Jane Dotson
Medicare is federal health insurance for people aged 65 and older, or those under 65 who are on Social Security Disability Income or diagnosed with certain diseases. In Washington, Medicare Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be high. Washington's Medicaid program assists residents facing financial hardship or disability, regardless of age, and it's possible to be on both Medicaid and Medicare simultaneously. Original Medicare includes Parts A and B, with the option to add Part D and Medigap coverage from private insurance companies. Part D provides coverage for prescription medications, while Medigap helps cover additional out-of-pocket expenses.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare in Washington? | People aged 65 and older, under 65 on Social Security Disability Income, or diagnosed with certain diseases. |
| What does Original Medicare include? | Part A (hospital insurance) and Part B (medical insurance). |
| What does Medicare Advantage (Part C) include? | An alternative to Original Medicare, with options for dental, vision, and hearing coverage. |
| What is Part D? | Coverage for prescription medications. |
| What is Medigap? | Supplemental insurance to cover additional out-of-pocket expenses, such as deductibles, copayments, and coinsurance. |
| How many plans are available in Washington? | 152 Medicare Advantage plans, 14 prescription drug plans, and 12 Medigap plans. |
| How much does it cost? | Monthly premium costs for Medicare Advantage plans in Washington have decreased. There were 14 stand-alone Medicare Part D prescription drug plans available in Washington in 2025, with monthly premiums starting at $0 per month. |
| Where can I get more information and support? | SHIBA (Statewide Health Insurance Benefits Advisors) volunteers and the Senior Medicare Patrol (SMP) can help beneficiaries, their families, and caregivers with queries and concerns. |
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What You'll Learn
Medicare Advantage plans
Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your original Medicare coverage. They are plans offered by private, Medicare-approved insurance companies and include coverage for hospitalizations and doctor visits like original Medicare Parts A and B.
To find the best plan in Washington, you can refer to sources that gather all the necessary information. The federal government-led Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage plans on their overall performance using a five-star system.
You can also contact SHIBA, the Washington Statewide Health Insurance Benefits Advisors, with questions related to Medicare coverage in Washington. The Medicare Rights Center offers a comprehensive national website and a helpful call center that can provide assistance with Medicare-related questions.
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Supplemental insurance plans
Medicare is federal health insurance for people aged 65 and older, or those under 65 who are on Social Security Disability Income or diagnosed with certain diseases. In Washington, Medicare beneficiaries can access a range of supplemental insurance plans, also known as Medigap plans, to fill in the gaps in their Original Medicare coverage. These plans are provided by private companies and are not connected with the federal government or the Medicare program.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). If you have Original Medicare, you can enrol in a Medigap plan to help cover additional out-of-pocket expenses such as deductibles, copayments, and coinsurance. These plans do not provide health insurance coverage but rather supplement your existing Medicare coverage. In Washington, there are 12 different Medigap plans available, and each plan establishes its own cost and coverage amounts.
When choosing a Medigap plan, it is important to compare company reputations, benefits, and pricing across different plan types. Some popular Medigap providers in Washington include Premera, Cigna, and Regence, with Premera offering pricing that is 31% lower than the state average for Plan G, the most popular plan nationwide.
It is also worth noting that Washington has maintained its pre-Affordable Care Act (ACA) high-risk pool (WSHIP), which serves as an option for disabled Medicare beneficiaries. Additionally, Washington's Medicaid program assists residents facing financial need or disability, regardless of age, and it is possible to be enrolled in both Medicaid and Medicare simultaneously.
If you have questions related to Medicare coverage in Washington, you can contact SHIBA (Statewide Health Insurance Benefits Advisors).
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Eligibility requirements
Medicare is a federal health insurance program designed primarily for Americans aged 65 and over. However, those under 65 may be eligible for Medicare if they have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
To be eligible for Medicare in Washington, you must be a US citizen or a permanent resident of at least five years. Additionally, you should be 65 or older. If you are under 65, you may still qualify for Medicare if you have a disability or specific medical conditions.
Medicare Part A, which covers hospitalization, home or skilled nursing, and hospice care, is typically "premium-free." You won't pay a premium for Part A if you receive retirement or disability benefits from Social Security or the Railroad Retirement Board, or if you are under 65 and meet certain medical criteria.
For Medicare Part B, which is medical insurance, you will likely pay a premium every month, and the amount may vary based on your income.
Medicare Part C, also known as Medicare Advantage, is a private insurance option that covers hospital and medical costs, and may include additional benefits like dental, vision, and hearing coverage. The premiums for Part C plans vary depending on the specific plan chosen.
Medicare Part D covers prescription medications, and like Part C, you may need to pay a premium for this coverage.
