Medicare in Oregon

Complete Guide & Resources

Medicare is a federal health insurance program designed to provide coverage to eligible individuals over the age of 65, as well as those with certain disabilities. 

Understanding Medicare in Oregon can be overwhelming, but with this comprehensive guide, you will be able to navigate the program and find the best coverage options for your needs.

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Medicare in Oregon by Numbers

Let us take a quick overview of Medicare Enrollment as of 2023 in Oregon:

  • More than 21% of Oregon residents are enrolled in Medicare. Of the 909,000 Medicare beneficiaries in the state, nearly 11% are under age 65.
  • Oregon has significant consumer protections related to Medigap plans, with an annual opportunity to switch plans and guaranteed-issue coverage (without higher premiums) for disabled beneficiaries under age 65.
  • More than half of Oregon Medicare beneficiaries opt for Medicare Advantage plans.
  • Oregon has 23 stand-alone Medicare Part D drug plans in 2021, ranging from $8 to $115 per month.

Getting to Know Medicare in Oregon: Overview and Eligibility

New to Medicare or are you turning 65?

There are many details of Medicare which can be confusing to many. Health Plans in Oregon is also available to help you know if you are eligible to receive it.

  • Those 65 and older likely qualify
  • Those younger than 65 with disabilities of 24 months or more may qualify
  • People with end-stage renal disease (ESRD) or other chronic conditions may be eligible

What is Medicare?

In 1965, Medicare was created as a federal health insurance program for people ages 65 and above. These people can sign up regardless of medical history, income, and health status. And in 1972, Medicare was expanded to also give coverage to people aged below 65 who have a long-term disability. 

At present, the program provides financial assistance to pay for many health care services, including doctor visits, hospitalizations, preventive services, prescription drugs, home health care, skilled nursing facilities and hospice care for 60 million older people and younger people with disabilities.

At this point in time, policymakers consider doing possible changes to Medicare in order to resolve the spiking annual growth rates on Medicare spending. Nevertheless, Medicare will still continue to give access to quality care and affordable coverage to its beneficiaries.

 

Medicare in Oregon

What are the different parts of Medicare?

Medicare in Oregon is composed of four main parts, each offering different levels of coverage. These parts include:

Hospital Insurance

Medical Insurance

Medicare Advantage Plans

Prescription Drug Coverage

Medicare Eligibility

To be eligible for Medicare in Oregon, you must meet the following requirements:

  • 65 years of age or older, or have certain disabilities.
  • US citizen or permanent legal resident who has lived in the US for at least five years and be receiving Social Security or railroad retirement benefits
  • have worked long enough to be eligible for those benefits but are not yet collecting them.

Individuals who are younger than 65 may also be eligible if :

  • they have been entitled to Social Security disability benefits for at least 24 months
  • receive a disability pension from the Railroad Retirement Board and meet certain conditions
  • have Lou Gehrig’s disease, permanent kidney failure, or have paid Social Security taxes for a specified period.

Medicare Qualifications by Parts 

Original Medicare is composed of Part A and Part B – Part A covers hospital insurance, while Part B covers Medical Insurance.

Most people get Part A for free, but some have to pay a premium for this coverage.

To be eligible for Premium Free Part A, you must:

  • be entitled to Medicare from your own earnings, your spouse’s, parent’s or you child’s.
  • must work for at least 10 years or 40 quarters and paid Medicare taxes during that time.

Understanding Medicare Coverage in Oregon: Part A and Part B

Part A of Medicare in Oregon covers hospital services, such as inpatient care, skilled nursing facilities, and hospice care. Part B, on the other hand, covers medical services, such as doctor visits, outpatient care, and medical equipment. Together, Part A and Part B make up Original Medicare, which serves as a foundation for all Medicare coverage in Oregon.

The Benefits of Medicare Advantage Plans in Oregon (Part C)

Medicare Advantage Plans, also known as Part C, are private health plans that provide additional coverage and benefits beyond what Original Medicare offers. In Oregon, Medicare Advantage Plans must cover all services covered by Original Medicare, and some may offer additional benefits. Medicare Advantage Plans may also have lower out-of-pocket costs, making them a more affordable option for some beneficiaries.
 

Prescription Drug Coverage in Oregon: Part D

Prescription drug coverage in Oregon is offered through Medicare Part D. This coverage is optional, but it can provide significant savings on prescription drugs. Part D plans vary by provider, so it’s important to compare coverage options and choose a plan that best fits your needs.

