collecting disability benefits or your 65th birthday occurs in June, your IEP begins on March 1 and ends on September 30. Once you enroll in Part A and/or Part B, you can sign up for a prescription drug plan.
  • General Enrollment Period: If you missed your IEP and do not qualify for a Special Enrollment Period (SEP), you can sign up for Medicare Part A and/or Part B during General Enrollment between January 1 and March 31. After that, you can join a prescription drug plan between April 1 and June 30.
  • Medicare Annual Enrollment Period: AEP lasts from October 15 and December 7 and is available to current Medicare beneficiaries. You can make any change to your Medicare coverage that you need to during Annual Enrollment, including joining an MA-PD or Part D plan.
  • Medicare Advantage Open Enrollment Period: Between January 1 and March 31, Medicare Advantage beneficiaries may either switch to a new MA plan or return to Original Medicare. If you to lose your prescription drug coverage due to making that change, you may also join for a standalone Part D plan during Open Enrollment.
  • Special Enrollment Periods: Special circumstances, like moving or losing your current coverage, may qualify you for a Special Enrollment Period. Find the full list of qualifying special circumstances on Medicare.gov.

How to Compare Medicare Part D Plans in Washington

Private insurance companies provide Medicare prescription drug plans in Washington, which means coverage and costs can vary widely. Comparing your Part D options carefully helps ensure you get the best prescription drug plan for your unique needs.

Step one is reviewing the plan's drug formulary, which is the list of medications the plan covers. If the formulary doesn't include one or more of your prescriptions, look for another plan.

Once you find a plan that covers your medications, you can look at costs. Medicare Part D out-of-pocket costs may include:

  • Annual deductible
  • Monthly premiums
  • Copays or coinsurance

To estimate your copayments, look at the plan's drug tiers. Drugs on a lower tier cost less than medications on upper tiers do. So, whichever tiers your prescriptions are on helps you estimate what your copayment or coinsurance would be for that medication.

You may qualify for Extra Help if your income and resources are limited. Usually, Medicare or Social Security will notify you via mail if you qualify. However, if you believe you meet the requirements for Extra Help but did not receive notification from either program, you should call your plan provider.

Please remember that all communications from both Medicare and Social Security are via U.S. mail. If you receive a call from someone who claims to work for either Medicare or Social Security, hang up the phone. Then, call the appropriate program (1-800-MEDICARE or 1-800-772-1213) and explain what happened.

Do You Have to Have Medicare Part D in Washington?

No part of Medicare is mandatory in Washington, including Part D. However, if you go 63 days or more without creditable prescription drug coverage, you may have to pay the Medicare Part D late enrollment penalty for the entire time you have Part D (whether it's a standalone or MA-PD plan). To be considered creditable, the plan must offer comparable benefits to what you'd get with Medicare Part D and at a similar price.

Find a Plan today!
Call a Licensed Sales Agent

1-888-992-0738 TTY User: 711

M-F 9am-8pm EST