Washington Medicare

Medicare Advantatge Information for Spokane County, WA

Medicare Advantage Plans in Washington: What You Need to Know

This website is here to provide you with clear and accurate information about your Medicare Advantage options, starting with this quick guide to the facts you should know:

Medicare Advantage is an alternative to Original Medicare.

To get a Medicare Advantage plan, you must purchase if through a private insurance company approved by Medicare. When you join a Medicare Advantage plan, you leave Original Medicare, but you’re still in the Medicare program. You must usually use the doctors, hospitals, and other providers in your plan’s network. 

For more information about the five different kinds of Medicare Advantage plans, see Types of Medicare Advantage Plans.

For help choosing the best plan for you, see How to Compare Medicare Advantage Plans.

When you're ready to start shopping, you can use our plan comparison page to find the Medicare Advantage plans available in your area.


How Do I Sign Up for Medicare Advantage in Washington?

Every Medicare Advantage Plan (Medicare Part C) comes with its own set of costs, benefits, and limits. You can use our plan comparison page to review and evaluate the Washington Medicare Advantage plans available in your area. After you choose a plan, you can sign up for it using the steps described in this article. We cover:

How to Enroll in a Medicare Advantage Plan 

When You Can Join Medicare Advantage

Special Enrollment Periods for Medicare Advantage


How Much Does Medicare Advantage Cost in Washington?

A Medicare Advantage plan (Medicare Part C) is a plan approved by Medicare but offered through a private insurance company. The plan must cover everything you get from “Original Medicare” (Medicare Parts A and B) but may also include additional coverage benefits, such as prescription drugs, dental care, vision or hearing care, and health wellness programs.

What You Pay for Medicare Advantage

What you will pay for your Washington Medicare Advantage plan depends primarily on the following factors:

  • whether the plan charges a monthly premium (usually you must pay your Part B premium plus an additional monthly premium for the plan — for 2106 most people pay at least the Part B premium of $104.90 per month)


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What Does Medicare Advantage Cover in Washington?

Federal law requires every Medicare Advantage plan to cover the services offered by Original Medicare, also called Medicare Part A and Medicare Part B. Usually, however, Medicare Advantage covers more than Original Medicare, including prescription drug benefits, eyeglasses, hearing aids, and dental visits, plus coverage for health and wellness programs. 

You can use our plan comparison page to find plans in your area of Washington and learn about exactly what each plan covers.

Typical Medicare Advantage Benefits

Here’s a list of what’s covered by a typical Medicare Advantage plan:

  • Doctor visits. For full coverage, Medicare Advantage Plans require you to use providers in their network. Most plans charge a small copayment for doctor and specialist visits.
  • Outpatient services.  Most plans charge a copayment and then cover all costs of services like x-rays, lab tests, and outpatient surgery.
  • Hospital stays. You must use network providers. Most plans charge a copayment but otherwise cover the full cost of inpatient hospital care. more...  
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How to Compare Medicare Advantage Plans

After you identify the Medicare Advantage plans available to you, you have a little more research to do. You’ll want to consider your health needs and your budget when choosing the best plan. Here are some things to think about:

  • What is the plan’s quality rating? Medicare rates plans for quality based on a scale of one to five stars. We include the rating for each plan on our plan comparison page. Star ratings take into account factors like customer service, member complaints, and quality of care, including managing chronic conditions. Highly rated plans (four or five stars) get extra government money to enhance your medical benefits.
  • What is the monthly premium? If it’s low, is the plan really a good deal? Remember that even a plan with no monthly premium isn’t free: you must continue to pay your Medicare Part B premium, plus any copayments, deductibles, or other payments required by the plan. 
  • What are the plan’s additional costs—copays, deductibles, annual out-of-pocket limits? Find out what you’ll have to pay to see a doctor or stay overnight the hospital. Pay attention to the out-of-pocket maximum. After you reach this yearly spending amount, the Medicare Advantage Plan pays for 100% of covered costs for the rest of the year. If you can’t afford that amount, you might consider reducing it by choosing a plan with a higher monthly premium.  more...  

How to Switch Medicare Advantage Plans

If you’re already enrolled in a Medicare Advantage Plan and you want to switch to a different one — or change back to Original Medicare — what should you do?

Changing to a New Medicare Advantage Plan

To change plans, all you need to do is join the new plan during one of the enrollment periods available to you. You’ll be dropped from your old plan as soon as your new coverage begins.

The normal period for switching plans is October 15 to December 7 of each year, but certain circumstances may qualify you to switch at another time. For more information, see How to Sign Up for Medicare Advantage in Washington.

You can use our plan comparison page to find and evaluate Medicare Advantage plans in your area.

Switching Back to Original Medicare

To change back to Original Medicare -- that is, Medicare Part A and Part B -- contact your current plan provider or call 1-800-MEDICARE (1-800-633-4227). If you make this change, you should also consider purchasing Medicare prescription drug coverage, known as Medicare Part D.

There are two main enrollment periods you can use to switch from Medicare Advantage to Original Medicare. You can use the normal open enrollment period that runs from October 15 to December 7 of each year, or you can use the special “disenrollment” period from January 1 through February 14.


Rules Your Medicare Advantage Plan Provider or Agent Must Follow

Among your many Medicare rights is a long list of rules that plan providers and agents must follow when they interact with you. To be a savvy plan shopper, you should familiarize yourself with these guidelines.

If a plan or agent doesn’t follow the rules, you’ll know to avoid that provider — and you may also want to report the violation.

Rules for Medicare Advantage Plans

Companies that provide Medicare Advantage plans may not:

  • request personal information over the phone, including your Social Security Number, bank account number, or credit card information
  • show up at your home uninvited 
  • call you, unless you are already a plan member
  • require you to speak to a sales agent to get basic details about the plan
  • offer you cash or gifts worth more than $15 to join a plan
  • give you free meals as part of a sales pitch
  • sign you up for a plan over the phone, unless you call them and say that's what you want
  • request payment online or over the phone (the plan must send you a bill in the mail)
  • claim they are selling Medigap (supplemental insurance) plans
  • sell you any product that is not directly related to health — such as life insurance or an annuity — while trying to sell you a Medicare Advantage plan more...  

For More Help With Medicare Advantage

If you need more help with Medicare Advantage, you may want to begin by searching the comprehensive resources available at Medicare.gov and read Medicare & You, the official Medicare handbook published by the federal government each year.

To get help from a live person, you can:

  • Call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-486-2048) for information about Medicare eligibility, answers to your questions about Medicare options and plans, or to search for Medicare providers.
  • Contact Washington’s State Health Insurance Assistance Program (SHIP) for free individual counseling and help with a wide variety of Medicare issues.

Both of these resources provide free translators for people whose first language is not English.


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