Medicare FAQ

If you are a senior in Vancouver, WA turning 65 and you are not covered by an active employer health plan, you should enroll during your Initial Enrollment Period (IEP) — a 7-month window starting 3 months before your birthday month, your birthday month, and 3 months after. Enrolling in the first 3 months ensures coverage starts on the 1st of your birthday month.

If you miss your IEP without a qualifying Special Enrollment Period, you may face a permanent late enrollment penalty for Part B (10% per 12-month delay) and Part D. Missing this window is one of the most costly Medicare mistakes seniors in Clark County make.

No. If you receive Social Security benefits, you are typically auto-enrolled in Parts A and B. However, Part D and any supplemental coverage — Medicare Advantage or Medigap — require you to actively choose and enroll on your own.

Medicare Part A is free for most people who paid Medicare taxes for at least 10 years. Part B has a monthly premium — $185.00 per month in 2026 for most beneficiaries. Part D and supplemental plans vary by carrier.

If your employer has 20 or more employees, you can generally delay Part B without penalty as long as you have active employer health coverage. Once that coverage ends, you have an 8-month Special Enrollment Period to enroll. If your employer has fewer than 20 employees, Medicare becomes primary and you must enroll at 65.

The most important step is obtaining Form CMS-L564, signed by your employer, which proves you had creditable group health coverage since age 65. Without it, Social Security may deny your Special Enrollment Period application. Timothy Jones recommends having HR complete their section 2–3 months before your planned retirement date.

No. COBRA is not considered 'active employer coverage' for Medicare SEP purposes. If you leave your job and choose COBRA instead of enrolling in Medicare, your 8-month SEP window continues to run. Many Vancouver seniors make this costly mistake, ending up with a permanent Part B late penalty.

If your employer has fewer than 20 employees, Medicare is primary at 65 even if you are still working. Your group plan may pay little or nothing if Medicare should have paid first. You must enroll in Medicare when you turn 65 regardless of employment status.

Timothy Jones recommends: 3 months out — confirm enrollment status with Social Security; 2 months out — have employer sign CMS-L564 and submit Part B application (CMS-40B); 1 month out — choose your plan: Medicare Advantage or Medigap plus Part D; Day of retirement — confirm your coverage start dates.

Medicare Advantage (Part C) is an all-in-one private plan replacing Original Medicare, often including dental, vision, and drug coverage with lower premiums but network restrictions and copays. Medicare Supplement (Medigap) works alongside Original Medicare, covering gaps like copays and coinsurance with higher premiums but very predictable costs and no network restrictions. The right choice depends on your health, doctors, and finances.

The Vancouver Clinic accepts select Medicare Advantage plans in 2026, including certain Humana, UHC, Providence, and Regence plans — but not all. Plan acceptance changes annually. Timothy Jones can verify your specific plan's TVC network status before you enroll.

An independent broker like Timothy Jones represents multiple carriers — Humana, UnitedHealthcare, Aetna, Regence, and more. His advice is not biased toward any single carrier. You pay the same premium whether you enroll through a broker or directly with the insurer — the broker's compensation is built into the plan rate, not added to your cost.

AEP runs October 15 to December 7 each year. Anyone with Medicare can join, switch, or drop a Medicare Advantage plan or Part D plan. Changes take effect January 1. This is the most important window for Clark County seniors to review their coverage.

OEP runs January 1 to March 31 and is only available to people already enrolled in a Medicare Advantage plan. You can switch Advantage plans or return to Original Medicare. Unlike AEP, OEP does not allow switching from Original Medicare to Advantage for the first time.

AEP (Oct 15–Dec 7) allows the widest range of changes and is open to all Medicare enrollees. OEP (Jan 1–Mar 31) is only for current Advantage enrollees, allowing a switch to another Advantage plan or back to Original Medicare. If you made an AEP change and had second thoughts, OEP may give you another opportunity.

Most Medicare Advantage plans already include drug coverage (MAPD plans). If you have a Medicare Supplement (Medigap) plan instead, you will need to enroll in a standalone Part D plan — Medigap does not cover prescriptions.

Starting in 2026, the Inflation Reduction Act caps your out-of-pocket prescription drug costs at $2,100 per year. This eliminates the old 'donut hole' coverage gap and is a major benefit for Clark County seniors with expensive medications.

If you go 63 or more days without creditable drug coverage, you will face a permanent late enrollment penalty: 1% of the national base premium for every month without coverage, added to your Part D premium for as long as you have Medicare.

No. Working with Timothy Jones is completely free. Brokers are compensated by insurance carriers at rates set by CMS. You pay the exact same premium whether you enroll through a broker or directly with the insurer.

Clark County has plans from Humana, UnitedHealthcare, Aetna, Kaiser Permanente, Providence, and Regence BlueCross BlueShield. Available plans and networks change each AEP. Timothy Jones can provide a current side-by-side comparison for your specific ZIP code.

Parts A and B work nationwide. However, Medicare Advantage plans are local network plans — an Oregon-based plan may not cover you in Clark County outside of emergencies. Medicare Supplement (Medigap) plans are portable across state lines. If you are a senior relocating between OR and WA, a plan review with Timothy is essential.

SHIBA (Statewide Health Insurance Benefits Advisors) is WA State's free Medicare counseling program. SHIBA volunteers can answer general questions but cannot recommend specific plans or enroll you. Timothy Jones does everything SHIBA does — plus he can compare actual plans and complete your enrollment — at no cost.

Yes. Timothy serves Vancouver, Camas, Battle Ground, Ridgefield, Washougal, and surrounding areas. He offers in-office meetings, phone consultations, and can come to you when needed. Call (360) 472-4261 or book online.

Legacy Health closed several urgent care and specialty clinics in Clark County in 2025. If you used Legacy-affiliated providers, your Medicare Advantage plan may no longer have adequate in-network coverage. This is a key reason to review your plan at every AEP with an independent broker.

The standard Part B premium for 2026 is $185.00 per month. Higher-income beneficiaries pay more through IRMAA adjustments. The Part B deductible in 2026 is $257.

IRMAA (Income-Related Monthly Adjustment Amount) is an additional premium surcharge for higher-income beneficiaries. In 2026, individuals with MAGI above $106,000 (couples above $212,000) pay more than the standard Part B premium. You can appeal IRMAA if your income decreased due to retirement or another life change.

Yes. Washington State Medicare Savings Programs can pay your Part B premium. Extra Help (Low Income Subsidy) can reduce Part D costs. Washington Apple Health may provide additional assistance. Timothy Jones can connect you with these programs during your free consultation.