Medicare is a federal health insurance program for U.S. citizens and qualified legal residents ages 65 and older. People under 65 with certain medical conditions also qualify. There are two main options for coverage — Original Medicare and Medicare Advantage.
Original Medicare is offered by the federal government:
- Part A helps pay for hospital stays and inpatient care.
- Part B helps pay for doctor visits and outpatient care.
You can also add one or both of the following:
- Part D helps pay for prescription drugs.
- Medigap (a Medicare supplement) helps pay for some of the costs not covered by Parts A and B.
Medicare Advantage plans (also called Part C) are offered by private companies approved by Medicare. These are all-in-one plans that:
- Combine Medicare Parts A and B, and often Part D, into a single plan
- Usually offer extra services, such as vision and dental care, travel benefits, and hearing aids and exams
Many Polyclinic providers accept Original Medicare. We also work with most Medicare Advantage plans in Washington State. Contact your provider for information. They'll look up your doctors and prescriptions to find plans that cover them.
Compare your choices
|Medicare Advantage||Original Medicare + supplement|
|Out-of-pocket costs and coverage||
|Choice of providers||
|Wellness exams and annual physicals||
What you need to know
Our focus is to keep you healthy, out of the hospital and doing what you love. Because of this, we recommend Medicare Advantage plans. These plans allow us to coordinate your care and work with your primary care doctor and your insurance company.
With a Medicare Advantage plan, all of your benefits are covered through one insurance company. Plans must include the same benefits as Original Medicare. And many offer extra benefits. These vary by plan and may include:
- An annual physical
- Gym membership
- Vision, hearing and dental coverage
- Emergency care when traveling in the United States and sometimes internationally
- Part D prescription drug coverage
Medicare Advantage plans can be less expensive than purchasing each part of Medicare separately. Plus, Medicare Advantage patients can take part in our Care Advantage Program, which helps you stay healthy and manage changes in your health and lifestyle.OR
Both Original Medicare and Medicare Advantage plans offer free preventive care and wellness visits.
Your first visit is called Welcome to Medicare. You are eligible for this within the first 12 months of enrolling in Medicare Part B.
Once you’ve been enrolled in Part B for longer than 12 months, you’re eligible for an Annual Wellness Visit (AWV). It focuses on preventive care and screening for common concerns that often happen with age, such as arthritis.
Original Medicare does not cover a traditional annual physical, but some Medicare Advantage plans do. Check with your insurance provider for details.
If you have any kind of long-term health condition, like asthma or diabetes, we’ll want to see you several times a year. This helps us stay on top of your condition and make sure you have what you need to take good care of yourself.OR
You can sign up for or make changes to your Original Medicare or Medicare Advantage plan during different periods:
- Initial Enrollment Period: A window of time starting three months before and ending three months after your 65th birthday
- Annual Enrollment Period: From Oct. 15 to Dec. 7, you can make changes to your plan for the upcoming calendar year
- Medicare Advantage Open Enrollment Period: From Jan. 1 to March 31, you can make changes to your Medicare Advantage plan
- Special Enrollment Period: An option available when certain events take place, such as moving to a different Medicare service area
If you’re still working at age 65 and have an employer health plan, or if you’re covered by your spouse’s health plan, you don’t have to sign up for Medicare. But once you’re eligible for Medicare, it’s smart to compare your health plan to a Medicare plan.
- Sometimes Medicare costs are lower and coverage is the same.
- Sometimes Medicare might offer better coverage than your employer.
- It doesn’t matter if you’re still working or aren’t receiving Social Security income yet.
We can help you get an objective review of your Medicare plan options. For information, call 1-206-774-5864, Monday through Friday, 8 a.m. to 5 p.m.OR
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