I’m on Medicare. How would SB 5222 affect me?

Here, we’ll explain how SB 5222 would expand coverage and reduce costs using a state-level universal healthcare program called the Whole Washington Health Trust.

The current system

Right now with Medicare, you’re part of a program administered by the Federal government. Your Medicare premiums come out of your SSI or SSDI payments. If you have supplemental coverage (such as Medigap, Medicare Advantage and/or Part D prescription drug coverage) you have additional premiums for services and fees not covered with basic Medicare. With Medicare coverage, you may have copays, coinsurance, and deductibles. Even many who are “dual eligible” for Medicare and Medicaid may have out of pocket costs.

Option to Remain As Is

If you’re happy with your current Medicare option, you can continue with it, just as you are today. After 51% of Washington residents enroll in the Whole Washington Health Trust, most employers would be required to pay the Health Security Assessment, but unless a federal waiver is granted to integrate Medicare benefits directly into the trust, Medicare eligible retirees are exempt from this assessment on their pay.  Medicare eligible residents may continue to use primary Medicare as their coverage or continue to use any Medicare Advantage Plan available to them.

Option to Enroll In the Whole Washington Trust

After SB 5222 passes, you will have the choice to enroll in the Whole Washington Health Trust for secondary insurance as a Medicare Advantage plan. Medicare eligible residents earning above 200% of the federal poverty level are exempt from owing premiums or copays for expanded coverage through the trust. Those earning over 200% of the federal poverty level would owe a premium to enroll in the trust.

Medicare would still be your primary coverage. If you enroll in the Whole Washington plan, you will receive the expanded, comprehensive benefits available through the Trust including vision, dental, hearing, and prescription co-pay caps of $250/year.

The Monthly Premium

If you opt in, you may be obligated to pay a Monthly Premium. You’ll have the same Monthly Premium cost protections as other Washington residents, based on where your income is relative to the Federal Poverty Level (FPL).

  • If you’re below 200% of the FPL (less than $24,280 for a single person household / $32,920 for two), you won’t owe any Monthly Premium.
  • If you’re above 200% of the FPL, you’d have a monthly premium. The Board of the new health trust will determine the final amount of the premium; however, the most your premium would be is $200/month.
    • If the Board follows the recommendations of Dr. Gerald Friedman, who conducted the financial analysis that is the basis for the I-1600, the Monthly Premium scale would be $34 (200-233% FPL), $67 (233-267% FPL), $101 (267-300% FPL) or $134 (>300% FPL) per month.

It’s possible the Monthly Premium could be eliminated at some point. The Board of Whole Washington Health Trust is required to lower the premium as much as possible each year after the transition period, but it can never go above $200 per month.

Reimbursements

If your household income is under 200% of the Federal Poverty Level (less than $24,280 for a single person household / $32,920 for two people) your Medicare premiums would be reimbursed by the Whole Washington Health Trust whether you enroll in the trust for expanded coverage or not. If your household earns over 200% of the federal poverty level you’ll need to enroll in the trust as your Medicare Advantage Plan to have your Medicare premiums reimbursed by the trust, unless a federal waiver is granted integrating the Medicare directly into the trust.

The process described above is complicated due to coordination and transfer of funds between federal and state entities. However, it gives Medicare recipients the ability to join the Whole Washington Health Trust for expanded coverage as soon as possible, without the need for a Federal Waiver. The Whole Washington plan will meet the benefit requirements to qualify as a Medicare Advantage plan and can administer Medicare benefits without special permission from the federal government.

Q. What’s a Federal Waiver, anyway?

A. Federal Waiver is granted by federal entities in negotiations with state entities. If granted, the “waived” health program can be integrated to fund the state Universal Healthcare program directly. This would save the federal government administrative costs because there would be large scale transfer of federal funds to the state Trust to cover medical services for state Medicare recipients instead of paying for services on an individual claim basis.

Post Federal Waiver

If and when Federal Waivers are obtained, you will no longer need to pay Medicare premiums, and reimbursements won’t be necessary. Instead, you’ll pay the Whole Washington Health Trust’s Monthly Premium (which can’t exceed $200 for adults earning over 200% FPL), and the Washington Health Trust would fully administrate it as Medicare on behalf of Washington residents.

Whether it’s a direct payment (post-Federal waiver) or a deduction and reimbursement (pre-Federal waiver), you will have immediate access to the statewide option of providers and the comprehensive healthcare as defined in the bill.

Summary – SB 5222 Universal Healthcare is a big win for Medicare recipients!

  • Your benefits expand to include medical, vision, dental, audiology and prescriptions.
  • Co-pays and deductibles are eliminated for everything but prescriptions.
  • There’s a cap on prescription costs — never more than $250/per person per year for adults earning over 200% FPL.
  • There’s a maximum amount for the monthly premium — never more than $200/month for adults earning over 200% FPL.
  • Low income earners are reimbursed for all Medicare premiums (anyone whose only income is SSDI or SSI).
  • There’s no “dual eligibility” loophole that requires spending down your income to get care with no out-of-pocket costs.
  • No networks – all providers in the state can accept the state plan and enjoy simple healthcare focused negotiations for reimbursements!
  • No more shopping for complicated plans!