Medicare WA & OR
Medicare in WA and Original Medicare – If you are just beginning your journey into Medicare, you may be feeling overwhelmed with everything there is to learn. There are very specific enrollment periods for Medicare, so if you are approaching your 65th birthday or you are retiring soon, you need to begin making decisions about your Medicare options. You’ll need to know terminology unique to Medicare and the differences between the types of plans available to you.
The first step is understanding what Original Medicare is and what kind of benefits it provides.
What is Medicare in Washington?
Medicare in Washington is the same “original” Medicare program established by the federal government in 1965 and was signed into law by President Johnson in 1965. Medicare Washington provides healthcare coverage to eligible beneficiaries for both inpatient and outpatient services at medical facilities nationwide and is a fee-for-service plan that is managed by the federal government.
Since its inception in 1965, Medicare has consisted of the same two parts. Medicare Part A and Medicare Part B. For more than 50 years, Medicare has provided coverage for Seniors and Americans with disabilities.
With Medicare in Washington, you can go directly to the doctor or hospital of your choice, bypassing prior authorizations or referrals. The government is responsible for paying its portion directly to your provider and you cover the left-over costs. The only qualification for care is that the doctor you choose accepts Medicare.
Part A and Part B Benefits and Cost
Inpatient services are covered under Medicare Part A. It helps to think of Part A as your “room and board” coverage for hospital visits. Most individuals receive premium-free Part A. The only requirement is that the individual (or their spouse) must have paid Medicare taxes through an employer for ten years. If that requirement has not been met, the premium for Part A will depend on how many years or quarters the individual did contribute to Medicare taxes.
Part A offers 80% coverage for eligible services after the deductible has been met. After an individual has been discharged from an inpatient facility for at least 60 days, a new benefit period begins.
Outpatient services are covered under Medicare Part B. This applies to doctor visits and many preventive services. Part B does have a monthly premium that is based on an individual’s income.
Like Part A, Part B offers 80% coverage for eligible services after the deductible has been met. This deductible applies one time per year.
Who is eligible for Medicare?
Medicare in Washington can be offered to individuals 65 or older, and in some cases to younger individuals with specific disabilities. Therefore, Medicare eligibility in the state of Washington depends on the following:
- You are 65 or older
- You are a legal citizen in the U.S. who has worked in the States for five or more years
- You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them
- You have been on Social Security Disability Insurance for at least 24 months
- You have Lou Gehrig Disease or End-Stage- Renal Disease
- You receive a disability pension
- You have a permanent kidney failure
- You or your spouse were government employees who don’t pay Social Security but have paid Medicare taxes while employed
Most beneficiaries who are eligible for Medicare often are eligible for Part A free monthly premium too. Medicare Part A premium is free for those beneficiaries who have worked for at least 10 years which is 40 quarters or have Railroad Retirement benefits. Also, you can get those benefits if your spouse fulfills this requirement.
However, if you didn’t work long enough to get these benefits you can still be eligible for Medicare if you have 65 or more. The only difference is that you’ll need to pay to get your Medicare coverage. Therefore, you will be responsible for paying Part A premium (your hospital insurance) as well as Part B (your medical insurance). You can buy Part B without having Part A but, if you buy Part A first you must buy Part B, too.
When to Enroll in Medicare in State of Washington
The Social Security Administration processes Medicare enrollment applications. Individuals can apply by phone, online, or in person.
There are three enrollment periods for Original Medicare.
Enrollment Period
Enrollment Period
Enrollment Period
Enrollment Period
This begins 3 months before an individual’s 65th birthday.
Enrollment Period
Enrollment Period
Medicare Premiums
Original Medicare as well as Medicare in Washington is not free. While many people do receive premium-free Part A, Part B does have a monthly premium. A standard premium for Part B is set each year. The amount an individual pays is based on their Adjusted Gross Income from two years prior. If their AGI is above a certain amount, the individual will pay a higher Part B premium.
The full cost of Washington Medicare will involve other factors like an individual’s income, the type of plans chosen, and if any late enrollment penalties apply.
Medicare Supplement Plans Washington 2026
Medicare supplement plans Washington are secondary payers to Medicare Washington, commonly known as Medigap. Medigap plans are private insurance options designed to supplement the Original Medicare program, which consists of Part A and Part B. These plans aim to assist individuals in covering the out-of-pocket expenses not covered by Original Medicare, such as deductibles, coinsurance, and copayments.
