Important Medicare disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov or 1‑800‑MEDICARE to get information on all of your options.
Not connected with or endorsed by the United States government or the federal Medicare program. Maru Insurance is a licensed independent insurance agency. Enrollment in a plan may be limited to certain times of the year.
How Medicare Advantage works in Washington
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers that contract with the federal government. An Advantage plan bundles your Part A and Part B coverage, usually adds Part D prescription drugs, and often includes extras like dental, vision, or hearing. In exchange, most plans use provider networks and set their own copays and annual out-of-pocket maximums.
Advantage vs. Original Medicare with a supplement
With a Medicare Advantage plan you get your benefits through a private network, often at a lower premium but with copays and network rules. With Original Medicare plus a Medigap plan you can see any provider that accepts Medicare and have more predictable costs, but you pay a separate supplement premium and add a standalone Part D plan. You cannot use both paths at once. Washington's Medigap birthday rule can make the supplement path more flexible if you later change your mind.
Enrollment windows
You can join, switch, or drop a Medicare Advantage plan during your Initial Enrollment Period around age 65, the Annual Enrollment Period each fall (October 15 to December 7), and the Medicare Advantage Open Enrollment Period (January 1 to March 31). Enrollment may be limited to these times.
How Maru helps
Maru is a licensed independent agency. Before you enroll, we check that your doctors and preferred hospitals are in a plan's network and that your medications are covered, then compare the Advantage plans available in your county on total cost—not just the headline premium. Our help costs you nothing.
How Medicare Advantage plans really work
A Medicare Advantage (Part C) plan is offered by a private insurer approved by Medicare. By law it must cover everything Original Medicare covers, and most plans add prescription drugs and extra benefits. The details that decide whether a plan fits you live in the fine print — here's what to look at:
- Plan type (HMO vs. PPO). HMOs keep costs down by using a set network and often requiring referrals; PPOs cost a bit more but give you more freedom to see out-of-network providers.
- The out-of-pocket maximum. Every Advantage plan caps what you'll pay for covered medical care in a year — a real protection Original Medicare alone doesn't offer.
- Networks and referrals. Check that your doctors and hospital are in-network, and whether specialist visits need a referral.
- Prior authorization. Some services need the plan's approval first; it's worth knowing which ones.
- Star Ratings. Medicare rates plans from 1 to 5 stars on quality and service — a helpful tie-breaker between similar plans.
- Drugs and extras. Confirm your prescriptions are on the formulary and see which extra benefits you'd actually use.
The parts of Medicare, explained in plain language
Medicare is built from parts that each do a different job. Understanding what each one does — and what it leaves out — is the first step to choosing coverage that actually fits your life.
| Part | What it covers | Good to know |
|---|---|---|
| Part A — Hospital | Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. | Most people pay no monthly premium for Part A because they or a spouse paid Medicare taxes long enough while working. |
| Part B — Medical | Doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. | Part B has a monthly premium and an annual deductible, and it typically pays 80% of approved costs, leaving you the other 20% with no cap. |
| Part C — Medicare Advantage | A private-plan alternative that bundles Part A and Part B, and usually Part D, into one plan. | Plans use networks and set an annual out-of-pocket maximum. Extras like dental, vision, or hearing are sometimes included. |
| Part D — Drugs | Prescription-drug coverage, offered as a standalone plan or built into a Medicare Advantage plan. | Each plan has its own list of covered drugs (a formulary). Going without creditable drug coverage can trigger a lifelong penalty. |
| Medigap — Supplement | Private coverage that pays much of what Original Medicare leaves you to pay, like deductibles and coinsurance. | Medigap works only with Original Medicare — not with Medicare Advantage — and does not include drug coverage. |
Medicare enrollment periods and deadlines
Timing is one of the most important parts of Medicare. Enrolling in the right window protects you from penalties and gaps — and some windows only come around once. Here are the periods that matter most:
| Window | When | What it's for |
|---|---|---|
| Initial Enrollment Period (IEP) | The 7 months around your 65th birthday — the 3 months before your birthday month, the month itself, and the 3 months after. | Your first chance to sign up for Parts A, B, and D and to buy a Medigap policy with the strongest protections. |
