Frequently Asked Questions
MEDICARE FAQ
FREQUENTLY ASKED QUESTIONS
Your Initial Enrollment Period begins 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. Enrolling on time helps you avoid late enrollment penalties.
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If you’re already receiving Social Security or Railroad Retirement Board benefits, you’ll usually be enrolled automatically about 3 months before your 65th birthday. If not, you’ll need to enroll yourself.
Still have questions? Call us at (503) 987-1113. Our help is always free.
You can enroll through the Social Security Administration:
- Online
- By phone
- At your local Social Security office
- Call us to help
If you’re unsure where to start, we’re happy to help guide you through the process.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Part A – Hospital Insurance
- Covers inpatient hospital care, skilled nursing, hospice, and some home health care.
- Usually premium-free if you’ve worked and paid Medicare taxes for at least 10 years.
Part B – Medical Insurance
- Covers doctor visits, outpatient care, preventive services, and medical equipment.
- Standard premium is $202.90 per month (2026).
Part C – Medicare Advantage
- Private insurance plans that combine Parts A and B.
- Most plans also include prescription drug coverage and may offer dental, vision, hearing, and other benefits.
Part D – Prescription Drug Coverage
- Helps cover prescription medications.
- Average premium is approximately $34.50 per month (2026).
- Included with most Medicare Advantage plans.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Costs vary depending on the coverage you choose.
Most people pay:
- Part A: Usually premium-free if eligible
- Part B: $202.90/month (2026)
- Deductibles and copays
- Possible premiums for Medicare Advantage, Part D, or Medicare Supplement plans
Still have questions? Call us at (503) 987-1113. Our help is always free.
Most people have their Medicare premiums automatically deducted from their Social Security benefits. If you’re not receiving Social Security yet, Medicare will bill you directly.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Original Medicare generally does not cover routine dental, vision, or hearing services.
Many Medicare Advantage plans include benefits like:
- Dental exams and cleanings
- Vision exams and glasses
- Hearing exams and hearing aids
Coverage varies by plan.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Original Medicare (Parts A & B)
- Provided by the federal government
- Lets you see any provider that accepts Medicare
- Generally pays about 80% of covered services, leaving you responsible for the remaining 20% unless you have supplemental coverage
Medicare Advantage (Part C)
- Offered by private insurance companies
- Includes Parts A and B
- Often includes prescription drug coverage, dental, vision, hearing, fitness benefits, and more
- Uses provider networks and has different costs depending on the plan
Still have questions? Call us at (503) 987-1113. Our help is always free.
If you don’t have Part D or other creditable prescription drug coverage, you could face a Late Enrollment Penalty if you go 63 or more consecutive days without qualifying coverage after becoming eligible.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Our services are completely free to you.
We’re compensated directly by the insurance companies if you enroll in a plan through us. There is never a fee for our guidance or assistance.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Medigap plans help pay some of the costs that Original Medicare doesn’t cover, such as:
- Part A coinsurance
- Part B coinsurance or copayments
- Skilled nursing facility coinsurance
- Hospice coinsurance
- Blood (first three pints)
Some plans also help cover:
- Medicare deductibles
- Emergency medical care while traveling abroad
Medigap plans can only be used with Original Medicare—not Medicare Advantage.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Yes.
If you have employer health coverage through a company with 20 or more employees, you may be able to delay enrolling in Part B without penalty.
If your employer has fewer than 20 employees, Medicare generally becomes your primary insurance at age 65.
Every situation is different, so it’s worth reviewing your options before making a decision.
Still have questions? Call us at (503) 987-1113. Our help is always free.
If your doctor leaves your plan’s network, your insurance company will notify you.
Depending on your situation, you may:
- Choose another in-network provider, or
- Qualify to change Medicare plans during an eligible enrollment period.
Still have questions? Call us at (503) 987-1113. Our help is always free.
No.
You can change plans during certain enrollment periods.