There are ten different Medicare Supplement plans, each labeled with a different letter, ranging from Plan A to Plan N. The benefits offered by these plans may differ, but every plan is obligated to comply with federal and state laws that dictate the minimum benefits that must be provided.
The amount of coverage you can get depends on which plan letter you choose. For example, Plans A and B are the plans with the most basic additional benefits like Part A hospital coinsurance costs whilst Plan F is known as the “first dollar plan” which covers all the out-of-pocket costs left by Original Medicare. However, Plans C and F are no longer available to Medicare beneficiaries who weren’t eligible before the 1st of January 2020. The second most comprehensive plan available for people new to Medicare is Plan G. It covers all the costs except the Part B deductible. Plan K, L, and M are known as cost-sharing plans, which means they do not cover cost 100%. With Plan K some benefits are covered by 50% while with Plan L some benefits are covered by 75%. Plan M is the most comprehensive cost-sharing plan because of all things that are covered you are only responsible for paying 50% of the Part A deductible. Plan N is also a good plan to consider because it only doesn’t provide coverage for Part B excess charges and Part B deductible, but provides one of the lowest monthly premiums in comparison to the benefits you can get.
Medicare Advantage
Medicare Advantage is also known as Part C of Medicare coverage. The difference is, that it is sold by private insurance companies. However, those plans are required to provide all benefits that are provided by Original Medicare. Because of that, you must be enrolled in Original Medicare – Part A and B to be eligible for Medicare Advantage plan. When you do so, it becomes your primary source of coverage.
There are several different types of Medicare Advantage plans, including:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
- Medical Savings Account (MSA) plans
The costs associated with Medicare Advantage plans vary depending on the specific plan and the individual’s location. Most Medicare Advantage plans require individuals to pay a monthly premium in addition to their Medicare Part B premium, which is $202.90 in 2026 (you are still required to pay the Part B premium to keep your MA plan). There may also be copayments for certain medical services, and some plans include an annual deductible. Most MA plans offer additional benefits not covered by Original Medicare, such as dental, vision, and hearing services, wellness programs, or gym memberships.
The maximum out-of-pocket cost (MOOP) for Medicare Advantage plans is capped each year. This means that there is a limit to the amount that an individual will have to pay out of pocket for medical services covered under the plan. The MOOP for each plan may vary, but the federal government sets an overall maximum amount each year. In 2026, the in-network MOOP limit set by CMS is $9,250 (the combined in-network/out-of-network limit for PPO plans is $13,900). Many plans choose to set lower MOOP limits to remain competitive.
Also, it is important to note that those plans may have restricted provider networks. This means that if you seek medical assistance with a doctor or hospital that isn’t contracted with your network you may not get coverage for required services or may have to pay higher out-of-pocket costs.
How to apply for Medicare in Washington
To apply for Medicare Washington firstly you must be eligible for the Medicare program. You may be eligible for Medicare if you met some requirements set by CMS. The first requirement is that you need to be a United States citizen or a permanent legal resident living in the U.S. for at least five years. If you met that criteria, one of the following must apply as well:
- a) if you are 65 years old or older;
- b) if you have been on Social Security Disability Insurance (SSDI) for two years;
- c) if you have been diagnosed with End-stage Renal Disease (ESRD) or Lou Gehrig`s disease.
Once you are eligible, the next step is to choose a plan that best suits your needs. You can sign up for Original Medicare – Part A and Part B by contacting Social Security during the Initial Enrollment Period (3 months before and after your 65th birthday, with birthday month included). If for some reason you missed your IEP, you can apply for Original Medicare during General Enrollment Period (January 1st – March 31st each year). But, if you are receiving Social Security benefits before your 65th birthday, then you will be automatically enrolled into Original Medicare on your 65th birthday.
If you want to apply for Medicare Advantage or Medicare Part D program, you will be able to do that when you first enroll in Original Medicare. If you choose not to apply for Part C or Part D at that moment, you can always do it during the Annual Enrollment Period (October 15th – December 7th each year).
After your application is approved, the CMS will send you a “Welcome to Medicare” packet via mail together with your Medicare cards and handbook “Medicare and You”.
