Washington State Medicare

#1 - Medicare Supplement (Medigap) Providers 

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There are 20 Insurance providers in the state of Washington.  Not all are available in every county.  Keep in mind that if you are new to Medicare you can enroll in a Medicare Supplement plan under the following state-specific rules.

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• No earlier than 30 days before you are enrolled in Parts A & B of Medicare

• Within 63 days after becoming a resident of Washington

• During open enrollment period established by federal or state law

• If replacing an existing plan, with no lapse in coverage

• Any time when enrolling during a guaranteed issue period

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#2 - Medicare Advantage Providers

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7 Counties out of 39 in Washington state do not have Medicare Advantage plans for 2022.

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Ferry              Garfield              Klickitat              Lincoln

Pacific              Pend Oreille              Skamania

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The other 32 counties offer various plans from just a few to over 50 for the more populous counties.  See below for a list of Medicare Advantage Providers, and the plans they offer.

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#3 - Community Rating 

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This model is used to price the monthly premiums for Washington State Medicare Supplement plans.  It refers to the insurance company's pricing system.  The Revised Code of Washington (RCW) 48.66.045, provides for community rating for Medicare Supplement policies.  What this means is that an insurance company has to charge the same amount across Washington state (the community) and not base premiums on age, gender, health status, or claims history.  For example, a healthy 65-year old in Kitsap County will pay the same amount as an unhealthy 85-year old in King County for a specific provider's plan.  In other states, the 85-year old could pay more based on health, age, and possibly other factors.

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#4 - Guaranteed Issue

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This is a big deal.  In most states, you have to qualify through medical underwriting to switch to another Medicare Supplement provider.  Not in Washington state.  Again, the Revised Code of Washington (RCW) 48.66.045, provides the Guaranteed Issue rights for the state.  With the exception of Plan A, you can switch from any Medicare Supplement plan to another plan.  Providers must offer you a Medicare Supplement plan without underwriting.  This means, regardless of your health you can change plans and/or providers.  This is important because prices for the exact same plan can vary between insurance providers.  Also, switching plans can be done at any time.  Many enrollees confuse Annual Election Period (AEP) as the only time they can change Supplement plans.    

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#5 - Pre-Existing Conditions

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This rule ties in with the Guaranteed Issue WAC and switching Medicare Supplement plans.  Federal rules allow insurers to impose waiting periods of up to six months.  In Washington State, insurance companies can only impose a pre-existing condition waiting period of 90 days or less on a Medicare Supplement Plan.  This is a huge advantage over the federal rules.  Keep this in mind when switching plans because your medical care might not be covered during this 90 day period.  

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#6 - Prescription Drug Plans (Part D of Medicare)

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Eleven insurance companies provide 29 different stand-alone Prescription Drug Plans (PDP) in Washington State.  These plans can be changed during AEP between October 15th and December 7th each year.  You can shop for and change your mind during the election period more than once.  According to the Center for Medicare Services (CMS), your last choice will be the one that takes effect on January 1st of the following year.