Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage plans offer the combined benefits of Medicare Parts A and B in a single policy. Known also as Medicare Part C, the Medicare Advantage program is different because it allows seniors and other eligible individuals to choose a private insurance plan rather than receiving benefits directly from the government. Every Medicare Advantage plan must provide at least the same level of coverage as Original Medicare with the exception of hospice care, but private insurers may include additional coverage, such as dental, vision and hearing, medical transportation and senior wellness programs.
Medicare Advantage plans must follow the regulations set out by the Centers for Medicare and Medicaid Services but may have specific rules regarding eligibility, out-of-pocket expenses and annual limits. Most Advantage plans offer prescription drug coverage as well, giving seniors the choice of forgoing Medicare Part D coverage if they choose. Of the almost 1.4 million Medicare users in Washington who are eligible for Medicare coverage, almost 5000,000 have chosen an Advantage plan, based on data from 2020. Seniors enrolled in Advantage plans make up about 36% of total Medicare enrollment, which is lower than the national average of 42%.
This guide reviews what Medicare Advantage plans in Washington cover, how seniors can qualify for an Advantage plan and where people can obtain coverage.
The Top 10 Medicare Advantage Plans in Washington
Washington has plenty of options available when it comes to finding a Medicare Advantage plan. Those eligible for Medicare Advantage in the state have a wide range of plans that allow them to customize their coverage to their individual needs. The table below reviews the most popular insurance providers in the state that offer Medicare Advantage plans. Each company may have more than one type of plan, so the information displayed provides a cost range, and the companies are listed based on the total enrollment in all of their plans.
The information presented is accurate as of April 2022. For more current information, you can visit Medicare.gov to learn more about the Advantage plans available in your area.
Name
Total Enrollment
Star Rating
Min Cost
Max Cost
Plan Types
UnitedHealthcare
209,379
4.5
$0
$88
HMO, PPO
Kaiser Permanente
127,121
5
$0
$296
HMO
Humana
79,205
4
$0
$200
HMO, PPO
Aetna Medicare
48,254
3.5
$0
$99
HMO, PPO
Premera Blue Cross Medicare Advantage
35,104
3.5
$24
$170
HMO
Regence BlueShield
29,416
4
$29
$158
HMO, PPO
Community Health Plan of WA Medicare Advantage
14,643
3.5
$41
$94
HMO
Molina Healthcare of Washington, Inc.
14,437
3.5
$0
$0
HMO
Regence BlueCross BlueShield of Oregon
13,558
4.5
$19
$195
HMO, PPO
Health Alliance Northwest
12,807
4
$32
$130
HMO
How Medicare Advantage Plans Work in Washington
Before choosing an Advantage plan, it’s important to know what makes Medicare Advantage different than Original Medicare and how to qualify. Insurance companies offer multiple plans and plan types. There are four types of plans available in Washington: health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS), and special needs plan (SNP), and each plan has its own rules regarding eligibility, network providers, how to see a specialist and what prescription medications are covered. The table below breaks down the four types of Medicare Advantage plans.
What Medicare Advantage Plans Cover in Washington
Medicare Advantage plans are required by law to cover everything offered by Medicare Parts A and B (except for hospice care) but may include expanded coverage. Advantage plans cover preventative care, diagnostic testing, emergency care, outpatient procedures and medical supplies. Many plans also cover vision, dental and hearing aids and may include discounts on gym memberships and other wellness services. Most plans also have prescription drug coverage.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Washington
Before seniors can enroll in an Advantage plan, they must first be enrolled in Medicare Parts A and B, live in the plan’s service area and meet the other eligibility requirements for the plan they’ve chosen. Medicare Advantage is available for retirees over the age of 65 or adults with disabilities that allow them to receive Medicare coverage. All beneficiaries need to be lawful citizens or residents of the United States.