It's important to note that Washington offers a range of Medicare Savings Programs with different eligibility criteria, including income and asset limits. These programs can provide financial assistance to Medicare enrollees and help with costs associated with premiums, deductibles, coinsurance, and copayments.
Additionally, Washington's Medicaid program, known as Apple Health, provides health insurance coverage for qualifying individuals, including children, pregnant women, parents, seniors, and individuals with disabilities. Eligibility for Apple Health is determined by factors such as income, household size, health status, and immigration status.
To determine your specific eligibility for Medicare and its various parts, as well as to explore the Medicare Savings Programs and Apple Health in more detail, you can refer to the official websites of Medicare, Social Security Administration, and Washington State Health Care Authority.
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Medicare counseling sessions
Medicare is federal health insurance for people aged 65 and over, those under 65 on Social Security Disability Income, or those diagnosed with certain diseases. Washington state consumers can find information about Medicare Advantage plans and SNPs, including prices, by searching for plans in their county.
The Medicare Advantage Open Enrollment Period, from January 1 to March 31, allows those already with Medicare Advantage plans to switch to a different Medicare Advantage plan or Original Medicare. Medicare Advantage plans are available to anyone eligible for Medicare, and premiums are not higher for those under 65. However, these plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be high.
Original Medicare does not cover outpatient prescription drugs, so many beneficiaries have supplemental insurance coverage. Medicare beneficiaries who do not have prescription drug coverage may need to obtain Medicare Part D prescription drug coverage. This can be purchased as a stand-alone plan or as part of a Medicare Advantage plan. There were 14 stand-alone Medicare Part D prescription drug plans available in Washington in 2025, with monthly premiums starting at $0 per month.
Medicare beneficiaries can also save on prescription drugs by choosing extra coverage from approved Part D plans. The Medicare Savings Program helps people on Medicare pay for all or part of their premiums. Many Medicare beneficiaries also receive financial assistance through Medicaid for the cost of services that Medicare doesn't cover, such as long-term care.
Medicare is a common health insurance in Washington, and therapists who are in-network with Medicare are available. Each session with an in-network therapist requires only a copay, which typically ranges from $0 to $75 per session. Depending on the plan, the provider's full session fee may need to be paid until the annual deductible is met.
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Medicare fraud protection
Medicare is federal health insurance for people aged 65 and over, those under 65 on Social Security Disability Income, or those diagnosed with certain diseases. In Washington, Medicare beneficiaries can receive financial assistance through Medicaid for costs that Medicare doesn't cover, such as long-term care.
Medicare fraud and abuse can occur anywhere and often results in higher healthcare costs and taxes. Medical identity theft is a serious crime that happens when someone uses your personal information without your consent to commit Medicare fraud or other crimes. To protect yourself from becoming a victim of Medicare fraud, you should:
- Protect your personal information and only give your Medicare card, Medicare Number, Social Security card, or Social Security Number to authorized individuals, such as your doctor or insurers acting on your behalf.
- Compare the dates and services on your calendar with your Medicare statements to ensure you received each listed service and that all the details are correct.
- Check your receipts and statements from providers for mistakes and contact their office if you suspect an incorrect charge.
- Familiarize yourself with how Medicare uses your personal information and what a Medicare health or drug plan can and cannot do before you join.
- Remember that Medicare will never call to sell you something or visit you at home. They will only call and ask for personal information in limited situations, such as returning your call after you've joined a plan, reported fraud, or left a message.
If you suspect Medicare fraud, you can call 1-800-MEDICARE (1-800-633-4227) or report it online. For those with a Medicare Advantage Plan or Medicare drug plan, you can also contact the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX. Additionally, Washington's Statewide Health Insurance Benefits Advisors (SHIBA) and the Senior Medicare Patrol (SMP) help Medicare beneficiaries, their families, and caregivers prevent, identify, and report Medicare fraud.
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Frequently asked questions
Medicare is federal health insurance for people aged 65 and older, or those under 65 who are on Social Security Disability Income or diagnosed with certain diseases.
In Washington, Medicare offers Part A (hospital insurance) and Part B (medical insurance), known as Original Medicare. Part C, or Medicare Advantage, is an alternative to Original Medicare and offers more affordable plans. Medicare Advantage plans may also include dental, vision, and hearing coverage, as well as travel coverage. Additionally, Medicare Part D provides coverage for prescription medications.
Washington's Statewide Health Insurance Benefits Advisors (SHIBA) can help you understand the different parts of Medicare, assess your needs, and enroll in the most suitable plan. You can also contact the Senior Medicare Patrol (SMP) to help prevent, notice, and report Medicare fraud.
