Here, we’ll explain how The Whole Washington Health Trust works with Medicare.
The current system
Right now with Medicare you’re part of a program administered by the Federal government, and Medicare premiums come out of your SSI or SSDI payments. If you have supplemental coverage (such as Medigap, a Medicare Advantage Plan, and/or Part D prescription drug coverage), you have additional premiums for services not covered by basic Medicare. You may have copays, co-insurance, and deductibles.
Option to Remain As Is
If you’re happy with Medicare, you can continue as is and use any supplemental Medicare Advantage Plan available to you.
Option to Enroll In the Whole Washington Health Trust
As soon as it’s available, you can enroll in the Whole Washington Health Trust for either full or supplemental coverage. You’ll receive expanded benefits, such as:
- Prescription Drug Coverage
- Most prescriptions are fully covered, including all generics. The most you’ll pay for prescriptions that aren’t covered is $250/per person, per year.
If your household earns less than 200% of the federal poverty level, you won’t pay a monthly premium.
If your household earns over 200% of the federal poverty level, you’ll pay a monthly premium.
The Monthly Premium
The Whole Washington Health Trust Board will determine the final amount of the premium; however, the most your Monthly Premium can be is $200/month.
- The Monthly Premium could be eliminated at some point. The Board is required to review and lower the premium as much as possible each year after the transition period.
Medicare Premium Reimbursements
If your household income is under 200% of the federal poverty level, your Medicare premiums would be reimbursed by the Whole Washington Health Trust when you enroll for full coverage during Phase 1 (see below).
The Whole Washington Health Trust Board is instructed to complete specific tasks to merge state and federal funds to win efficiencies on both the individual and systemic level.
Phase 1 – Medicare Advantage Plan Application
When the Whole Washington Health Trust passes, the Board will apply to enter into a commonly used contract with CMS (Centers for Medicare and Medicaid Services) to become a Medicare Advantage Plan. In this phase, if you enroll in the WWHT, Medicare will still fund your primary care.
Phase 2 – Medicare Advantage Plan Contract Granted
When the Whole Washington Health Trust is granted the Medicare Advantage Plan contract, both primary and supplemental care will be funded by the Whole Washington Health Trust. In this phase, you will no longer need to pay Medicare premiums, and reimbursements won’t be necessary.
Phase 3 – Passage of Federal Legislation
When the State-Based Universal Healthcare Act is passed (introduced by U.S. Representative Ro Khanna), federal funds will flow directly into the Whole Washington Health Trust. This will make the system much simpler behind the scenes but will not impact the individual experience in this phase.
Summary – The WWHT is a big win for Medicare recipients
- Your benefits expand to include medical, vision, dental, audiology and prescriptions
- Co-pays and deductibles are eliminated
- Prescriptions are never more than $250/per person per year for those earning over 200% FPL
- The monthly premium is never more than $200/per person per month for those earning over 200% FPL
- No dual eligibility loophole that requires you to reduce your income
- No provider networks
- No shopping for complicated plans