Cover Oregon, a key part of the Affordable Care Act, is a new way for individuals, families, and employees of small businesses to get health coverage — either through private insurance companies or the Oregon Health Plan. If you have Medicare, you do not need to visit Cover Oregon to get health coverage. Below are frequently asked questions about Medicare and Cover Oregon.
If I have Medicare, do I need to do anything?
No. Medicare isn’t part of Cover Oregon. If you have Medicare, you’re covered and don’t need to do anything about Cover Oregon. Cover Oregon won’t affect your Medicare choices or benefits.
Does Medicare coverage meet the Affordable Care Act’s requirement that all Americans have health insurance?
If you have Medicare Part A (hospital insurance), you’re covered and won’t need to get a plan through Cover Oregon. Having Medicare Part B (medical insurance) alone doesn’t meet this requirement.
Can I get a Cover Oregon plan in addition to Medicare?
No. It’s against the law for someone who knows that you have Medicare to sell you a health plan through Cover Oregon or an insurance company. This is true even if you have only Part A or only Part B. If you want coverage to supplement Medicare, contact the Oregon Insurance Division sponsored Senior Health Insurance Benefit Assistance (SHIBA) program at 1-800-722-4134 (toll-free) to learn more about Medigap policies. You can also learn more about other Medicare options, such as Medicare Advantage plans, by calling SHIBA or visiting Medicare.gov.
Can I choose Cover Oregon coverage instead of Medicare?
Generally, no. However, there are a few exceptions:
- You can choose Cover Oregon if you’re eligible for Medicare but haven’t enrolled because you would have to pay a premium for Part A, or because you’re not collecting Social Security benefits.
- If you’re paying a premium for Part A, you can drop your Part A and Part B coverage and get a plan through Cover Oregon.
- If you do not have five years documented legal resident status to qualify for Medicare or Medicaid, you may be able to get a Cover Oregon plan.
Your household income will determine whether you qualify for financial help to pay for the plan through Cover Oregon.
Before making either of these choices, there are two points to consider:
- If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for as long as you have Medicare.
- Generally, you can enroll in Medicare only during the Medicare general enrollment period (from Jan. 1 to March 31). Your coverage won’t begin until July of that year.
What if I become eligible for Medicare after I join a Cover Oregon plan?
You can get a health insurance plan through Cover Oregon before your Medicare begins. You can then cancel your health insurance plan when your Medicare coverage starts.
Once you’re eligible for Medicare, you’ll have an initial enrollment period to sign up. For most people, the initial enrollment period for Medicare starts three months before their 65th birthday and ends three months after their 65th birthday.
In most cases, it’s to your advantage to sign up when you’re first eligible because:
- Once you’re eligible for Medicare, you won’t be able to get lower costs for a Cover Oregon plan based on your income.
- If you enroll in Medicare after your initial enrollment period ends, you will have to pay a late enrollment penalty for as long as you have Medicare.
Note: You can keep your Cover Oregon plan after your Medicare coverage starts. However, once your Part A coverage starts, any premium tax credits and reduced cost-sharing you get through Cover Oregon will stop.
Can I get a stand-alone dental plan through Cover Oregon?
Yes. You may purchase a dental plan through Cover Oregon or directly from a health insurance company. Contact your agent or Cover Oregon 1-800-COVEROR (268-3767) (toll-free) to learn more about dental plan options.
Help paying for my Medicare costs
- If you need help with your Part A and B costs, you can apply for a Medicare Savings Program. To apply, contact your local state Aging and People with Disabilities office by calling 1-800-282-8096 (toll-free). TTY users should call 1-800-282-8096 (toll-free). You may also locate local office information at www.oregon.gov/dhs/spwpd/pages/offices.aspx.
- If you need help paying for Medicare prescription drug costs, visit socialsecurity.gov/i1020, or call Social Security at 1-800-772-1213 (toll-free) to learn about the Extra Help program. TTY users should call 1-800-325-0778 (toll-free). Oregon SHIBA’s state certified counselors can also help you complete and submit an Extra Help application.
- For more information or help, contact Senior Health Insurance Benefit Assistance (SHIBA) at 1-800-722-4134 (toll-free). SHIBA is part of the Oregon Insurance Division within the Department of Consumer and Business Services. SHIBA receives a grant from the Centers for Medicare and Medicaid Services to provide local help with Medicare.
- To learn more about Medicare enrollment, coverage, and plan choices call SHIBA at 1-800-722-4134 (toll-free) or visit http://www.shiba.oregon.gov, Medicare.gov, or call 1-800-MEDICARE (toll-free).
Note: Although this fact sheet focuses on Cover Oregon, much of this information applies if you are considering buying a plan outside of Cover Oregon. Contact SHIBA for more information.