2018 Washington Medicare Advantage Plans (Definitive Guide)

Medicare Advantage

(watch our video at the bottom)

Are you considering a Medicare Advantage plan to save money?

Most of the Seniors we work with are on a fixed income when they retire, that means coming up with the huge co-pays and cost sharing under an Advantage plan can cause a great financial hardship.

Do you want the insurance company telling you what treatment you can or cannot receive? How about the insurance company telling you they don’t want to pay for your expensive NECESSARY surgery because they want you to try 3 months of alternative treatment while you stay at home and suffer?

Medicare Supplement plans are absolutely the best way to go coverage wise. You have a consistent monthly premium, all your bills are covered, and you get the freedom to not only choose your doctors and hospitals but most importantly you stay in control of your own healthcare.

Medicare Supplement and Medicare Advantage plan Comparison

Concerns for Seniors on Medicare

Medicare supplement

Medicare Advantage

The choice to pick your own doctors and hospitals


The Piece of mind knowing you don’t have co-pays and co-sharing


Prior Authorization for Tests and Procedures


Required to use a Predetermined Network of Doctors and Hospitals


Can I lose my insurance?

Yes, many people have to change year to year because the plan they had before no longer exists

Excessive out of pocket cost sharing usually around 20% for Part B administered Drugs (chemotherapy is a big one) and durable medical equipment


How Does a Medicare Advantage plan Work?

Medicare advantage replaces Medicare Part A & Part B

A Medicare advantage plan replaces original Medicare A&B. When you purchase a Medicare advantage plan, original Medicare A&B are no longer paying your insurance bills. Original Medicare starts paying a monthly premium to your Medicare advantage plan company in addition to the premium your Medicare advantage plan company is already charging you. Medicare pays your Medicare Advantage plan company in the neighborhood of $700-$2000 per month. This is in exchange for taking all of your risk off original Medicare and putting it on that private insurance company (the Medicare Advantage plan.) 

How does Medicare Advantage deal with being responsible for all of your medical bills?

There are three types of Medicare Advantage plans, HMO(Health Maintenence Organization), PPO( Prefered Provider Network, PFFS ( Private Fee for Service).  Most of Washington only has access to HMOs so that’s what we’re going to focus on here.  The other two styles of plans have/are being faded out because HMO plans make more money for the company.

The first thing an HMO advantage plan is going to do is setup a network of doctors you’re required to use and give you a primary care physician. The next thing they do is put a referral system in place. You have a foot problem? You have to schedule an appointment with your primary doctor, go see your primary doctor, your doctor writes a referral for an in network podiatrist ( foot doctor) and in 6 weeks you see your foot doctor. 

The next thing a Medicare advantage plan does to help subsidize the financial risk they’re taking on you is to make sure you have a LOT of skin in the game. So they add in cost sharing and co-pays for everything that you do.


Mike's Take: A Medicare Advantage plan's purpose is specifically to ensure that you don't get what the company deems to be unnecessary treatment. A Medicare Advantage plan is going to try and cut costs anywhere they can. That's why they have out of pocket expenses, to make sure you have something to lose (your money) if you need medical treatment. That's also why most of the plans are Health Maintenance organizations. So they can manage your healthcare and make financial decisions that are best for the company instead of what's best for you.
Mike Worrell Insurance Agent
Mike Worrell

Understanding Cost Sharing and Co-Pays under a Medicare Advantage Plan

Medicare Advantage cost sharing

First, you’re going to have cost-sharing and co-pays for everything that you do. You’ll have a co-pay for the doctor and specialist. In rare cases there is no co-pay for a primary care doctor but that doesn’t happen much in Washington

Your co-pays  for a hospital stay will vary from $100-$400 per day depending on the plan.

Co-insurance, you will be responsible for 20% of the bill for certain expensive Medical conditions. Most advantage plans only cover 80% of Medicare Part B administered drugs. That includes Chemo therapy for cancer treatment, Injections, infusions, and vaccinations. That can get incredibly costly very quickly. Another big one is diagnostics, X-rays, MRIs, Cat scans, PET scans, Ultrasounds, blood tests and much more are only covered at 80%, leaving you to pay 20% of the bill.

