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Medicare Advantage Plans in Washington

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How Medicare Advantage plans work in Washington

Medicare Advantage (Medicare Part C) is a program that serves as an alternate way to receive your Original Medicare coverage. Medicare Advantage plans are available from private health insurance companies that contract with Medicare in Washington, as they do in other states.

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage plans are required to cover the same benefits as Part A and Part B (except hospice care — Medicare still covers that even when you’re enrolled in a Medicare Advantage plan). And many plans go beyond this coverage and provide benefits like routine vision services, fitness programs, and prescription drug coverage.

There are several types of Medicare Advantage plans, although availability may vary throughout Washington (as it does in other states). For example, there are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. Another example is a plan category called Special Needs Plans (SNPs), which are designed for beneficiaries with specific illnesses or conditions.

Medicare Advantage prescription drug coverage

Some Medicare Advantage plans combine medical coverage and prescription drug benefits into one comprehensive plan. These are called Medicare Advantage Prescription Drug plans, and some may be available in your county in Washington.

No matter what kind of Medicare Advantage plan you might choose, there are a few more things to know about them.

  • You must first enroll in Medicare Part A and Part B to be eligible for a Medicare Advantage plan.
  • You’re still in the Medicare program when you have a Medicare Advantage plan, and you need to continue paying your Part B premium.
  • You must live within the plan’s service area.
  • If you have end-stage renal disease (ESRD), you might not be eligible for Medicare Advantage plans except for a Special Needs Plan — but to find out for sure, you can ask either the plan itself or Medicare (contact information for Medicare is at the bottom of this page).
  • You can’t enroll in a Medicare Advantage plan anytime you’d like, in most cases. There are certain times when you can sign up.

Comparing Medicare Advantage plans in Washington

How do you find a Medicare Advantage plan that may meet your needs? Here are a few things you may want to consider.

  • First, look at more than just a plan’s monthly premium. Some plans may have premiums as low as $0, but there may be other plan costs, such as copayments, coinsurance, and deductibles. These costs may vary among plans.
  • Think about the additional benefits that you’d be likely to take advantage of, such as routine dental coverage or fitness programs. Different plans offer different extra benefits, so you may want to select a plan with the benefits that you prefer.
  • Do you take prescription medications? You might want to make sure you choose a plan that not only offers prescription drug coverage, but covers your medications specifically. Each plan has its own list of covered prescription drugs called a formulary, and these may vary from one insurance company to the next. You may want to make sure a plan’s formulary covers your prescriptions before you sign up. The formulary may change at any time. You will receive notice from your plan when necessary.

Note that not every Medicare Advantage plan is available in every county of Washington, and plan costs may vary as well. You can enter your zip code where indicated on this page to display a list of plan options available in your area.

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