What’s the difference between Medicare, Medicaid and the Oregon Health Plan?

January 25, 2022April 22, 2024 Resources and Tips

Health insurance can be a very confusing topic no matter your age, and knowing the difference between Medicare, Medicaid and the Oregon Health Plan can help you make decisions about your health care.

Medicare

Medicare is a federal insurance program and offers the same coverage everywhere in the United States. It is available for most people over 65, regardless of income, as well as younger disabled people and dialysis patients.

Medical bills are paid from trust funds that employees and employers have paid into for years. Patients pay part of costs through deductibles for hospitals and other expenses. Small monthly premiums are required for non-hospital coverage.

There are different Medicare enrollment periods so become familiar with the one that applies to your situation. You can join, switch, or drop a Medicare Health Plan or a Medicare Advantage Plan (Part C) with or without drug coverage during these times:

• Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
• Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
• Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time.

Medicaid

Medicaid is an assistance program. It serves low-income people of all ages. Patients usually pay no part of the costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state and is run by state and local governments within federal guidelines. In Oregon, it’s known as the Oregon Health Plan (OHP). If you are under age 65 and you don’t have Medicare, you may qualify for the OHP.

There are different Oregon Health Plan programs such as:

• Oregon Health Plan Plus for children ages 0-18 and adults ages 19-64
• Oregon Health Plan Plus Supplemental for pregnant women aged 21 or older
• Oregon Health Plan with Limited Drug for adults who qualify for both Medicaid and Medicare Part D

Here are some common questions if you are new to Medicare:

---

I hear Medicare only covers 80% of the bill. Who covers the rest?

OHP and Medicare can work together if Medicare is your primary source of health coverage. Let’s say you qualify and meet the OHP’s low-income requirements. In that case, OHP can cover services that Medicare doesn’t, such as dental care, some prescriptions, and rides to health care appointments. It may also help cover the 20% Medicare doesn’t pay.

​Would you please explain Medicare and all its parts?

More than 830,000 Oregonians are currently enrolled in Medicare, half of them on the original Medicare health insurance plan. The remaining 40% are enrolled in Medicare Advantage (otherwise known as Part C Medicare).

Medicare has four different parts:

1. Hospital insurance with Medicare Part A covers inpatient hospital and inpatient care in a Skilled Nursing Facility, hospice care, and home health services.
2. Medical insurance with Medicare Part B covers physician services, outpatient care, durable medical equipment, and many preventive services.
3. Medicare Advantage Plan with Medicare Part C is a group of Medicare-approved private insurance companies that charge a premium to cover Part A and Part B services. It may even offer prescription drug coverage and other supplemental benefits.
4. Prescription Drug Plan with Medicare Part D is Medicare-approved private company that provides prescription drug coverage on an outpatient basis.

Do you need help understanding Medicare options?

Whether you’re new to Medicare or already enrolled, the Council on Aging has Senior Health Insurance Benefits Assistance (SHIBA) volunteer Medicare counselors to guide you through your Medicare options. Caregivers and advocates may also attend. Learn more here.

To schedule a SHIBA appointment in Central Oregon, call (541) 678-5483, Option #3. Please leave a message. A certified SHIBA counselor will usually return calls by the end of the next business day. Counseling is available in English and Spanish. Asistencia con Medicare y consejería de SHIBA en español están disponibles llamando al (541) 678 5483.