Medicare has limited enrollment periods, and there could be penalties for not enrolling during the initial period. Special enrollment periods are available for people who experience specific life events that allow them to enroll free of penalties. Seniors enrolled in Medicare may change their coverage during each enrollment period. See the following list for more information on enrollment periods and timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Washington
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Washington’s SHIBA program provides free unbiased and confidential help to seniors who are researching their Medicare Advantage options. Its volunteer advisors are located throughout the state and help seniors assess their coverage needs, determine what plans they’re eligible for and evaluate and compare health insurance plans. SHIBA volunteers can also help seniors enroll in Medicare, speak with the Medicare office on the senior’s behalf and provide referrals to other programs and local agencies. SHIBA serves Washington residents of all ages and backgrounds and doesn’t restrict eligibility for services. SHIBA also collects and reports possible fraud complaints and organizes an array of events, including Medicare classes and Open Enrollment events, walk-in clinics, one-on-one counseling sessions, health fairs and presentations about insurance fraud.
WASHAA is a nonprofit organization that promotes health advocacy and assists individuals in understanding and accessing health care. It helps seniors understand what Medicare plans they’re eligible for and explains their out-of-pocket costs, such as coinsurance and co-pays. Its volunteer advocates assist seniors in researching in-network health care providers, and they clarify the out-of-network options and associated costs. The organization also advises on the denials and appeals process for health care services that are denied coverage. Its health advocates help people from all walks of life, and services are available to anyone who needs them. In addition to helping seniors understand their Medicare options, the organization offers a variety of services, including helping patients and families understand complicated medical information and diagnoses, resolve billing errors and negotiate to reduce medical bills and facilitate older adult services, such as transportation and meal delivery and end-of-life planning.
The Washington Office of the Insurance Commissioner serves as an advocate for Medicare beneficiaries and educates the public about access to insurance and medical care. Through this resource, seniors can learn how health insurance works, get information regarding their coverage options and out-of-pocket costs and receive free, unbiased Medicare counseling in their area. The Office of the Insurance Commissioner also assists seniors in appealing Medicare coverage or payment decisions and filing complaints against their insurance company. This office serves all Washington residents, regardless of income or age. Other services it provides include educating the public on identifying and reporting Medicare fraud and abuse, outlining health insurance options for those with disabilities and enrolling in Original Medicare or a Medicare Advantage plan.
To contact the Washington Office of the Insurance Commissioner, seniors can call 1-360-725-7080 or 1-800-562-6900 on weekdays during normal business hours. They can also send a message through the office’s website.
The AdvoConnection Directory is an extensive directory of independent health advocates who provide an array of supports to seniors. Some services that advocates may provide include accompanying participants to medical appointments, finding legal assistance after a medical error, helping to research Medicare Advantage plan options and handling claim denials and appeals for medical billing. Seniors can search for advocates who are experienced in specific fields, such as medical navigation assistance, health insurance, legal assistance related to health care and paperwork. All advocates and case managers listed in the directory are registered members of the Alliance of Professional Health Advocates. This service is available to everyone and doesn’t have eligibility requirements. On the website, seniors can also read about topics on patient empowerment.
Contact Info
To locate an advocate near them, seniors can visit the AdvoConnection website and provide their zip code and the services that they need. Once the results are provided, seniors can review their options and contact advocates directly for more information.
The Washington Association of Area Agencies on Aging (W4A) is a membership organization that comprises over a dozen Area Agencies on Aging in the state. W4A provides a variety of resources to seniors and individuals with disabilities, including advocacy and informational resources. Services vary by location and include caregiver support, information on Medicare Advantage plans and guidance on assistance programs that are available for low-income seniors who are unable to afford their premiums, deductibles and copays. To be eligible for assistance through W4A, seniors must be at least 65 years old and live in the service area of a local agency. In addition to helping seniors understand their Medicare Advantage options, W4A facilitates services, such as meal deliveries, volunteer chore services and case management.
Seniors can contact W4A by calling 1-360-485-9761 or by emailing the organization at [email protected]. Contact information for local AAA offices can be found on the website.
Aging and Disability Resource Centers, which are operated by the Washington State Department of Social and Health Services, provide easy access to home and community supports and services for seniors and those with disabilities. Its local centers increase awareness of the options that are available to seniors, including insurance programs like Medicare Advantage. It provides objective information, advice and counseling, enabling seniors to make informed decisions and more easily access public and private supports and services programs. These services are available to all Washington residents and have no age or income restrictions. In addition to options counseling, ADRC provides a wide array of services, including informational resources for long-term services and supports, adult abuse and prevention and in-home care.
Contact Info
Services through ADRCs are provided at the county level. To find the service providers for their counties, seniors can consult the state’s DSHS resources page.
