Turning 65 in Washington: How to Choose a Primary Care Doctor for Medicare

Turning 65 brings a flood of mail: Medicare cards, Medicare Advantage ads, supplement quotes, and Part D brochures. Most of it is about insurance. Very little of it is about the question that matters most for your health: Who is going to be your doctor?

Here’s a straightforward guide for Washington residents approaching Medicare, from a Spokane internist who cares for many Medicare patients.

Know your enrollment window

Your Initial Enrollment Period is seven months long: the three months before your 65th birthday month, your birthday month, and the three months after.

• If you’re already collecting Social Security, you’ll usually be enrolled in Parts A and B automatically.
• If you’re not, you’ll need to sign up through Social Security.
• If you’re still working with employer coverage, you may be able to delay Part B without penalty. Confirm the details with your employer and Social Security before you skip it.

Don’t miss it. The Part B late enrollment penalty is 10% for each full 12-month period you could have had Part B but didn’t, and it generally lasts for as long as you have Part B. Part D has its own separate late penalty.

Your plan choice affects which doctors you can see

This is the part many people don’t think about until it’s too late.

Original Medicare (Parts A and B), usually with a Medicare Supplement (Medigap) and a Part D plan:

• You can see any doctor in the country who accepts Medicare. There are no networks.
• Premiums are typically higher, but out-of-pocket costs are predictable.
• In most cases, your best chance to buy a Medigap policy without medical underwriting is the six months after your Part B starts.

Medicare Advantage (Part C):

• Private plans that replace Original Medicare, often with low or no premiums and extra benefits.
• Most use provider networks. HMO plans generally require you to use in-network doctors and may require referrals to see specialists.
• Networks vary widely from plan to plan, even within the same insurance company.

The practical advice: choose your doctor, then choose your plan. If you already have a primary care doctor you like, or one you want to establish with, confirm that the doctor accepts the specific plan you’re considering before you enroll. Plan names can be confusing. Call the doctor’s office and give them the exact plan name.

Free, unbiased help in Washington

Washington offers free, unbiased Medicare counseling through SHIBA (Statewide Health Insurance Benefits Advisors), a program of the Office of the Insurance Commissioner. SHIBA volunteers don’t sell insurance and can help you compare options. Call 1-800-562-6900 or visit insurance.wa.gov.

Take advantage of Medicare’s preventive visits

Once you’re on Medicare Part B, you’re entitled to:

• The “Welcome to Medicare” preventive visit within your first 12 months of Part B
• An Annual Wellness Visit every year after that, with no copay when it’s done as a wellness visit

These visits focus on prevention: screening schedules, vaccines, fall risk, memory, medication review, and planning. They’re also a good time for advance care planning, which means documenting your wishes in case you ever can’t speak for yourself. Learn more about our Annual Wellness Exam.

(One note: wellness visits are about prevention. If you want to address a specific problem, like knee pain or a medication change, that part may be billed as a regular visit.)

Why 65 is a great time to establish with an internist

Internal medicine physicians specialize in adults, including the complexities that often come with age: multiple chronic conditions, multiple medications, and coordination among specialists. Around 65 is when:

• Screenings like colon cancer, bone density, and lung cancer (for past smokers) need to be up to date
• Medication lists often grow and deserve a careful review
• Heart and metabolic risks such as blood pressure, cholesterol, and blood sugar matter more than ever
• Having one doctor who knows the whole picture becomes invaluable, especially if you’re ever hospitalized

And there’s new good news for Medicare beneficiaries who struggle with weight: the Medicare GLP-1 Bridge now covers certain weight-loss medications for eligible patients at a $50 monthly copay.

Aristos Internal Medicine welcomes Medicare patients

We’re accepting new Medicare patients at our North Spokane office, with virtual visits available throughout Washington. Dr. Kyle Varner is board certified in Internal Medicine and Obesity Medicine and has about a decade of experience caring for patients in Spokane, including in the hospital.

Turning 65 soon, or already on Medicare without a doctor you like? Schedule an appointment online or call (509) 426-5425. We’ll help you confirm your plan is accepted before your first visit.