Annual Enrollment Period
October 15 – December 7
- Switch Medicare Advantage plans
- Return to Original Medicare
- Add, change, or drop Part D coverage
Medicare Advantage Open Enrollment
January 1 – March 31
- Switch to another Medicare Advantage plan
- Return to Original Medicare
You may also qualify for a Special Enrollment Period if you:
- Move
- Lose employer coverage
- Gain or lose Medicaid
- Experience certain other qualifying life events
Still have questions? Call us at (503) 987-1113. Our help is always free.
No—but changing plans isn’t always automatic.
Your best opportunity is during your 6-month Medigap Open Enrollment Period, when you can enroll without answering health questions.
If you want to switch later, you may need to go through medical underwriting, unless you qualify for a guaranteed issue right.
Good news for Oregon residents: Oregon has a Medigap Birthday Rule, which allows many Medigap policyholders to switch to another plan of equal or lesser benefits once each year without medical underwriting, regardless of their health.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Not always.
If you’re still working and have health insurance through an employer with 20 or more employees, you may be able to delay enrolling in Medicare Part B without paying a late enrollment penalty. If your employer has fewer than 20 employees, Medicare generally becomes your primary insurance when you turn 65.
Because every situation is different, it’s important to review your options before deciding when to enroll.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Yes, in many cases.
Your decision to enroll in Medicare does not automatically affect your spouse’s employer-sponsored health insurance. However, every employer plan is different, so it’s a good idea to review your benefits before making any changes.
We’re happy to help you understand how Medicare may work alongside your family’s coverage.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Usually—but it depends on the plan you choose.
With Original Medicare, you can generally see any doctor who accepts Medicare patients.
With Medicare Advantage, you’ll typically use a network of doctors and hospitals. Before enrolling, it’s important to verify that your preferred providers participate in the plan you’re considering.
We can help you check your doctors before you enroll.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Missing your enrollment deadline can result in delayed coverage and, in some cases, lifetime late enrollment penalties for Medicare Part B or Part D.
Fortunately, you may qualify for a Special Enrollment Period if you’re still working, lose employer coverage, move, or experience another qualifying life event.
If you’re unsure whether you’ve missed a deadline, contact us – we can help you understand your options.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Yes.
Each year during the Annual Enrollment Period (October 15 – December 7), you have the opportunity to review your current coverage and make changes if another plan better fits your healthcare needs.
Depending on your situation, you may also qualify to change plans during other enrollment periods.
Reviewing your coverage each year helps ensure you’re getting the benefits and value you need.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Although both help cover your healthcare costs, they work very differently.
A Medicare Supplement (Medigap) plan works alongside Original Medicare and helps pay out-of-pocket costs like deductibles, copays, and coinsurance. It does not include prescription drug coverage.
A Medicare Advantage (Part C) plan replaces Original Medicare and is offered by private insurance companies. Many Medicare Advantage plans include prescription drug coverage along with additional benefits such as dental, vision, and hearing coverage.
We’ll help you compare both options so you can choose the one that best fits your needs.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Absolutely.
We’ll take the time to understand your healthcare needs, medications, preferred doctors, and budget before comparing available Medicare plans. We’ll explain your options in plain language so you can make an informed decision.
Our goal is to help you choose the coverage that’s right for you, not to pressure you into a particular plan.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Yes!
Our Medicare guidance, plan comparisons, enrollment assistance, and annual reviews are provided at no cost to you.
If you enroll in a plan through us, we’re compensated by the insurance company—not by you. Your premium is the same whether you work with us or enroll directly, so you receive personalized local support at no additional cost.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Yes! One of the biggest benefits of working with Understanding My Medicare is that our relationship doesn’t end after enrollment.
If you have questions about your coverage, receive confusing Medicare mail, need help finding an in-network provider, or want to review your plan before Annual Enrollment, we’re here to help. We believe ongoing support is just as important as choosing the right plan in the first place.
Still have questions? Call us at (503) 987-1113. Our help is always free.
Choosing Medicare is an important decision, and every person’s healthcare needs are different.
Working with a local Medicare advisor gives you the opportunity to ask questions, compare plans, verify your doctors and prescriptions, and receive personalized guidance based on your situation. Best of all, you’ll have someone local to call whenever you need assistance, not just during enrollment.
Still have questions? Call us at (503) 987-1113. Our help is always free.