Frequently Asked Questions
Below you’ll find answers to common questions people have about Medicare.
Medicare and Medicaid are two different programs.
Medicare is America's health insurance program for people age 65 or older, individuals with certain disabilities, and those with permanent kidney failure. Originally established in 1965, the program helps to cover the cost of health care for nearly 49 million people.
Medicaid is a state-run program that provides hospital and medical coverage for low-income citizens. Eligibility rules and coverage are determined by each state.
Some people qualify for both Medicare and Medicaid. For more information about Medicaid, contact your local medical assistance agency, social services, or welfare office.
D-SNP stands for Dual Eligible Special Needs Plan. This is a type of insurance available to people who qualify for both Medicare and Medicaid. These plans allow people who are eligible to enjoy better coverage by combining Medicare and Medicaid benefits under one plan and insurance company.
D-SNPs have strict guidelines to decide if you are eligible. Eligibility is determined by your state and the type of Medicaid coverage for which you qualify.
The Medicare program is largely funded by the government through payroll taxes paid by both workers and employers. Depending on which type of Medicare coverage you have, you may pay a monthly premium to cover some of the costs, which could be deducted from Social Security checks or paid directly to your insurer. Many times, Medicare Advantage plans are available with no additional premium beyond the cost of Original Medicare.
Plan premiums vary based on what type of coverage you choose and which insurance company provides your benefits. Your household income can also affect the cost of Medicare for you.
If you have lower income and are eligible for Medicare, your state Medicaid program may assist you with premiums and cost sharing.
There are several ways! You can enroll by phone, by mail or enroll online in a Medicare Advantage plan from Health Net Medicare Advantage for Oregon and Washington. You must have Medicare Part A and Part B to be eligible to enroll.
You must have Medicare Part A and Part B to sign up for a Medicare Advantage Plan. There are three time periods when you can choose to enroll in coverage:
- Initial Enrollment Period (IEP) is the seven-month window around your 65th birthday. Use this time to review your options and select the plan with coverage that best fits your needs. When you first become eligible for Medicare, you'll likely be automatically enrolled in Original Medicare by the Social Security Administration. You'll have time to select supplemental or prescription drug coverage, decline Part B coverage, or choose to purchase a Medicare Advantage plan in place of Original Medicare.
- Annual Election Period (AEP) happens between October 15 and December 7 each year. This is a designated time period each year for everyone eligible for Medicare to update their coverage. During AEP, you can enroll in a plan, change your existing coverage, or sign up for additional plans for prescription drug coverage or Medicare Supplement. You can also return to Original Medicare should you choose to do so.
- Special Enrollment Period (SEP) is a period of time surrounding an event in your life that affects your Medicare coverage. If you experience the loss of health insurance coverage that was previously provided through a job, spouse or union health insurance, you may qualify for a Medicare Special Enrollment Period. If you are eligible for a Medicare Special Needs Plan, you do not need to wait for an enrollment period.
Yes - you may change your coverage during the Annual Election Period: October 15 – December 7. To switch to Original Medicare, contact your current plan provider, or call 1-800-MEDICARE. TTY users should call 1-877-486-2048. Medicare can be reached 24 hours a day/7 days a week.
To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be dis-enrolled automatically from your old plan when your new plan's coverage begins. If you have a Medicare Special Needs Plan, you can change your plan at the beginning of any month and do not need to wait for an enrollment period.
Yes! In most cases, your current Medicare coverage will renew automatically each year unless you make changes to your coverage. You may choose to change your coverage during the Annual Election Period: October 15 – December 7.
If you are a member of a Dual Eligible Special Needs Plan (DSNP), your renewal is contingent upon your Medicaid eligibility.
If you qualify for a Special Enrollment Period, you can change plans according to that situation.
Original Medicare includes hospital insurance (Part A) and medical insurance (Part B). Your coverage under Original Medicare will include deductibles, co-insurance and copayments for various services. Original Medicare does not cover prescription drugs and it does not cover services for vision care, dental or hearing.
Medicare Advantage plans offer the same coverage as Part A and Part B but many also include extra benefits such as prescription drug coverage, dental, vision and hearing care. Many of your services in a Medicare Advantage plan will be covered by a copayment, which allows you to know exactly what your healthcare expense will be. Not all Medicare Advantage plans are alike, so you have to look for the one that has the benefits, services and costs that work for you.
General Medicare Questions
Get answers to general medicare questions including Medicare basics, coverage and enrollment.