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.

Most people pay no monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years — CMS calls this premium-free Part A. Part A still has a deductible if you are admitted to the hospital. Part B carries a monthly premium — $202.90 per month in 2026 for most beneficiaries — plus an annual deductible. Part D and supplemental plans have their own premiums that vary by carrier and plan.

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 contracts with some Medicare Advantage plans and not others, and the list is set each plan year. Two plans from the same insurance company can be contracted differently, and participation can differ from one TVC physician to the next. We do not publish a list, because a stale one is how people end up in a plan that does not include their doctors. Before you enroll, search the plan's own provider directory for each of your doctors by name. Then call the plan, ask it to confirm on the record that those doctors are in network for the coming plan year, and ask for a reference number for the call. You can also ask TVC billing which Medicare plans it is contracted with for the coming year.

Read how to check your Vancouver Clinic doctors against a plan, or call Timothy at (360) 472-4261.

Have a Providence Medicare Advantage plan? Read the September 2026 update: Providence Medicare Advantage Is Ending for 2027.

An independent broker like Timothy Jones represents several organizations rather than one, so you can compare plans from more than one insurance company in a single conversation, checked against your own doctors and prescriptions. You pay the same premium whether you enroll through a broker or directly with the insurance company. The insurance company pays the broker, and that payment is not added to your premium. We do not offer every plan available in your area. Currently we represent 5 organizations which offer 33 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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.

In 2026, the Inflation Reduction Act caps your out-of-pocket prescription drug costs at $2,100 per year, with a $615 standard deductible. CMS has set the 2027 cap at $2,400 with a $700 deductible, effective January 1, 2027. Either way the old 'donut hole' coverage gap is gone, which 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 comes at no cost to you. Brokers are compensated by insurance carriers, within limits CMS sets for Medicare Advantage and Part D plans. You pay the exact same premium whether you enroll through a broker or directly with the insurer.

The answer changes every year: which plans are offered, what they cost, and which doctors they include. Plans can start sharing next year's details on October 1. To see the Medicare Advantage and drug plans offered where you live, including plans we do not represent, use Medicare's Plan Finder at Medicare.gov or call 1-800-MEDICARE. If you already have one of those plans, it sends you an Annual Notice of Change by September 30 saying what changes for next year. Timothy Jones can compare the plans he represents against your doctors and prescriptions for your 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 Washington's free, unbiased Medicare counseling program, and its counselors do not sell insurance. Timothy Jones is a licensed broker who can compare the plans he represents and help you enroll, at no cost to you. He does not offer every plan in your area. Those are different roles, and both are worth using.

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

Not yet, and maybe not at all. UnitedHealthcare and Legacy Health are negotiating a new contract. Legacy issued a termination notice so the old rates would not auto-renew while they keep talking. If there is no agreement by September 30, 2026, Legacy would go out of network for UnitedHealthcare members on October 1, 2026, including Medicare Advantage. Until then nothing changes, and emergency care is covered at the in-network level either way.

Read the full explainer: UnitedHealthcare and Legacy Health, what to do with that letter, or call Timothy at (360) 472-4261.

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 $202.90 per month. Higher-income beneficiaries pay more through IRMAA adjustments. The Part B deductible in 2026 is $283.

IRMAA (Income-Related Monthly Adjustment Amount) is an additional premium surcharge for higher-income beneficiaries. In 2026, individuals with MAGI above $109,000 (joint filers above $218,000) pay more than the standard Part B premium, plus an extra amount on top of their Part D 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 no-cost consultation.