Question 1

What is Medicare and who is eligible in Washington state?

Accepted Answer

Medicare is a federal health insurance program for people 65 and older, and for some people under 65 with disabilities or certain conditions. In Washington state, you become eligible when you turn 65, or earlier if you meet disability criteria or have illnesses like End-Stage Renal Disease (ESRD) or ALS.

Question 2

What are the different parts of Medicare (Part A, Part B, Part C / Advantage, Part D)?

Accepted Answer

Part A covers hospital stays and some skilled nursing; Part B covers outpatient medical services; Part D covers prescription drugs; Part C (Medicare Advantage) is offered by private insurers and typically bundles Parts A and B and usually Part D, often with extra benefits.

Question 3

What is Medigap (Medicare Supplement) and when should I consider it?

Accepted Answer

Medigap plans help pay some out-of-pocket costs that Original Medicare does not fully cover, such as deductibles, copayments, and coinsurance. You might consider Medigap if you have Original Medicare and want to limit out-of-pocket risk. Washington has rules that may allow people to switch Medigap plans under certain conditions.

Question 4

Can I get financial help or subsidies for health insurance in Washington?

Accepted Answer

Yes. Through Washington Healthplanfinder, individuals and families may qualify for premium tax credits and, in some cases, cost-sharing reductions based on income. For Medicare enrollees with limited income and assets, programs such as Medicare Savings Programs may provide help.

Question 5

When is open enrollment for individual and family coverage in Washington?

Accepted Answer

Open enrollment for Washington’s marketplace (Healthplanfinder) typically occurs in late fall (for example, November into January) for coverage starting the next calendar year. Outside that period, you generally need a qualifying life event to enroll.

Question 6

What qualifies as a life event for special enrollment in Washington?

Accepted Answer

Common qualifying events include losing employer coverage, losing Apple Health coverage, moving to a new county or state, changes in household such as marriage, divorce, or birth, and certain income changes that affect subsidy eligibility. You typically have a 60-day window to enroll after the event.

Question 7

What does Apple Health cover, who qualifies, and how do I apply?

Accepted Answer

Apple Health covers a range of services including medical and mental health care, and often dental and vision for children, depending on eligibility. Qualification depends on income, family size, and certain categories such as disability. You can apply through the Washington State Health Care Authority or via Washington Healthplanfinder.

Question 8

How much does health insurance cost for individual or family plans in Washington?

Accepted Answer

Costs vary by metal level (Bronze, Silver, Gold), insurer, age, county, and subsidy eligibility. Premium tax credits can significantly reduce monthly premiums, while plans with better cost sharing generally have higher premiums.

Question 9

What are essential health benefits, and which ones are required in Washington?

Accepted Answer

Essential health benefits are core services required under the Affordable Care Act, such as preventive care, maternity and newborn care, mental health services, and prescription drugs. Washington also has state regulations that may expand coverage in areas like gender-affirming care and abortion services.

Question 10

How do I know if my doctors or preferred providers are in network?

Accepted Answer

Each plan has its own provider network. Before choosing a plan, confirm that your doctors and hospitals are included. In-network care typically has lower out-of-pocket costs; out-of-network care can cost much more. This is especially important for Medicare Advantage plans in Washington.

Question 11

How do Medicare prescription drug plans (Part D) work in Washington?

Accepted Answer

Part D can be a standalone prescription drug plan with Original Medicare or included within a Medicare Advantage plan. You choose a plan that covers your medications. Plans differ in premiums, formularies, and pharmacy networks, and you can review and change plans during annual enrollment periods.

Washington Health Insurance FAQs: Medicare, Apple Health, and Family Coverage

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