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. 

 Q: When can I sign up for Medicare?
A: Your Initial Enrollment Period starts three months before your 65th birthday, includes your birthday month, and ends three months after.

Q: What if I miss my enrollment period?
A: You may have to wait until the General Enrollment Period (January 1–March 31) and could face late penalties.

Q: Can I change my plan later?
A: Yes. You can switch plans during the Annual Enrollment Period (October 15–December 7) each year.

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. 

Medicare Part A is Hospital 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 is Medical Insurance, 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. 

Changes coming to the Medicare Part D program in 2026 include:

• Capping annual out-of-pocket drug costs at $2,100 (on your plans formulary) for individuals with Medicare Part D coverage.
• The standard Part D deductible is projected to increase. (estimate: $615)
• Cost sharing under the new Part D redesign will be adjusted among beneficiaries, plans, manufacturers, and Medicare. 
• Beneficiaries may opt into the Medicare Prescription Payment Plan (MPPP) during or before the plan year.

 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. 

 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. 

If you have not yet applied for your Medicare card - please make me aware of that before scheduling your meeting. I can provide helpful instructions for that process. If you are Medicare eligible or becoming eligible, we want to get that process started. 

 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.

If you have not yet applied for your Medicare card - please make me aware of that before scheduling your meeting. I can provide helpful instructions for that process. 

 Q: What if I’m still working at 65?
 

• If your employer has 20 or more employees:
  You can usually keep your work insurance and delay Medicare Part B (which has a monthly cost) without penalty. Most people still sign up for Part A since it’s free. When you retire, you’ll get a special window to add Part B.
   
• If your employer has fewer than 20 employees:
  Medicare usually becomes your main insurance at 65. That means you’ll need Part A and Part B to avoid gaps in coverage.
   
• Prescription coverage:
  If your job’s plan includes drug coverage, check if it’s “creditable.” If it is, you can wait to sign up for Part D. If not, you’ll want to enroll in a Medicare drug plan to avoid penalties.
   

👉 Tip: If you have an HSA (Health Savings Account), stop contributing once you sign up for Medicare.

Always check with your HR or benefits department before making a decision so you don’t miss important deadlines.

 As an Independent Insurance Producer, I partner with multiple leading insurance carriers across Washington State. This allows me to provide you with a clear, unbiased comparison of plans available in your area, ensuring you have a comprehensive view of your options.

In addition, I am licensed to offer Health and Life insurance in Idaho, extending the same level of service and support to clients there.

Glad you asked! Yes! 

 As a licensed Health and Life Insurance Agent, I provide guidance on a wide range of coverage options, including vision and dental insurance, hospital indemnity plans, final expense policies, cancer coverage, long-term care solutions, and annuities. My goal is to help you find the right protection to fit your needs and give you peace of mind.