Medicare is one of the most important benefits available to older Americans — and one of the most confusing. With multiple parts, dozens of plan options, strict enrollment deadlines, and a landscape that changes every year, it is easy to feel overwhelmed. But understanding the basics of how Medicare works can make a significant difference in both the quality of your healthcare and the amount you pay for it. This guide is designed to give older adults in Happy Valley and Clackamas a clear, plain-language foundation for making confident Medicare decisions.
SHIBA — Free Medicare Help in Oregon
Oregon’s Statewide Health Insurance Benefits Advisors program, known as SHIBA, offers free, unbiased Medicare counseling to Oregon residents through a network of trained volunteer advisors. SHIBA advisors can help you understand your Medicare options, compare plans during enrollment periods, resolve billing problems, and navigate coverage disputes — all at no cost and with no sales agenda.
This is one of the most valuable and underused resources available to older adults in our community. To find a SHIBA advisor serving Clackamas County, visit oregonshiba.org or call 1-800-722-4134. Appointments are available by phone and in person at locations throughout the county.
Choosing a Plan
If you are approaching 65 for the first time, the best starting point is medicare.gov — the official federal Medicare website — where you can learn about your options, compare plans, and begin the enrollment process. For comparing specific plans side by side, Medicare Plan Finder is the official tool for searching and comparing Medicare Advantage, Part D, and Medigap plans available in your area. You can enter your medications, preferred pharmacies, and doctors to see estimated costs and coverage details for each plan.
Oregon residents have some additional resources worth knowing about. The Oregon Guide to Medicare Insurance Plans, published annually by the Oregon Department of Human Services, is a comprehensive reference covering Medigap policies, Medicare Advantage plans, and Part D options available to Oregon residents. It is one of the most thorough plain-language guides available and is updated each year to reflect current options. You can download the current edition as a PDF or request a printed copy.
The Oregonian newspaper publishes an annual Medicare supplement, typically timed to the fall Annual Enrollment Period, that walks readers through plan options, costs, and changes for the coming year. Keep an eye out for it in October — it is a useful overview written specifically for Oregon readers.
Taking advantage of these resources before making a Medicare decision can make a meaningful difference — both in the coverage you end up with and the amount you pay for it.
The Four Parts of Medicare
Medicare is divided into four parts, each covering a different aspect of healthcare.
Part A covers hospital stays, skilled nursing facility care following a hospitalization, some home health services, and hospice care. Most people who have worked and paid Medicare taxes for at least ten years receive Part A without paying a monthly premium.
Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Part B requires a monthly premium — the standard amount in 2026 is available at medicare.gov — and covers most medically necessary services not covered by Part A.
Part C, also known as Medicare Advantage, is an alternative to Original Medicare offered by private insurance companies approved by Medicare. Medicare Advantage plans must cover everything Original Medicare covers and often include additional benefits such as dental, vision, hearing, and fitness programs like SilverSneakers. Plans vary significantly in cost, network, and coverage — comparing options carefully each year during the Annual Enrollment Period is important.
Part D covers prescription drugs and is available either as a standalone plan added to Original Medicare or included within a Medicare Advantage plan. The specific drugs covered and the cost sharing involved vary by plan, making it important to compare Part D options based on your specific medications each year.
Original Medicare vs. Medicare Advantage — Which Is Right for You?
This is one of the most common and consequential decisions older adults face when first enrolling in Medicare or reviewing their coverage each year. Original Medicare — Parts A and B, sometimes supplemented by a Medigap policy and a Part D plan — offers broad flexibility in choosing providers and is accepted by most doctors and hospitals nationwide. Medicare Advantage plans often offer lower out-of-pocket costs and additional benefits but typically require you to use a network of providers and may require referrals for specialist care.
The right choice depends on your health needs, your preferred providers, your budget, and your lifestyle. There is no universally correct answer — which is why free one-on-one counseling from a trained Medicare advisor is so valuable, and why we strongly recommend taking advantage of Oregon’s SHIBA program before making a decision.
Key Enrollment Periods and Deadlines
Missing Medicare enrollment deadlines can result in permanent premium penalties and gaps in coverage, so understanding when to act is important.
Your Initial Enrollment Period begins three months before you turn 65 and ends three months after the month of your 65th birthday — a seven-month window in which to enroll in Medicare for the first time. If you are still working and covered by an employer plan at 65 you may be able to delay enrollment without penalty, but the rules are specific and worth confirming with a SHIBA advisor.
The Annual Enrollment Period runs from October 15 through December 7 each year and is the primary window during which Medicare beneficiaries can switch between Original Medicare and Medicare Advantage, change their Part D plan, or make other coverage changes that take effect January 1.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year and allows people already enrolled in a Medicare Advantage plan to switch to a different Advantage plan or return to Original Medicare.
Fitness Programs — A Medicare Benefit Worth Knowing About
As we covered in an earlier Elder Beat post, many Medicare Advantage and Medicare Supplement plans include a free fitness program membership — giving you access to participating gyms, fitness centers, and online wellness classes at no extra cost. Kaiser offers the Bold app while others offer either Silver Sneakers or Silver & Fit. If you aren’t sure whether your plan includes a fitness program, call your plan’s member services number.
How Medicare Is Funded
Medicare is funded through a combination of payroll taxes, federal general revenues, and the premiums paid by beneficiaries. Understanding where the money comes from can help explain why the program works the way it does — and why certain parts are free to some people and not others.
Part A is funded primarily through payroll taxes collected under the Federal Insurance Contributions Act, commonly known as FICA. Both employees and employers pay 1.45 percent of wages into the Medicare Hospital Insurance Trust Fund throughout a worker’s career, which is why most people who have worked for at least ten years qualify for Part A without paying a monthly premium. They have, in effect, already paid for it.
Part B and Part D are funded differently. Approximately 75 percent of their costs are covered by federal general tax revenues — meaning the broader federal budget — with the remaining 25 percent covered by the monthly premiums beneficiaries pay. This is why Part B and Part D always carry a premium, regardless of how long you have worked.
Medicare Advantage plans under Part C are funded through a combination of federal payments to the private insurance companies that administer the plans and the premiums beneficiaries pay. The federal government pays each Advantage plan a set amount per enrollee, which is why these plans are sometimes able to offer additional benefits — dental, vision, hearing — while keeping member premiums relatively low.
It is also worth knowing that Medicare is not means-tested — meaning eligibility is not based on income. However, higher-income beneficiaries pay more for Part B and Part D through a surcharge known as IRMAA, the Income-Related Monthly Adjustment Amount, which is calculated based on your income from two years prior.
Getting Help with Medicare Costs
If paying Medicare premiums and cost sharing is a financial challenge, help may be available. Medicare Savings Programs help qualifying lower-income beneficiaries pay their Part B premiums and reduce cost sharing. The Extra Help program assists with Part D prescription drug costs. Oregon 211 can connect you with local assistance programs, and the National Council on Aging’s BenefitsCheckUp tool can help identify programs you may be eligible for.
Do you have a Medicare tip or experience you would like to share with our community? Leave a comment below — your insight might help a neighbor make a better decision during the next enrollment period.
