by TogetherHealth logo
Find a Medicare plan
Get Started →
Medicare by location > Medicare in Washington: Who’s Eligible, How to Apply, & More

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

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 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!

What you should read next

Mental health can be an issue regardless of a person's age. In fact, it’s estimated that more than 25% of the adult population struggles with their mental health. And issues relating to mental health can have an enormous impact on your ability to navigate and enjoy life (especially in your golden years). So if you rely on Medicare coverage, you might wonder “Does Medicare cover mental health counseling?” And the good news is that Medicare does cover a wide variety of mental health services. This guide will help you understand what you can expect from Medicare coverage for mental health and answers common questions about this coverage. Medicare and Mental Health As we mentioned, Medicare does cover mental health care. There are two kinds of mental health treatment: outpatient and inpatient. With outpatient care, you see a doctor or therapist from time to time. Inpatient care involves living in a facility or institution. Keep in mind that Original Medicare will have specific coverage levels with copayments or coinsurance.Medicare Advantage plans have to offer at least as much coverage as Original Medicare and often may offer more coverage, and potentially lower cost shares. . Does Medicare Cover Counseling?Counseling is a common outpatient treatment for a variety of mental health conditions. Is mental health therapy covered by Medicare? Yes, it is!Outpatient care is covered under Medicare Part B. The coverage will only apply if the therapist accepts an assignment from Medicare. You’ll pay your Part B deductible (if it hasn’t already been paid) and then 20% of the Medicare-approved amount for the counseling services.There are specific types of treatment that are not covered. These may include:Transportation to and from mental health appointmentsActivities for recreation to divert attention from other issuesSupport groups for socialization (group psychotherapy is covered)Job skills training or testing not related to your mental health treatmentMealsIf you have a Medicare Advantage plan, you will get at least as much coverage as Original Medicare. There may also be additional benefits. You’ll want to check with your specific plan.If you need counseling for mental health, don’t be afraid to get the care you need!How Many Therapy Sessions Does Medicare Cover?There is no specific limit to the outpatient therapy sessions covered by Medicare, provided they are necessary and there is a reasonable expectation that the treatment will help you improve. If you require inpatient mental health care in a hospital or institution, there is a lifetime limit to the number of days Original Medicare will cover.Your Medicare Advantage plan may have different guidelines, although they shouldn’t be more restrictive than Original Medicare. Be sure you talk to your insurance provider directly to ensure your therapist is in the network and to find out how therapy sessions are covered.Does Medicare Cover Depression?Depression is one of the most common mental health diagnoses. Unfortunately, the number of American adults struggling with depression or anxiety significantly increased during the COVID-19 pandemic.With Medicare, you can get one depression screening per year at no cost to you as long as your provider accepts an assignment from Medicare. If you need therapy or counseling, you’ll pay your Part B deductible (if it hasn’t already been paid) and then 20% of the Medicare-approved cost per session. Learn more about the latest updates to Medicare deductibles and premiums.Medicare Advantage plans will offer similar arrangements but may have additional benefits as well. You’ll want to talk to your insurer before you set up your depression screening and therapy appointments. The most important part of getting coverage through Medicare Advantage is to use the provider network that is part of the plan.Does Medicare Cover Mental Health Hospitalization?Is psychiatric treatment covered by Medicare if you need to be hospitalized? Inpatient care is covered by Medicare under Part A.Similar to other inpatient hospitalization, you’ll pay a $0 deductible for each day up to 60 within a benefit period. Days 61-90 will have a $389 per day charge in 2022. Beyond 90 days per benefit period, you’ll need to use your lifetime reserve days, which you only have 60 of in your lifetime. This article can provide additional information about Medicare costs.Overall, mental health hospitalization is limited to 190 days over your lifetime. After that, Original Medicare will not provide coverage and you’ll need to pay 100% of your costs.In addition to the inpatient hospitalization costs, you’ll also pay 20% of the Medicare-approved amount for therapy or other mental health services you get while you’re in the hospital. These are covered by Medicare Part B. Prescription drugs may be covered under Medicare Part D or Part A.If you have a Medicare Advantage plan, you may have similar limits or they may be more generous. You’ll need to check with your specific plan for details.Medicare Mental Health Reimbursement RatesHow much does mental healthcare cost with Medicare? With Original Medicare, you’ll pay the normal copayments or coinsurance for either inpatient or outpatient care. For example, a therapy session will cost you 20% of the Medicare-approved amount, as long as your deductible has been paid and your therapist accepts the assignment.With Medicare Advantage, you may have different deductibles, copayments, or coinsurance. You’ll need to talk to your insurance company to find out the details. It’s a good idea to do this before you commit to treatment so that you can ensure you know what to expect.  Contact Us to Learn More About Medicare and Mental Health CoverageIf you have any additional questions about Medicare and mental health coverage, or you’d like to talk to a licensed agent to choose the right Medicare plan for your needs, we're here to help. Contact us today!
