What You Need to Know About Medicare in Oregon
Medicare can feel complicated, but it doesn’t have to be. With the right information, you can understand how it works, who qualifies, and how it can support your health. This guide breaks it down step-by-step. It will also explain how Neighborhood Health Center (NHC) can help you get the most from your coverage.
What is Medicare?
Medicare is a national health insurance program run by the U.S. government. It helps pay for medical care when you reach a certain age or have certain health conditions.
Think of Medicare as a safety net that ensures millions of Americans have access to affordable healthcare as they age or face health challenges.
Who Qualifies for Medicare?
- Age 65+: U.S. residents who meet the age requirements
- Under 65 with disabilities: If you receive Social Security Disability Insurance for 24 months
- Any age with certain conditions: People with ALS or End-Stage Renal Disease (kidney failure)
The Four Parts of Medicare
| Part | What It's Called | What It Covers | Cost |
| Part A | Hospital Insurance | Inpatient hospital care, skilled nursing, hospice, some home healthcare | Usually free if you worked and paid Medicare taxes for 10+ years |
| Part B | Medical Insurance | Doctor visits, outpatient care, preventive services, medical supplies | Monthly premium (around $174 in 2024) |
| Part C | Medicare Advantage | Everything in A & B, often includes dental, vision, hearing, prescriptions | Varies by plan |
| Part D | Prescription Drug Coverage | Help paying for medications | Varies by plan |
Original Medicare vs. Medicare Advantage
You can choose between Original Medicare and Medicare Advantage (Part C).
Original Medicare (Parts A + B)
Positives:
- See any provider who accepts Medicare
- Go to any hospital that takes Medicare
- No referrals needed for specialists
Things to consider:
- You pay 20% for many services
- Need to add Part D for prescriptions
- May want extra insurance for gaps
Medicare Advantage (Part C)
Positives:
- Usually bundles A, B, and D in one plan
- May include extra benefits like dental or vision
- Often has an out-of-pocket maximum
Things to consider:
- Must use providers in the plan's network
- May need referrals for specialists
- Benefits can change each year
At NHC, we partner with Medicare agents who work with our Membership & Engagement Services team to help you determine the right program for you that also helps you keep your primary care provider. Contact our Membership & Engagement Services team and get your questions answered.
How to Enroll in Medicare
Automatic Enrollment
If you're getting Social Security at 65, you'll automatically get Medicare Part A and Part B. Your card comes in the mail three months before your birthday.
Manual Enrollment Needed If You:
- Aren't receiving Social Security benefits at 65
- Are still working with employer insurance
- Have certain government employment
- Live outside the U.S. when you turn 65
Your Enrollment Window
If you need to sign up yourself, you have 7 months:
- 3 months before your 65th birthday
- The month you turn 65
- 3 months after your 65th birthday
- During this window, you choose Original Medicare or Medicare Advantage.
Where to Sign Up
- Visit Medicare.gov online
- Call 1-800-MEDICARE (1-800-633-4227)
- Visit your local Social Security office
Open Enrollment in 2025: October 15 - December 7
Every year, you can change your Medicare plan during Open Enrollment. Your coverage continues automatically, but you can:
- Switch between Original Medicare and Medicare Advantage
- Change Medicare Advantage plans
- Add/drop/change Part D plans
- Add/drop Medigap policies
Use the same enrollment methods above to make changes.
NOTE: What Medicare Doesn't Cover
Standard Medicare covers many healthcare services, but not everything. Here are a few things that aren’t covered:*
- Long-term nursing home care
- Most dental care (cleanings, fillings, dentures)
- Eye exams for glasses
- Hearing aids
- Cosmetic procedures
- Healthcare outside the U.S.
*Some Medicare Advantage plans may include these services.
Good news: Some services Medicare doesn't cover might be available at reduced cost through NHC's sliding fee discount program.
How NHC Supports Medicare Patients
At NHC, we want you to feel confident about your coverage and care. Here’s how we support Medicare patients:
- We accept most Medicare and Medicare Advantage plans
- If you qualify, sliding fee discounts are available for services Medicare doesn’t cover
- Whole-person care: NHC provides medical, dental, behavioral health care, as well as pharmacy services
- Bilingual support: English and Spanish-speaking teams to help you navigate your benefits and care
Common Questions about Medicare
Is Medicare free?
Part A is usually free (if you or your spouse worked 10+ years and paid Medicare taxes). Parts B, C, and D have monthly costs.
Do I still need other insurance if I have Medicare?
You may want extra coverage to help with costs. Many people get additional coverage like:
- Medigap policies for extra protection. Medigap is Medicare Supplement Insurance that can help pay for things not covered by your plan
- Employer insurance if still working
- Medicaid if you have a low income
Can I use Medicare at a community health center like NHC?
Yes! As a Federally Qualified Health Center (FQHC), NHC is specially designed to serve Medicare patients.
What if I'm still working at 65?
You may be able to delay Part B if you have employer coverage. Our Outreach & Enrollment Coordinators can help review your options.
Tips for Getting the Most from Medicare
Use Your Preventive Services
Medicare covers these at no cost:
- Annual wellness visits
- Cancer screenings
- Flu shots
- Many other preventive services
Keep Good Records
Save your Medicare card, bills, and benefit statements.
Review Your Coverage Each Year
Your needs change, and plan benefits can change too. Look at options during Open Enrollment each fall.
Ask Questions
Don't hesitate to ask about your coverage. NHC staff are here to help you understand your benefits.
When to Get Help
Get help with Medicare if you:
- Don't understand your coverage
- Have trouble paying for healthcare
- Want to compare plan options
- Have enrollment questions
- Need help using your benefits
Ready to Use Your Medicare Benefits?
Call us to:
- Schedule appointments
- Ask coverage questions
- Learn about sliding fee discounts
- Get help understanding benefits
Remember: You're Not Alone
Medicare is here to help you stay healthy, but it can be tricky to understand. At NHC, we’re committed to making it easier. Whether you’re enrolling for the first time or exploring new options, our team can guide you every step of the way.
Ready to learn more? Call NHC today to schedule an appointment or speak with our enrollment team.