Medicare in Washington: Who’s Eligible, How to Apply, & More

Washington State is a great place to live, with natural beauty and lots of fun activities to do. If you live in Washington and are approaching age 65, you may have questions about Medicare.

Understanding who is eligible for Medicare, how to apply, and how to use your benefits is essential as you get older. You don’t want to delay Medicare enrollment unless you have a qualifying group plan from an employer after age 65.

Here’s what you need to know about Medicare in Washington State.

Does Washington State Have Medicare?

Medicare is a national program that provides health coverage for those 65 and older, as well as Americans with specific health conditions. That means Washington State, as well as all other U.S. states, has Medicare available.

Original Medicare, made up of Parts A and B, is the default Medicare program. If you’d like prescription drug coverage as well, you can add Medicare Part D.

There are approximately 4.6 million people enrolled in a prescription drug plan in Washington and 5.6 million people enrolled in Medicare Advantage.

Some people prefer a Medicare Advantage plan, which is Medicare Part C. This plan replaces Original Medicare and often includes drug coverage and additional benefits as well. However, the plan is sold by private insurance companies and will have a limited medical network, and there may be additional monthly costs as well.

Who is Eligible for Medicare in Washington State?

Medicare provides health insurance for those who are less likely to get coverage from their employers, which includes older Americans and those who are disabled or have serious health issues.

To qualify for Medicare in Washington, you need to be a permanent resident or American citizen who has lived in the U.S. for at least five years.

Also, one of the following must apply:

• You’re age 65 or older
• You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
• You have end-stage renal disease (ESRD)
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

How do I Apply for Medicare in Washington State?

Many Washington residents will be enrolled automatically in Original Medicare when they are eligible. Part A is premium-free for most Americans, and Part B will have a monthly premium.

However, it’s important to review your coverage before simply moving forward with automatic enrollment. Your initial enrollment period has special privileges, such as automatic acceptance for Medigap (Part F) plans that can save you significantly on out-of-pocket costs. To get Medigap, you’ll need to apply for coverage before your initial enrollment period expires.

Learn more about the different enrollment periods in this Medicare guide.

Also, if you want to enroll in a Medicare Advantage plan instead of Original Medicare, you’ll need to do so during your enrollment period.

If you are not automatically enrolled, you’ll need to apply by doing one of the following:

• Contact your local Social Security office
• Call 1-800-772-1213 to enroll over the phone
• If you retired from a railroad, call the Railroad Retirement Board at 1-877-772-5772
• Sign up for Part A online at www.socialsecurity.gov and Part B using Form CMS-40B

After your initial enrollment period, you can only change your Medicare plan once a year during the annual enrollment period, unless you have a life event that creates a special enrollment period. So be sure you get the coverage you need right away!

What is the Medicare Savings Program in Washington State?

The Medicare Savings Programs (MSP) are four options that allow those with lower incomes and assets to better afford their Medicare costs.

The most comprehensive is the Qualified Medicare Beneficiary program (QMB). This program helps pay for Part A and B premiums, deductibles, coinsurance, and copayments. You qualify for this program if you have monthly earnings under $1,094 for an individual ($1,472 for a married couple), and assets under $7,970 ($11,960 for a married couple).

There is also a Specified Low-Income Medicare Beneficiary program (SLMB), which has slightly higher income and asset limits and pays for Part B premiums only. The Qualifying Individual program (QI) has higher limits than SLMB and also only pays for Part B premiums.

If you qualify for the QMB, SLMB, or QI programs, you will also get extra help with your Medicare Part D costs.

The final Medicare Savings Program is for those who are disabled but able to return to work. This can cause you to lose your Social Security disability benefits and premium-free Medicare Part A. The Qualified Disabled and Working Individuals program (QDWI) has fairly high income and asset limits and helps pay for Part A premiums.

Is Medicare Mandatory in Washington State?

Medicare is never mandatory, but if you decline to enroll when you are eligible and then change your mind and decide to use it later, you could pay much higher premiums as part of the late-enrollment penalty.

Because Medicare Part A is premium-free for most people, it makes sense to enroll in that as soon as you are eligible. Medicare Part B can be delayed if you are still working and have a qualifying group plan from an employer. When your employment ends, you can enroll in Medicare Part B without a penalty.

You can have Medicare Part A and not use it, and simply decline Medicare Part B even if you aren’t working. However, it may be expensive to get Medicare Part B later if you want it. If you want to completely reject all Medicare and not use it at all, you also have to reject your Social Security retirement benefits.

In most cases, it’s better to enroll when you are eligible unless you have insurance through your employer and don’t need Part B until later.

Does Washington State Have Medicare Advantage Plans?

Washington State does have a variety of Medicare Advantage plans, known as Medicare Part C. Medicare Advantage in Washington will vary depending on the private insurer who offers it, so be sure to compare different plans before making your final decision.

Medicare Advantage completely replaces Original Medicare and often includes additional benefits and prescription coverage as well. Many times, you can get these plans for no more than you were paying each month for Medicare Part B, although some plans may have an additional premium.

However, it’s important to keep in mind that Medicare Advantage plans are generally limited to a local medical network, and you may not be able to get non-emergency medical care outside of that area. That means if you travel often you might prefer to keep the national Original Medicare coverage instead. Learn more about the differences between [Original Medicare and Medicare Advantage].

What is the Best Medicare Advantage Plan in Washington State?

The best Medicare Advantage plan is the one that gives you the coverage you need at a price that makes sense for your budget. Many people choose an Advantage plan because they enjoy having predictable costs, rather than paying 20% as you do with Original Medicare.

You’ll want to compare plans based on the medical providers they include, the drugs they cover, and the extra benefits you can receive. Getting vision and dental coverage can be a significant bonus over Original Medicare, as long as it is comprehensive enough for your needs. Once you find a plan that works for you, enroll. Then compare your options again each year to make sure you’re still getting the best coverage for your money.

Contact Us to Learn More About Medicare in Washington

This guide was designed to answer common questions about Medicare in Washington State, but you may still have questions or concerns. It can be helpful to talk to a licensed insurance agent to compare plans and get advice. For assistance choosing your Medicare plan, contact us today!