Read More
  One main concern for today’s medical care is ensuring that we prevent illness, or detect illness early so that it can be treated quickly. That’s why annual wellness visits are an important part of your Medicare coverage. This guide will help you understand your annual wellness visit, including who’s eligible for it, and how to schedule and take advantage of this coverage. Let’s get started! Medicare Wellness Exam Eligibility There are two times you are eligible for a Medicare wellness exam. The first time is when you first enroll in Medicare. You are entitled to a “Welcome to Medicare” preventive visit within the first 12 months after you enroll in Medicare Part B. You will need to choose a medical provider that is enrolled in Medicare and accepts assignments. For your first preventive visit, your Medicare Part B costs do not apply unless the doctor performs tests or services that aren’t covered under preventive benefits. After your Welcome to Medicare visit, you are eligible for a Medicare wellness exam once every 12 months. This is a visit that allows you to create or update your personal plan to prevent disease and disability. This wellness exam does not cost you anything unless the doctor performs tests or services that aren’t covered under preventive benefits. Annual Wellness Visit CoverageWhat is a Medicare wellness visit? What can you expect at your annual visit? You’ll start by filling out a questionnaire known as a “Health Risk Assessment.” This will help you and your doctor work together to create a personalized prevention plan. The goal is to help you stay healthy, understand your risk factors, and help detect any problems early.What is Included in an Annual Medicare Wellness Visit?After you’ve done the questionnaire, it’s time to review the results. Some of the things you might discuss include:Medical historyCurrent medicationsYour current weight and blood pressure, and how to keep them in a healthy rangeTesting for and detection of cognitive impairmentsRisk factors and ways to address themCreating a schedule for preventive care, such as vaccinations and screeningsYou’ll leave the annual wellness visit aware of your current health and the steps you can take to improve or maintain your good health. Medicare Wellness Exam CostsHow much does it cost to have a wellness visit? Most of us don’t have a lot of extra money, so it’s important to understand the costs of these visits.Does Medicare Pay for a Wellness Checkup?In most cases, it doesn’t cost anything. Your Part B deductible and coinsurance do not apply for normal preventive benefits and your personalized prevention plan. However, if your doctor provides additional tests and services during the visit that are not part of the preventive benefits, you may have your normal Part B deductible and coinsurance. Those services turn the visit into a normal doctor’s appointment, instead of a wellness visit.Medicare Annual Wellness Exam: Related QuestionsThere are a lot of common questions that Medicare beneficiaries have about wellness visits. Here are several that might help you better understand this important benefit.Is An Annual Wellness Visit Required by Medicare?Do you absolutely have to go to an annual wellness visit? The good news is that it is optional. However, it’s very helpful and can put you on a path to better health and give you a better understanding of your risk factors.Can You Refuse a Medicare Wellness Visit?Because your Medicare Wellness Visits are not mandatory, you can definitely refuse them. However, you’ll miss out on creating a personal prevention plan that takes into account your current health and risk factors. That might mean that you don’t avert health problems that are preventable.Do Medicare Advantage Plans Cover Annual Wellness Visits?Medicare Advantage plans, which are full replacements for Original Medicare, are required to offer at least as much coverage as Original Medicare. That means you can expect a Medicare Advantage annual wellness visit. Generally, you’ll find an annual preventive appointment to be cost-free, but you’ll need to look at the specifics of your plan. Wellness in Medicare Advantage might provide more preventive care in your annual appointment than Original Medicare offers as well. You’ll need to check with your provider for details.Keep in mind as you schedule your annual wellness visit with Medicare Advantage, you will need to see a provider within the plan’s provider network to get cost-free care.Learn More About Medicare CoveragePreventing illness and addressing risk factors as early as possible is an important part of living a happy and healthy life. If you have additional questions about your Medicare coverage or need help comparing plans, contact us today!
