Washington Medigap Plans: A Comprehensive Guide

Washington Medigap plans are designed to help fill gaps in Medicare coverage, providing additional financial protection for eligible individuals. There are 10 standardized plans, labeled A through N, each offering a unique set of benefits.

Medicare Supplement Insurance (Medigap) plans are available to anyone with Medicare Part A and Part B. However, if you have a Medicare Advantage plan, you're not eligible for Medigap coverage.

Washington residents can purchase Medigap plans from private insurance companies, but the plans and prices may vary between companies. The most popular Medigap plans in Washington are Plan F and Plan G.

The Open Enrollment Period for Washington Medigap plans is from October 15 to December 7 each year, during which you can enroll in or change your plan without medical underwriting.

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In Washington, every standardized type of Medigap plan is offered, but Plans F and G offer the most comprehensive coverage and are the most popular.

Plans F and G come in a high-deductible version, making them a good option for those who want to save on premiums.

Medigap Plan C and Plan F are no longer available to new beneficiaries who turn 65 after January 1, 2020, due to federal law prohibiting new beneficiaries from joining plans that cover the Medicare Part B deductible.

However, if you already have one of these plans, you can keep it, or you can join Plan C or Plan F if you qualified for Medicare before January 1, 2020.

You should expect premiums to rise significantly over the next few years for these plans.

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Medigap plans cover a range of services, including Part A coinsurance and hospital costs, up to an additional 365 days after Medicare benefits are used up.

These plans also cover Part B coinsurance or copayment, which is the cost of doctor visits and other outpatient services.

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The first three pints of blood are covered, as are Part A hospice care coinsurance or copayment and skilled nursing facility care coinsurance.

Some plans also cover the Part A deductible, which is the amount you pay for hospital care before Medicare kicks in.

Additionally, Medigap plans may cover Part B excess charges, foreign travel emergency services, and out-of-pocket limits.

Here's a breakdown of some common benefits across Medigap plans:

Every standardized type of Medigap plan is offered in Washington, but Plans F and G offer the most comprehensive coverage and are the most popular.

Plans F and G come in a high-deductible version, which might be a good option for those who want to save on premiums.

The 10 Medigap plans, labeled with a letter from A to N, are available in 47 states and the District of Columbia, with identical coverage for each plan type.

However, your monthly premium will depend on various factors, so you might pay a different premium than your neighbor for the same plan.

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Plans F and C are unavailable for Medicare beneficiaries who turn 65 after January 1, 2020.

Issue-age-rated Medigap plans, also called entry age-rated plans, have premiums based on your age when your Medigap plan was issued, and they won't increase due to your age.

Medigap Plan Gs all provide the same exact coverage, but you might pay a different premium than others with the same plan due to unique factors.

Washington Medigap plans have some unique differences compared to other states.

Each state sets its own guidelines around Medigap, as long as they meet the minimum federal requirements. Washington has enacted some consumer protections for its Medigap beneficiaries.

The state doesn't allow Medigap insurers to base premiums on age. This means that older beneficiaries won't pay more for their coverage.

Washington limits the waiting period for people with preexisting conditions. This gives them a chance to get the coverage they need without being delayed.

Medigap enrollees in Washington have guaranteed issue rights year-round. This means they can change their Supplement plan without going through medical underwriting.

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Choosing the right Washington Medigap plan can be a daunting task, but it's essential to get it right. You'll want to consider the monthly premium, which is in addition to your Part B monthly premium, and affects your monthly cash flow.

The type of plan you choose, your age, gender, tobacco use, and state of residence will all impact your premium amount. It's also a good idea to think about the benefits you need, as not all plans include the same coverage.

You'll want to check which benefits are most important to you, such as basic coverage for Part A copays and coinsurance, three pints of blood, and hospice care.

It's also a good idea to research the insurance provider you're considering, looking at their ratings and past experience with consumers.

Some plans and insurers offer extra discounts or perks, such as discounted hearing aid providers or eyeglass suppliers.

Here are some key factors to consider when choosing a Washington Medigap plan:

Community rating is required in Washington, which means your premiums are generally higher in the beginning, but cost less over the life of your policy compared to age-based pricing.

It's a good idea to use a tool like the Find a Plan tool to compare Medigap plans in Washington and review Medicare plan options in your area.

Your Medigap Open Enrollment Period is a six-month window after your Medicare Part B coverage begins, during which insurance companies can't ask you about your health history or charge you a higher premium based on your age.

In Washington, you can expect to pay around $99 to $329 each month for a Medigap plan A, G, or N if you enroll during your open enrollment period.

Medigap policies can be rated in three ways: community rated, issue-age rated, and attained-age-rated. Community rated plans charge the same premium to everyone, regardless of age, while issue-age rated plans base premiums on your age when you buy the policy and don't increase as you grow older.

If you're eligible for Original Medicare, you can purchase a Medigap plan, but there's no guarantee you'll be able to buy one later on or that it won't cost more. You'll get the best prices and most choices if you purchase a Medigap plan during the initial six-month open enrollment period.

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Here are the three ways Medigap policies can be rated:

Medigap premiums can vary significantly depending on your location. In Washington, you can expect to pay around $99 to $329 each month for a Medigap plan A, G, or N during your open enrollment period.

In some cases, premiums may be based on your age when you buy the policy and won't increase as you grow older. This is known as issue-age rated.

Other factors that can affect your premium include your insurer, policy pricing structure, and whether or not you smoke. Your gender and where you live can also play a role.

Here's a breakdown of the pricing structures used by insurance carriers:

In DC, Medigap premiums can range from $24 a month for a high-deductible Plan G to $947 for the highest-cost Plan F in 2024.

If you're 65 or older and have Original Medicare, you qualify for Medicare Supplement Insurance in Washington.

You can purchase a Medigap plan if you're eligible for Original Medicare, but if you don't buy one during the initial six-month open enrollment period, there's no guarantee you'll be able to buy one later on.

This six-month window begins the first month you have Medicare Part B coverage, and it's the best time to get the most choices and the best prices.

Insurance companies can opt to decline coverage based on your pre-existing health conditions if you try to buy a plan after this initial period.

You can use Medicare's online plan finder tool or call a licensed insurance agent to help you compare Medigap plans and find the one that best fits your needs and budget.

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