Frequently Asked Questions

 All US citizens become eligible for Medicare when they turn 65. Non-citizen permanent residents are eligible at 65 also, provided they have lived in the country for at least five years.

If you are under 65, you might qualify for Medicare if:

• You are permanently disabled and have received Social Security Disability benefits for at least 24 months
• You have been diagnosed with end-stage renal disease (kidney failure)
• You have been diagnosed with Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and are receiving Social Security Disability benefits

As with most large, complex government programs, Medicare can seem a bit overwhelming at first. That’s why we’ve created this guide to help you navigate the application procedure, annual enrollment, and more.

The Medicare.gov Web site also has a tool to help you determine if you are eligible for Medicare and when you can enroll.  It is called the Medicare Eligibility Tool. by clicking this link you will be redirected to an external site. 

You can call (or log in to your account) the SS Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at www.socialsecurity.gov. by clicking this link you will be redirected to an external site for Social Security. 

The Medicare.gov Web site also has a tool to help you determine if you are eligible for Medicare and when you can enroll.  It is called the Medicare Eligibility Tool. by clicking this link you will be redirected to an external site. 

 Generally, we advise people to sign up for Medicare when they’re first eligible to avoid a gap in coverage and/or late enrollment penalties. For most people, Medicare eligibility starts three months before turning 65 and ends three months after turning 65. This applies IF your effective dates for Part A & Part Be are the same. If those dates are different, you have a 3 month period before activating Part B to apply. Some people get Medicare automatically, but not everyone. It is importantly to pro-actively seek guidance for your unique situation. 

Visit Medicare.gov for more on eligibility and enrollment. 

  You don't need to be enrolled in Medicare before we meet. Our meeting can help you understand your options and guide you through the enrollment process when you're ready. 

Medicare Part A is considered hospitalization insurance. Part A covers costs related to:

• Inpatient care in a hospital
• Skilled nursing home care Inpatient care in a skilled nursing facility that is not custodial or long-term
• Hospice care
• Home health care

Medicare Part B provides for the rest of your non-hospitalization healthcare needs, ie: doctors visits, testing, etc. Under Part B you receive coverage for:

• Medically necessary services such as doctor visits, tests, and other services as needed to diagnose or treat your condition
• Preventive services like routine screenings, check-ups, vaccinations, and more
• Clinical research
• Ambulance services
• Durable medical equipment
• Mental health services
• Limited outpatient prescription drugs

Together, Part A & Part B are called "Original Medicare". 

Medicare Part C, or Medicare Advantage is designed to roll the coverage of Parts A and B into one plan, offered by a private health insurance company that contracts with Medicare.. By law, Advantage plans must offer at least the same coverage as Original Medicare. Other rules may differ, or the network might offer additional benefits. Many Advantage plans also include Part D, or prescription drug coverage.

Common types of Part C plans include:

• Health Maintenance Organization (HMO) plans
• Preferred Provider Organization (PPO) plans
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs)
• HMO Point of Service Plans (HMOPOS)
• Medicare Medical Savings Account (MMSA)

If you choose this option, you will have the opportunity to compare plans, benefits and rates each year during Annual Enrollment Period. (Oct. 15th - December 7th) Plans do have a tendency to change each year. 

 Significant changes are coming to Medicare Part D in 2025, affecting premiums, drug coverage, and out-of-pocket costs. Stay ahead by understanding these updates and preparing now. 

Changes coming to the Medicare Part D program in 2025 include:

• Elimination of the Prescription Drug Coverage Gap (Donut Hole) Phase.
• Capping annual out-of-pocket drug costs at $2,000 for individuals with Medicare Part D coverage.
• Requirement for all Medicare plans that include Part D coverage to offer enrollees the option of a Prescription Payment Plan. 
• Part D plans and drug manufacturers will pay a larger share of drug costs to alleviate the burden on members.

 Medicare is divided into several “parts,” each designed to work together to provide comprehensive coverage. However, gaps between these parts can leave some individuals facing difficulties in obtaining coverage for certain situations or incurring high out-of-pocket expenses. To address these gaps, Medicare Supplement Plans, commonly known as “Medigap” plans, were created.

A Medigap plan, when combined with Original Medicare, offers nationwide acceptance and typically results in the lowest out-of-pocket costs, providing the greatest flexibility. The cost of a Medigap plan is influenced by factors such as age, gender, geographic location, tobacco use, and eligibility for household discounts. Consequently, premiums can vary significantly depending on your personal circumstances and the insurance carrier you choose.

What IS a Medicare Supplement Plan? 

 A Medicare Supplement Plan, or Medigap, helps cover costs that Original Medicare doesn't, such as deductibles, co-pays, and coinsurance. First, Medicare pays its portion, then the Supplement plan covers some or all of the remaining costs, depending on the specific plan. The enrollment period for these MediGap plans are the same as the Annual Enrollment that occurs each Fall. 

 Please bring the following items to our meeting:

• Identification
• Medicare cards (if you have them)
• Names of your preferred doctors
• List of prescribed medications, including dosages and frequency

To streamline our meeting, you can also complete the survey on the appointment page beforehand.

 As an Insurance Producer, I am contracted with multiple major insurance carriers in Washington State. This enables me to help you evaluate plans that serve your area and provide you with a comprehensive view of your options. 

I am also licensed for Health and Life in Idaho State.

Glad you asked! Yes! 

As a health and life insurance agent, I can assist you with a range of services, including vision and dental insurance, hospital indemnity plans, final expense coverage, cancer plans, long-term care, and annuities.