Read More
  Many people who have Medicare rely on it as their only health coverage. However, some Medicare beneficiaries have other insurance alongside their Medicare coverage. Using Medicare with another type of insurance brings up a lot of questions, from “What insurance is primary or secondary?” to “Can I keep my employer's health insurance with Medicare?” This guide will answer many common questions about using Medicare alongside other insurance coverage. This will help you get a better understanding of how to maximize your benefits.   How Medicare Coordinates With Other Insurance Coverage If you have two different health insurance plans, it’s important to know which insurance plan will be the primary payment source. The other plan will provide backup for the costs that the first plan doesn’t cover. Understanding how Medicare works with other insurance plans can help you decide when to bring your Medicare health insurance card and when to bring your other plan information instead.  What Insurance is Primary or Secondary?When you have more than one payer — that is, more than one health insurance plan — there are rules that determine which plan is the first payer. That plan is considered primary, and then the other plan is secondary.When you have a health need, the primary plan provides coverage to the limits of its benefits and the secondary plan only pays if there are costs not covered by the primary plan.However, that doesn’t mean the secondary plan will pay all remaining costs. For example, you may have out-of-pocket costs like coinsurance or a copayment, or the services might not be part of what the secondary plan covers.When Medicare is working with other insurance plans, Medicare is usually the secondary payer. If you have an employer group plan from your job or your spouse’s job, that plan pays first. Here are some examples of Medicare working with other insurance, along with who pays first. If you have Medicare and:A group plan through your current job: The group plan pays first.A group plan through your spouse’s job and the company has more than 20 employees: The group plan pays first.A group plan from a previous employer that you have retired from: Medicare pays first.VA coverage: You use your VA benefits at VA providers and Medicare at other providers. Learn more about how Medicare works with VA benefits. Active-Duty TRICARE: TRICARE pays first.Non-Active-Duty TRICARE: Medicare pays first unless you use a military hospital or federal care provider.Medicaid: If you are dual-eligible for Medicare and Medicaid, Medicare pays first. How Does Medicare Work With Employer Health Insurance?The most common situation that people 65 and older are in when they have two insurance plans is this: they qualify for Medicare but they also have employer-provided health insurance. People aren’t necessarily retiring at age 65 anymore, which is why this happens. But don’t worry, your employer group plan will pay for your health benefits. If you go beyond those benefits, you can see if Medicare can provide additional coverage. Do I Have to Enroll in Medicare if I Have Employer Coverage?It’s a good idea to enroll in Medicare Part A (hospital coverage) as soon as you’re eligible. It’s premium-free for most Americans. However, if you have a qualifying group plan through an employer, you can delay your enrollment in Medicare Part B without paying the late-enrollment penalty. Another option is to drop your employer-based coverage and use Medicare instead. You’ll have to compare the coverage options and determine which is best for you. Can I Keep my Employer Health Insurance With Medicare?Some people worry that if they become eligible for Medicare they cannot keep their employer's health insurance. That’s not true! You don’t have to use government health insurance right away if you have other coverage. In fact, if you’re worried about the Medicare coinsurance costs, it might be best to keep your employer health insurance plan as the primary payer. That way, you can pay a set copayment or coinsurance amount, which can be more manageable than paying 20% of the Medicare-approved amount of care.Learn More About Medicare PlansAs you can see, you can have both Medicare and another health insurance plan. It’s just important to know which plan is the primary payer so you can ensure your bills are processed in a timely manner.Do you have more questions about Medicare plans and how they work in your specific situation? We’re here to help. Our licensed agents can address your concerns and help you compare plans to get the right coverage for your needs. Contact us today!
Read More
(800) 596-1715 (TTY 711)
Talk to a licensed insurance agent
Mon.-Fri. 8am - 8pm ET
Privacy PolicyTerms of UseCalifornia Privacy NoticeDo Not Sell My InfoInterpreter ServicesNotice of Nondiscrimination
GENERAL DISCLAIMERS, LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. Insurance agency services may be provided by one of our sister companies, Total Insurance Brokers, LLC, TogetherHealth Insurance, LLC, HealthPlan Intermediaries Holdings, LLC, or HealthPocket d/b/a AgileHealthInsurance Agency, which are all part of the Benefytt Technologies, Inc. family of companies.
Alternatively, you may be referred, via a link, to a selected partner website, which is independently owned and operated and may have different privacy and terms of use policies from us.
If you provide your contact information to us, an insurance agent/producer or insurance company may contact you.
If you do not speak English, language assistance service, free of charge, is available to you; contact the toll-free number listed above.
For a list of all available plans, please contact 1-800-Medicare(TTY users should call 1-877-486-2048) or consult
This site is not maintained by or affiliated with the federal government's Health Insurance Marketplace website or any state government health insurance marketplace.
© 2021 LLC