All Medicare advantage plans have an out of pocket maximum. However with rising costs, most out of pocket maximums in Washington State are $6,700. So you have to spend $6,700 of your own money before the plan covers you 100%. That only lasts for the calendar year too, that out of pocket maximum resets every January 1st. The out of network limit for most plans is $10,000 (of your own money) in a calendar year.

Mike's Take: Living on a fixed income, especially just Social Security is tougher than ever in this day and age. If the cost of a Medicare Supplement plan ( Plan F/ Plan G/ Plan N) is going to be a tight squeeze for you, then you shouldn't even consider a Medicare advantage plan. A Medicare Supplement is a stable premium that can be worked into a monthly budget that covers everything Medicare A&B doesn't cover. A Medicare Advantage plan leaves you open to $6,700(under most plans in WA) in potential out of pocket costs every single year.
Mike Worrell Insurance Agent
Mike Worrell

If I Don’t Like My Medicare Advantage Plan, Can I change it?

If you’re wanting to change your Medicare advantage plan, it’s probably because you’re having problems with it. You’re frustrated that they won’t approve the treatments you want, you can’t see the doctors you want to see, or you’re spending a fortune in out of pocket expenses. 

If this is the case you are most likely stuck being insured by Medicare advantage plans. If you want to return to original Medicare and a Medicare Supplement, you need to qualify with your good health. If you have medical conditions and you have a Medicare advantage plan, you most likely will not qualify for a Medicare supplement plan. 

The best time to purchase a Medicare supplement plan is right when you start Medicare part A & Part B, which most people do at age 65. There is no consideration of your health when you first start Medicare. You can purchase any Medicare supplement that you like. After that one 6 month window of opportunity, you will have to show a relatively clean bill of health to purchase a Medicare supplement down the road. The 6 month window doesn’t start until you start Medicare Part B, for those of you who start medicare Part A and continue to work for years to come, the 6 month open enrollment window begins when you start Medicare Part B.

Mike's Take: This is so important. I get contacted by seniors every year, who have a Medicare Advantage plan, they're extremely unhappy with it for atleast one or more of the reasons above, and they want to change to back to original Medicare and purchase a Medicare Supplement plan. I have to be the bearer of bad news and tell them there is nothing I or anyone else can do to help. The conversation usually goes like this:
Me: "I'm very sorry. You cannot qualify for a Medicare Supplement because of your Health conditions."
Senior: "I thought I could change at the end of the year regardless of my health? Me: "No you can't I'm sorry you were misinformed"
Senior: " I thought Obamacare changed that and they can't deny me anymore"
Me: "No unfortunately Obamacare did not effect Medicare supplement underwriting, you cannot qualify, I'm very sorry you are just finding this out"

Moral of the story is: You don't want to find yourself in this position as so many seniors find themselves in every year.
Mike Worrell Insurance Agent
Mike Worrell

Do Medicare Advantage Plans Offer Coverage for Prescriptions?

Yes, most Medicare Advantage plans offer coverage for Prescription drugs. Not all of them do though. If you enroll in an HMO Medicare advantage or a PPO Medicare advantage and it does not offer prescription drug coverage, you won’t be able to purchase a stand-alone prescription drug plan. You will have to do with out.

How does Prescription drug coverage and a Medicare Advantage plan work?

Medicare advantage plans that have prescription drug coverage as a part of the plan tend to have rather poor prescription drug coverage.  They are designed for mass enrollments so they’re not going to offer top notch coverage. Another thing to consider is, if you get on expensive prescriptions and your MAPD (Medicare Advantage Prescription Drug plan) doesn’t cover the cost of your prescriptions very well, you’re stuck on that plan and whatever it covers. Remember also, once you develop medical conditions you’re probably stuck on a Medicare Advantage plan for life because you now cannot qualify for a Medicare supplement.

How can I ensure I can get decent prescription drug coverage if I get on expensive drugs in the future?

The only way to ensure you can upgrade your coverage as your needs change over time is to purchase a Medicare Supplement plan and a Stand-alone Prescription drug plan. Stand-alone prescription drug plans can be changed at the end of the year, regardless of your health or medications.  In Washington state you’re left with HMOs with a small handful of PPO’s. There are no PFFS (Private Fee for Service) Medicare Advantage plans left.


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Related Articles:

Learn more about Prescription drug coverage here: https://washingtonmedicareplans.com/prescription-drug-coverage/

Learn about Washington Medicare Supplement plans:  https://washingtonmedicareplans.com/medicare-supplement/