Medicare FAQ

Medicare FAQ for Spokane Residents

Medicare can feel complicated because enrollment timing, employer coverage, prescription drugs, provider access, and supplemental coverage all interact. These answers cover the questions we hear most often from Spokane-area residents. They are general guidance, not a substitute for an individual eligibility or coverage review.

What are the main parts of Medicare?

• Part A (Hospital Insurance) generally covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and some home health care.
• Part B (Medical Insurance) generally covers medically necessary physician services, outpatient care, preventive services, durable medical equipment, and certain other services.
• Part C (Medicare Advantage) is another way to receive Part A and Part B benefits through a Medicare-approved private plan. Most Medicare Advantage plans also include Part D prescription drug coverage.
• Part D is Medicare prescription drug coverage offered through Medicare-approved private plans.
• Medigap (Medicare Supplement Insurance) works with Original Medicare and can help pay some of the deductibles, coinsurance, and copayments Original Medicare leaves to you.

Original Medicare includes Part A and Part B. After enrolling in those parts, you generally choose between Original Medicare—often paired with separate Part D and, if desired and available, Medigap—or a Medicare Advantage plan.

When should I enroll in Medicare?

For most people who become eligible at 65, the Initial Enrollment Period lasts seven months: the three months before the month you turn 65, your birthday month, and the three months after it. Some people are enrolled automatically, while others must enroll through Social Security.

Do not assume that COBRA, retiree coverage, Marketplace coverage, or every employer plan lets you delay Part B without consequences. The correct timing depends on whose current employment the coverage is based on and other details. Confirm your situation before delaying enrollment because late enrollment penalties and gaps in coverage can apply.

Do I need both Part A and Part B?

You generally need both Part A and Part B to receive full Original Medicare benefits, join a Medicare Advantage plan, or purchase a Medigap policy. There are situations in which someone delays Part B because of qualifying current-employment coverage, but that decision should be checked carefully before the enrollment deadline.

Is Original Medicare or Medicare Advantage better?

Neither option is automatically best for everyone.

With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare. Many people also consider a separate Part D plan and a Medigap policy. Compare premiums, expected out-of-pocket costs, access to providers, travel needs, and whether Medigap enrollment rights or medical underwriting may affect a future switch.

With Medicare Advantage, you receive Medicare-covered Part A and Part B services through a private plan. Plans may use provider networks, prior authorization, referrals, and plan-specific cost sharing. Most include Part D, and some offer extra benefits. Benefits, provider networks, drug coverage, and costs can change from year to year.

Can I keep my doctors?

With Original Medicare, you can generally see any provider in the country who accepts Medicare. With Medicare Advantage, access depends on the plan type and provider network; out-of-network care may be unavailable or cost more except in specific circumstances.

Always verify a provider directly with both the provider's office and the plan before enrolling. A directory is useful, but it should not be the only confirmation.

How does Medicare prescription drug coverage work?

Part D helps pay for covered prescription drugs. Each plan has its own formulary, pharmacy network, cost-sharing structure, and coverage rules. A medication may be covered differently from one plan to another, so comparing only the premium can be misleading.

Review your complete medication list, dosages, preferred pharmacies, and any restrictions such as prior authorization, quantity limits, or step therapy. Even if you currently take few or no prescriptions, going without creditable drug coverage can lead to a late enrollment penalty later.

What is Medigap, and can I have it with Medicare Advantage?

Medigap is supplemental insurance designed to work with Original Medicare. It helps cover certain out-of-pocket costs left by Part A and Part B. You cannot use a Medigap policy to pay Medicare Advantage cost sharing, and you generally cannot have both types of coverage at the same time.

Your federal Medigap Open Enrollment Period generally begins the first month you are 65 or older and enrolled in Part B and lasts six months. Outside protected enrollment rights, changing or obtaining Medigap coverage may involve medical underwriting depending on the situation and state rules.

Does Medicare cover long-term nursing home care?

Medicare does not generally cover long-term custodial care when that is the only care needed. It may cover limited skilled nursing facility care when Medicare requirements are met. Medicaid, long-term care insurance, personal resources, or other programs may be relevant for longer-term custodial care.

Should I review my coverage every year?

Yes. Medicare Advantage and Part D plans can change premiums, deductibles, copayments, formularies, pharmacy networks, provider networks, and other rules for the next plan year. Review the Annual Notice of Change and compare your current doctors, prescriptions, pharmacies, expected care, and budget before deciding whether to stay or change.

Where can I get Medicare help in Spokane?

You can compare plans through Medicare.gov or call 1-800-MEDICARE. Washington's Statewide Health Insurance Benefits Advisors (SHIBA) program provides free, unbiased Medicare counseling through the Office of the Insurance Commissioner.

Health Insurance Options is an independent licensed insurance agency. Our local agents can help Spokane-area residents compare the plans and carriers we represent at no added cost. We do not offer every plan available, so you may also wish to review Medicare.gov or SHIBA for information about all options.

What should I bring to a Medicare review?

Bring your Medicare card or eligibility dates, current insurance information, a complete medication list with dosages, preferred pharmacies, doctors and specialists, expected procedures or travel needs, and any notices from your current plan. Do not send sensitive personal or health information through an unsecured form or email.