| Medigap Open Enrollment | A one-time 6-month window that starts the month you're 65 and enrolled in Part B. | You can buy any Medigap plan sold in your state with no health questions — a guaranteed right that usually doesn't return. |
| Annual Enrollment Period (AEP) | October 15 – December 7 every year. | Switch Medicare Advantage or Part D plans for the coming year; changes take effect January 1. |
| Medicare Advantage Open Enrollment | January 1 – March 31 every year. | If you're already in a Medicare Advantage plan, make a one-time change or return to Original Medicare. |
| General Enrollment Period | January 1 – March 31 every year. | A fallback to enroll in Part B if you missed your IEP (a late penalty may apply). |
| Special Enrollment Periods (SEPs) | Triggered by life events — losing employer coverage, moving, and more. | Let you make changes outside the standard windows when something qualifying happens. |
What Original Medicare doesn't cover
Original Medicare is strong, but it has real gaps. Knowing them up front helps you decide what extra coverage — if any — is worth it for you. Original Medicare generally does not cover:
- Routine dental care, dentures, most vision and eyeglasses, or hearing aids
- Prescription drugs you take at home (that's Part D's job)
- Long-term custodial care, such as an extended nursing-home stay
- Most care outside the United States
- An annual cap on your out-of-pocket spending under Parts A and B
A Medigap policy, a Medicare Advantage plan, or standalone add-ons can each fill different gaps. We help you weigh which gaps are worth covering for your health and budget — without pushing you toward anything you don't need.
Help paying for Medicare
Several programs can lower what you pay for Medicare, and many people who qualify never apply. If money is tight, it's worth checking — we can point you in the right direction at no cost:
- Extra Help (Low-Income Subsidy). Federal help that lowers Part D drug costs, including premiums, deductibles, and copays, for people with limited income and resources.
- Medicare Savings Programs. State programs (such as QMB, SLMB, and QI) that can help pay Part B premiums and, in some cases, other costs.
- Free counseling. Your State Health Insurance Assistance Program offers free, unbiased Medicare help — SHIBA in Washington and SHINE in Florida.
Questions worth asking before you choose a plan
Whether you work with us or shop on your own, these questions cut through the noise and keep the decision focused on what matters to you:
- Are my doctors and preferred hospital in the plan's network?
- Are all of my prescriptions on the plan's drug list, and at what tier?
- What will I actually pay in a normal year — and in a bad one?
- Do I travel or split time between states, and will my coverage travel with me?
- How much provider freedom do I want versus a lower premium?
- If my health changes later, can I switch — and would I face health questions?
A quick Medicare glossary
| Term | What it means |
|---|---|
| Premium | The amount you pay each month to keep a plan, whether or not you use care. |
| Deductible | What you pay out of pocket before your coverage starts paying. |
| Coinsurance / copay | Your share of a cost after the deductible — a percentage (coinsurance) or a flat amount (copay). |
| Formulary | The list of prescription drugs a Part D or Advantage plan covers, organized in tiers. |
| Network | The doctors, hospitals, and pharmacies a plan has contracted with. |
| Out-of-pocket maximum | The most you'll pay in a year under a Medicare Advantage plan before it covers 100%. |
| Guaranteed issue | Your right to buy certain coverage without answering health questions. |
Medicare notes for Washington
Washington offers a consumer-friendly Medigap "birthday rule": each year around your birthday you get a window to switch to an equal or lesser Medicare Supplement plan without new medical underwriting — a valuable protection few states offer. For free, unbiased counseling, Washington runs the SHIBA program (Statewide Health Insurance Benefits Advisors) through the Office of the Insurance Commissioner. As an independent agency licensed in Washington, we compare the plans available where you live and help you use windows like the birthday rule to your advantage.
Frequently asked questions
What's the difference between the enrollment windows I keep hearing about?
Will I be penalized if I sign up late?
Does Medicare cover dental, vision, or hearing?
Is there help if I can't afford my Medicare costs?
Is Medicare Advantage free in Washington?
Can I keep my own doctors on a Medicare Advantage plan?
Do you offer every Medicare Advantage plan in my area?
What does your help cost?
Licensed independent insurance agent (NPN 22261820) · WA & FL
Written and reviewed by Vadim Marusin, a licensed independent insurance agent. Maru Insurance is an independent agency (WA License WAOIC #1365574, FL License #G363233) representing multiple A-rated carriers across Washington and Florida.
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