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 provides health insurance to over 65 million Americans, including 1.5 million in the state of Washington. Benefits are generally open to seniors aged 65 and over, as well as certain qualifying younger adults. Most beneficiaries enroll in Original Medicare at age 65, which splits coverage between hospital and inpatient care (Part A), outpatient visits and medical equipment (Part B) and a prescription drug benefit (Part D). Since 2003, Medicare enrollees have had an alternative to Original Medicare, known as Part C or Medicare Advantage.
Medicare Advantage Plans are issued by private insurance companies that are licensed to offer care plans in individual states. By law, these plans must provide the same level of coverage as Original Medicare Parts A and B, but they’re typically combined into a single package with one monthly premium. Most Medicare Advantage Plans go beyond minimal coverage to include prescription drug benefits, dental and vision care and several other benefits not included in traditional plans, such as hearing aids and planning services.
These plans are attractive to many Washington seniors for the simplicity of having a single bill each month, which may be as low as $0, and expanded coverage options. They also tend to be more flexible than Original Medicare benefits and may be offered as HMOs, PPOs or as specialty benefits plans for people with unique care needs. In 2023, 45% of Medicare enrollees in Washington have signed up to get their Medicare benefits through a Part C plan, which is close to the 48% national participation rate. This represents a year-over-year growth of nearly 8% from 2022, a time when national participation only rose by 7%.
This guide lists the top providers for Medicare Advantage in Washington, along with price data and Medicare star ratings. Enrollment figures are also given for the most popular care plans. The goal is to help seniors and their families find a Medicare Advantage Plan that works for them and get a head start on planning for great health coverage over age 65.
The Top 10 Medicare Advantage Plans in Washington
Seniors in Washington have a lot of choices when it comes to enrolling in Medicare Advantage Plans. As of July 2023, 157 Part C plans are available in a variety of plan types, including HMOs and PPOs. Many providers in the state offer multiple plans, so prices in the below table are given as a range. Enrollment numbers are the sum of membership stats across all of the plans a given provider offers. The ensuing table provides data that is up-to-date as of July 2023. Older adults who would like more information can visit Medicare.gov to learn the details about their benefits, eligibility criteria and coverage limits.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
UnitedHealthcare
180438
3.5
$0 – $86
PPO, HMO
Kaiser Permanente
98597
N/A
$0 – $296
HMO
Humana
72924
4
$0 – $199
PPO, HMO
Braven Health
47335
N/A
$0 – $57
HMO
Aetna Medicare
38517
2.5
$0 – $119
PPO, HMO
Healthfirst Medicare Plan
26300
N/A
$0 – $153
PPO
Highmark Inc.
23251
N/A
$0 – $99
HMO
Molina Healthcare of Washington, Inc.
20126
N/A
$0 – $0
HMO
Independence Blue Cross
13876
N/A
$0 – $157
PPO, HMO
EmblemHealth Medicare HMO
12586
N/A
$0 – $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.
