Initial Enrollment Period (IEP):
You have a 7-month window to enroll—3 months before your 65th birthday month, the month of your birthday, and 3 months after. If you’re already receiving Social Security benefits, you may be enrolled automatically.

If You Miss Your IEP:
You can enroll during the General Enrollment Period (Jan 1–Mar 31 each year), but your coverage won’t begin until July 1. You may face a late enrollment penalty if you didn’t have other creditable coverage.

Still Working at 65?
You can delay Part B (and Part D) without penalty if you have creditable employer coverage through your job or a spouse’s. Be sure to confirm the coverage is creditable and notify Medicare when you retire or lose the coverage.

Special Enrollment Periods (SEPs):
If your situation changes (like losing employer coverage, moving out of your plan’s area, or becoming eligible for Medicaid) you may qualify for an SEP to enroll or switch plans without penalty.

Original Medicare is made up of Part A (Hospital Insurance) and Part B (Medical Insurance) and covers many medically necessary services, but it doesn’t cover everything.

What Original Medicare covers:
Part A (Hospital Insurance):

• Inpatient hospital stays

• Limited skilled nursing facility care (only after a qualifying hospital stay and not for long‑term care)

• Hospice care

• Certain home health services
  
  

Part B (Medical Insurance):

• Doctor visits and specialist care

• Outpatient services (labs, imaging, outpatient procedures)

• Preventive services (annual wellness visits, screenings, vaccines)

• Durable medical equipment (wheelchairs, walkers, oxygen, etc.)

• Mental health and some therapy services
  
  

What Original Medicare does NOT cover:

• Most routine dental care, dentures, and cleanings

• Routine vision exams, eyeglasses, and contacts

• Hearing aids and routine hearing exams

• Routine physical exams (outside of covered wellness visits)

• Long‑term custodial care, such as ongoing nursing home or assisted living care

• Care outside the U.S. (with limited exceptions)
  
  

Important things to know:

• Original Medicare generally pays 80% of approved costs under Part B after the deductible; there is no annual out‑of‑pocket limit unless you have other coverage.

• Many people in Washington choose to add Medicare Supplement Insurance (Medigap) or enroll in a Medicare Advantage plan to help cover costs or add benefits like dental, vision, or hearing.

• Prescription drugs are not included unless you enroll in a separate Part D drug plan or a Medicare Advantage plan that includes drug coverage.

Medicare costs depend on which parts you choose and your specific circumstances, including income and work history. Here's a breakdown:

• Part A (Hospital Insurance):

  • Usually premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years.

  • If you don’t qualify for premium-free Part A, you may have to pay a monthly premium

  • Deductibles and coinsurance apply for hospital stays.
    

• Part B (Medical Insurance):

  • Has a monthly premium—the standard is $174.70 in 2024, but higher-income individuals may pay more (known as IRMAA).

  • Includes a deductible ($240 in 2024) and typically 20% coinsurance for most services after that.

  • No out-of-pocket maximum unless you have additional coverage.

• Part C / Medicare Advantage:

  • Costs vary by plan and county in Washington State.

  • You still pay your Part B premium, and may have an additional plan premium (some plans have $0 premiums).

  • Out-of-pocket maximums are required and vary by plan.

• Part D (Prescription Drug Plans):

  • Monthly premiums vary by plan.

  • Higher-income beneficiaries may also pay an IRMAA surcharge.

  • Plans may also include deductibles, copays, and coinsurance depending on the drugs you take.
    

When you enroll in Medicare, you can choose between two main coverage paths. Here's how they differ:

• Medicare Advantage (also known as Part C):

  • All-in-one plans offered by private insurers that replace Original Medicare (Parts A & B).

  • Most include Part D (drug coverage) and may offer extra benefits like dental, vision, hearing, and fitness programs.

  • Typically have provider networks (like HMOs or PPOs); you may need referrals or pre-approvals.

  • Plans have annual out-of-pocket limits, but costs vary based on plan and service use.

  • Popular in urban areas; rural access may be limited in some parts of Washington State.

• Medicare Supplement Insurance (also known as Medigap):

  • Works with Original Medicare to help pay costs like deductibles, copays, and coinsurance

  • Does not include Part D, so you’ll need to buy a separate drug plan, if you need drug coverage.

  • No extra benefits like dental or vision, but gives you nationwide provider flexibility (any provider that accepts Medicare).

  • Monthly premiums are usually higher, but predictable costs and fewer out-of-pocket surprises.

  • No network restrictions or referrals required.

• Key Differences to Consider:

  • Medigap = flexibility + cost protection, but higher premiums.

  • Advantage = convenience + extras, but may have more restrictions and cost variation.

You have several opportunities each year—and in certain special situations—to change your Medicare coverage. Here's a summary:

• Annual Enrollment Period (AEP):
  October 15 – December 7

  • Anyone with Medicare can:

    • Switch between Original Medicare and Medicare Advantage

    • Change Medicare Advantage plans

    • Join, drop, or switch a Part D prescription drug plan

  • Changes take effect January 1 of the following year.

• Medicare Advantage Open Enrollment Period (MA OEP):
  January 1 – March 31

  • If you're already in a Medicare Advantage plan, you can:

    • Switch to a different Medicare Advantage plan

    • Drop your Advantage plan and return to Original Medicare (and add a Part D plan if desired)

  • You can only make one change during this period.

  • You can’t switch from Original Medicare to a Medicare Advantage plan during this time.

• Special Enrollment Periods (SEPs):
  These allow you to make changes outside the regular enrollment periods if you qualify due to specific life events, such as:

  • Losing other health coverage (e.g., employer, Medicaid)

  • Moving out of your plan’s service area

  • Qualifying for Medicaid or Extra Help

  • Enrolling in or leaving a Medicare Savings Program or Special Needs Plan (SNP)

  • Plan termination or contract violation by the plan

The timing and duration of SEPs vary by situation, and in most cases you have 2 months from the event to make a change.

We’re happy to guide you through the entire Medicare Process. The best time to reach out is after you’ve enrolled in Medicare Part A and Part B through Social Security.

Once you’re enrolled in Parts A & B, we can help you:

• Review your coverage options

• Compare Medicare Advantage plans and Medicare Supplement (Medigap) plans

• Determine if you need Part D prescription drug coverage

• Enroll in Medicare Advantage, Medicare Supplement and/or drug plans

• Understand enrollment deadlines and avoid potential penalties

We’re here to make your next steps easy, clear, and personalized to your needs. Reach out when you're ready and we'll walk you through the rest.ment process, but the best time to contact us is after you’ve enrolled in Medicare Part A&B (through Social Security). At that point, we can go over your options, of adding either Medicare Advantage of a Supplement Plan

Nothing! Our help is no-cost to you.
We’re paid through Medicare if you enroll through us. This lets us offer unbiased guidance to help you choose the plan that’s right for you.