Washington Medigap Plans work differently than plans in other states, and it can be confusing. Read a comprehensive overview of the Medigap policies and the Evergreen State’s special rules, especially those related to changing policies.
WA Medigap Basics
Medigap plans, also known as Medicare Supplement plans, are offered by private insurance companies and serve to bridge the gaps in coverage left by Original Medicare Parts A and B. Each plan is identified by a different letter, indicating a specific level of coverage.
For instance, this means that the benefits provided by a Medigap Plan A remain consistent across all insurance companies offering that plan, as they are standardized. Therefore, any insurer offering Medigap Plan A will provide identical benefits. This standardized approach facilitates the comparison of Med Supp plans, with the only variation being the premium costs. Medigap prices are regulated so no one can offer the same plan from the same provider lower than Senior65.com.
Click here to get a WA Medigap quote.
Washington Medigap Plan Chart of Current Plans
This chart shows the benefits included in each of the standard Medigap plans effective on or after Jan. 1, 2023:
| Benefits | A | B | D | G* | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| Medicare Part A Deductible ($1,632) | 100% | 100% | 100% | 50% | 75% | 50% | 100% | |
| Part B Deductible ($240) | ||||||||
| Medicare Part A Hospital Coinsurance and 365 additional hospital days | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B Coinsurance | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| First 3 Pints of Blood for a Transfusion | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part A Hospice Coinsurance or Copay | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility Coinsurance | 100% | 100% | 50% | 75% | 100% | 100% | ||
| Medicare Part B Excess Charges | 100% | |||||||
| Foreign Emergency Healthcare | 80% | 80% | 80% | 80% | ||||
| Max Out-of-Pocket | $7,060 | $3,530 |
*Medigap Plan G High Deductible is identical coverage as Plan G but requires a deductible first
If knowing about so many plans is overwhelming for you and you’re still unsure if this is right for you, you can read our article on the pros and cons of enrolling in a Medigap plan.
When to buy a Medigap policy in Washington
The ideal time to purchase a MedSup plan is within the initial six months from the day you reach the age of 65 (or older) and are enrolled in both Medicare Parts A and B. During this six-month period, commonly known as the Guaranteed Issuance or Medigap Open Enrollment Period, the plan cannot require you to undergo a health screening or deny you coverage based on preexisting conditions.
If you fail to enroll during this initial six-month period, you still have the option to apply for a Medigap plan in Washington. However, the insurance company is not obligated to sell you one and may inquire about your health through screening questions. If you missed your Medigap Initial Enrollment Period, please read our article about it or feel free to call us at 800-930-7956.
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Washington Medicare Excess Charges
Part B Excess charges occur when doctors bill above Medicare-approved rates. If providers don’t accept Medicare assignment, they can charge up to 15% extra. Fortunately, Medigap Plan G covers 100% of excess charges, ensuring your insurance pays these fees. Explore more in our article “How to Avoid Medicare Excess Charges.”
Are there any Washington Medigap discounts?
Yes, there are! To learn more about Washington discounts click on the following links:
Discounts vary by state, county, and insurance providers so give us a call to review.
Special WA Medigap Rule: Year-Round Medigap Switching
Washington Medigap Plans have a special rule that allows you to change your policy at any time of the year. If you are currently enrolled in a Medigap plan B through N, you have the flexibility to switch to another Medigap plan at any time. Unlike other states, switching plans in WA is not tied to your birthday. Access the Ultimate Medigap Birthday Rule Guide for Every State Here.
Note: If you have a Medigap plan A, you can switch to any other Medigap plan without the need for a written health screening questionnaire as well. (source)
if you are transitioning from a different type of health insurance plan to a Medigap plan, the rules may vary, and some insurers may require you to complete a written health screening questionnaire. If you are unsure about whether you need to undergo a written health screening, drop a comment/question in the section below or directly call Senior65.com at 800-930-7956. We’re here to assist you in every possible way.
Community-Rating Requirement for WA Medigap Premiums
Another key aspect of Washington state is that Medigap insurance companies in WA are required to community-rate their policies’ monthly premiums. This means that the premiums charged for Medigap plans cannot vary based on factors such as the age, gender, or health status of the policyholders. Instead, the premiums are set based on the community as a whole.
Regardless of individual circumstances, all beneficiaries with the same Medigap plan will pay the same monthly premium. This community-rating approach ensures that everyone has equal access to Medigap coverage at a fair and consistent price. You can find further information in this official document.
Next Step
If you found this article helpful in understanding Washington Medigap plans, we encourage you to collaborate with our licensed agents at 800-930-7956. Our agents have extensive knowledge of how Medigap operates in your state, and the best part is that our services come at no cost to you. Don’t waste time, get a Medigap quote here!