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BlogMedicare Blog

Understanding Medicare in Washington

By March 26, 2019 No Comments

Are you new to Medicare? Or are you helping a family member who will transition to Medicare? Let Health Plans in Washington help you answer your Medicare questions.

What is Medicare?

Medicare is a federal health insurance program that provides health care coverage to people who are 65 or older, younger people with disabilities and people with End-Stage Renal Disease (ESRD).

When you’re enrolled in Medicare, you’ll get your red, white, and blue Medicare card in the mail. Image below:

medicare-in-washington

Your Medicare card shows effective dates for your Part A (Hospital Insurance) and/or Part B (Medical Insurance).

Keep in mind: Your Medicare card is very important. Your Medicare number is unique. Make sure to bring your Medicare card if you need to go to hospital, see your doctor or if you will be needing health care services.

How can I replace my Medicare card?

If you lost or damaged your Medicare card, you can either:

  • Sign in to your MyMedicare.gov account to print official copy. If you don’t have an account on MyMedicare.gov, you can create one.
  •  Call 800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
  • Sign in to my Social Security account, select the “Replacement Documents” tab. Then select “Mail my replacement Medicare Card.” If you don’t have an account yet, you can create one.
  • Call Social Security 1-800-772-1213 (TTY 1-800-325-0778) or contact your local Social Security office.

How to change my name or address on my Medicare card?

Medicare uses the name and address you have on file with Social Security. To make a change on your name or address, visit your online my Social Security account or call 1-800-772-1213 (TTY 1-800-325-0778).

What are the Four Parts of Medicare?

  • Medicare Part A (Hospital Insurance) – covers inpatient hospital stays, skilled nursing facility, hospice care, and some home health care services.
  • Medicare Part B (Medical Insurance) – covers certain doctor visits, outpatient care, medical supplies, and preventive services.
  • Medicare Part C (Medicare Advantage) – this part serves as an alternative to Original Medicare. Medicare Part C is offered by private insurers. You can enroll with them and they will manage your Medicare health coverage through a contact they have with the government. Also referred as “bundled” plan because it includes Original Medicare (Part A and B) and usually Part D coverage.
  • Medicare Part D (prescription drug coverage) – these plans are offered by insurance companies and other private companies approved by Medicare. Each prescription drug plan, has a formulary (list of generic and branded drugs) that determines how much you pay for your prescription.

medicare-in-washingtonAm I eligible for Medicare?

Medicare is for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

You are eligible for premium-free Medicare Part A (Hospital Insurance) if you are 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Medicare Part A at age 65 without having to pay premiums if you:

  • are receiving Social Security or Railroad Retirement Board benefits.
  • are eligible to receive Social Security or Railroad benefits but haven’t filed them yet.
  • or your spouse had Medicare-covered government employment.

If you are under age 65, you can get Medicare Part A without having to pay premiums if:

  • You are getting Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have ESRD or you’re patient requiring dialysis or transplant.

What if, you or your spouse did not pay Medicare taxes?

If you or your spouse are already 65 or older, you may be able to buy Medicare Part A. This is for as long as you are a US citizen or a permanent legal resident.

Does Medicare cover all health care cost?

Medicare covers some of health care cost but not all. Depending on your Medicare plan, you have to pay for premium, deductibles and copays. Some people with low income and resources qualify for assistance programs. These programs are Extra Help and Medicare Savings Program that help pay for Medicare related costs. For those who don’t qualify for federal or state-run programs, you need to pay out-of-pocket costs or buy additional insurance.

How much does Medicare cost?

PART A (Hospital Insurance)
Monthly premium:
• Most people eligible for Medicare don’t pay monthly premium for Medicare Part A. You can get Premium-free Part A if you are receiving Social Security or Railroad Retirement Board benefits, you are eligible to receive Social Security or Railroad benefits but have not yet filed for them or if you or your spouse had Medicare-covered government employment.
• If you paid Medicare taxes for less than 30 quarters or if you’ll buy Part A, the standard Part A premium is $437.
• If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.

Late Enrollment Penalty: If you don’t buy Medicare Part A when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.

PART B (Medical Insurance)
Monthly premium: 2019 standard Part B premium is $135.50. Most people will pay the standard Part B premium amount. If your modified adjusted gross income (MAGI) as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard Part B premium and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

Late Enrollment Penalty: If you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty and you need to pay this penalty as long as you have Part B. Monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until General Enrollment Period (January 1st to March 31st) to enroll in Part B and your coverage will start July 1st.

Part C (Medicare Advantage)
Monthly premium: Medicare Part C monthly premium depends on the Medicare plan you enrolled, same with the amount you need to pay for your deductibles and copays.

Part D (Medicare Prescription Drug Coverage)
Monthly premium: Medicare Part D monthly premium depends on Part D plan you enrolled, same with the amount you need to pay for your deductibles and copays. Based on your income or resources, you may qualify for federal or state-run programs. These programs will help you pay for the cost of prescription drug coverage.  

Late enrollment penalty: You may need to pay a late enrollment penalty if you go more than 63 consecutive days without prescription drug coverage. Late enrollment penalty fee depends on how long you went without Part D coverage.

When should I apply for Medicare?

You can enroll to Medicare either three months before your 65th birthday, the month of your birthday or three months afterward.

Let’s say your birthday is June 15th, your enrollment window begins in March and lasts till the end of September. If you enroll in Medicare during the three-month window before June, your coverage will start June 1st. If you enroll in July, your coverage will be effective Aug 1st. Once you turn 65 and enroll within your enrollment window, your coverage starts the first day of the following month you enrolled.

Can I still apply for Medicare even if I missed my Initial Enrollment Period?

YES. You have another chance to enroll during General Open Enrollment, which runs from January 1st to March 31st each year and your coverage will start July 1st of the same year. However, there’s a penalty for late enrollment in Medicare Part B amounting to 10% premium increase for each full 12-month period that you could have been in Medicare but did not sign up. Also, there’s late enrollment penalty for your Medicare Part D. This if you go more than 63 consecutive days without prescription drug coverage.

Take note of these Medicare enrollment dates:

  • Initial Enrollment Period (IEP): 7- month period. Begins 3 months before you are eligible and ends 3 months after your eligibility begins.
  • General Enrollment Period (GEP): Jan 1st to Mar 31st
  • Annual Election Period (AEP): Oct 15th to Dec 7th (time when you can change Medicare plans and be effective Jan 1st of the following year).
  • Special Enrollment Period (SEP): Anytime during the year if you qualify.
  • Open Enrollment Period (OEP) for Medicare Advantage: Jan 1st to March 31st – If you start the year on a Medicare Advantage plan, you can either dis-enroll and return to Original Medicare or make a one time switch to another Medicare Advantage plan during this period.

How do I apply for Medicare in Washington?

Note: If you’re already receiving Social Security benefits before you turn 65 or been receiving Social Security disability for 24 months, you will automatically be enrolled in Medicare.

Need help in choosing Medicare plan or answer your Medicare questions?

Health Plans in Washington can assist you in choosing Medicare plan and answer your Medicare questions at no cost. We’ve been working with Medicare beneficiaries for over a decade. You can call us at 360-787-1048 or 206-801-3958.