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. 

a notebook with a stethoscope on top of it. next to it is a pen and a business card that says medicare

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. 

elderly person filling out paperwork

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. 

 

a hearing aid in an elderly person's ear

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 
  • Bilingual support: English and Spanish-speaking teams to help you navigate your benefits and care 
doctor smiling and chatting with happy patient in an exam room

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. 

patient smiling while doctor listens to her heart with a stethoscope

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.Â