Medicare in Washington

Medicare is a federal health insurance system that provides affordable care for seniors aged 65 and older, in addition to younger adults with specific disabilities or permanent kidney failure. It’s separated into several parts that help cover the costs of medically necessary health care services. 

Many people in Washington use Original Medicare, which is divided into Part A and Part B. While Part A covers inpatient services, such as hospital stays, and is typically premium-free, Part B is for outpatient services, such as doctor visits and lab tests, and requires a monthly premium of $164.90 to be paid, as of 2023. In comparison, Medicare Advantage (Part C) enables individuals to access Part A and Part B through private health insurance companies and usually includes Part D coverage, helping pay for prescription drugs. Some insurers also offer extras with these plans, covering things Original Medicare doesn’t.

Medicare Advantage Plans are highly popular in Washington. In 2023, 1,481,582 people were eligible for Medicare in the state, representing over 19% of the total population and a 2.51% increase in eligible residents compared to 2022. Of these individuals, 45% were enrolled in Medicare Advantage, up 10.58% from the previous year, but total enrollment was still three points below the national average. The federal government spends approximately $829.9 billion per year on Medicare as of 2023 and spent $10,191 per person as of 2020. Washington’s total spend is a little below average, at $9,265 per person.

The information in this guide helps seniors living in Washington understand their Medicare eligibility, coverage and associated costs. It also includes a list of nonprofit agencies that provide free resources to help seniors choose the correct health insurance and care for their needs.

Options for Medicare Coverage in Washington

Original Medicare may be the most popular choice for seniors to manage their benefits, but it isn’t the most appropriate path for every older adult. Washington’s seniors have several options available to help them build a care plan that works best for them. Available plans may include Original Medicare, Medicare Advantage, Medigap and other privately issued supplemental policies.

Original Medicare (Parts A & B)

Under Original Medicare, seniors pay for services as they receive them and must pay an annual deductible. The deductible in 2023 for Part A was $1,600 for the first 60 days of hospital care in a benefit period, while Part B’s deductible is $226. Part B also requires payment of a monthly premium of $164.90. Beneficiaries typically pay 20% out of pocket for most eligible services, with Medicare covering the other 80% of the cost.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage Plans fall into four main categories, including Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Private Fee For Service (PFFS) and Special Needs Plans (SNPs). While each Medicare Advantage Plan provides the same benefits as Original Medicare, some require seniors to receive care from a designated provider network. Eligibility rules, deductibles, premiums and other costs can also vary between plans.

More information about Medicare Part C plans in Washington is also available on the Medicare Coverage Options page. 

Who Should Consider Medicare Advantage 

Medicare Advantage may be a good option for those who: 

• Want more control over out-of-pocket medical expenses
• Need additional benefits such as prescription drug coverage and dental care 
• Are generally healthy and may benefit from low premiums 

The Top 10 Medicare Advantage Plans in Washington

Medicare Advantage providers are licensed to operate on a state-by-state basis. Washington seniors have several plans available to choose from. The table below lists some highly rated Medicare Advantage plans available in Washington, based on the number of residents enrolled in them. More information on Medicare Part C plans in Washington is available on the Medicare Advantage Plans in Washington page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Washington

It can be a challenge for seniors to navigate the complex web of Medicare Part C and Medigap options that are open to them, especially when they’re new to the programs. Fortunately, multiple state and nonprofit agencies are available to help Washington seniors find and apply for the benefits they may be eligible for, as well as to provide help with applications and appeals. Some agencies also offer referrals for professional help and financial assistance, especially with premium and prescription drug coverage.