I paid less than 10 years, do I qualify for a premium-free Part A? 

Suppose you don’t have enough work credits, some situations can still get you a premium-free Part A:

  • You’re self-employed and deduct your premiums from your taxes.
  • You’re in the military.
  • You work for a church or other organization that doesn’t pay Social Security taxes.
  • You are or were employed by a local or state government agency that doesn’t participate in Social Security.
  • You were a domestic or farm worker.
  • Your 62 or older spouse earned enough credits

What if I pay less than 10 years, do I still qualify for a credit?

Even if you have not completed 40 quarters, you can still qualify for a tax credit. 

Bear in mind that you can still apply for Medicare Part A and pay a monthly premium.

The eligibility for Part B premium depends if the beneficiary is qualified for a premium-free Part A or pays for it monthly. If the beneficiary is entitled to a free Part A premium, he is entitled to enroll in Part B. However, if he pays for a monthly premium, the following rules should be applied before enrolling in Part B:

  • Be age 65 or older;
  • Be a U.S. resident; AND
  • Be either a U.S. citizen, OR
  • Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

How much does Medicare cost?

In 2022, people enrolled in Medicare can expect higher premiums and deductibles for the medical care they’ll have under the state’s health care program for age 65 individuals and those with disabilities. But benefits will most likely stay the same this year. There are some changes that those with Medicare would like to check on this year:

You may consult us for further information and quotes: 503-928-6918

Option: 1 Original Medicare + Prescription Drug plan  

This option allows you to add Part D (Prescription drug coverage) to your Original Medicare (includes Part A – hospital insurance and Part B – medical insurance) through the Medicare Prescription Drug plan (PDP). Original Medicare can be added to one of the following:

  • Medicare Savings Account (MSA) Plan
  • Medicare Private Fee- for Service (PFFS) Plan given that it does not offer prescription drug coverage
  • Medicare Cost plan if it does not provide Medicare prescription drug or if it offers Medicare prescription drug plan but the enrollee does not decide on getting the drug coverage.

Option 2: Medicare Advantage Plan

To be eligible with this Medicare coverage, you must have enrolled on both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Most Medicare Advantage plans available in Oregon are available with affordable premiums and may offer additional health care benefits.

Option 3: Medicare Supplement Insurance ( Medigap plan )

Offers to fill the “gaps” in Original Medicare. Medicare covers much, but not all, including healthcare services and supplies. This policy can help cover remaining health care costs – copayments, coinsurance, and some deductibles.
 
 Source: Medicare.gov

Timeline of Medicare Enrollment Period in Oregon

During these periods, You have the option to enroll in, change to, or discontinue a Medicare Health Plan or a Medicare Advantage Plan (Part C) that includes or does not include drug coverage.
 
  • Initial Enrollment Period (IEP): 7-month period. Begins 3 months before you are eligible for it (i.e., turning 65), and ends 3 months after your eligibility begins.
  • General Enrollment Period (GEP): Jan 1 to Mar 31
  • Annual Election Period (AEP): Oct 15 to Dec 7
  • Special Enrollment Period (SEP): Anytime during the year
  • Medicare Advantage Disenrollment Period (MADP): Jan 1 to Feb 14
 

Special Election Period in Oregon

There are special situations where you may qualify to enroll in a Medicare plan or change the plan you may be currently enrolled in, even when enrollment has ended.  Some of those situations include the following:

  • You are turning 65
  • You moved to a different address
  • You lose your current coverage:
    • You no longer eligible for Medicaid
    • You left coverage from your employer or union
    • You involuntary lose drug coverage

Other Events include:

  • You are eligible for both Medicare and Medicaid
  • You qualify for extra help with your prescription drug coverage
  • You have a severe or disabling condition such as Cardiovascular disease or diabetes and there’s a Medicare Chronic Care Special Needs Plan (SNP) available
  • You can switch to a 5-star Medicare Advantage Plan, Cost Plan, or Prescription Drug Plan

Oregon Birthday Rule on Medigap 

In Oregon, there is a birthday rule for Medigap Policies. The state allows 31 days to change your Medigap policy, skipping the underwriting process.This rule starts on your birthday each year and gives you a chance for open enrollment for the next 30 days. This requires an ACTIVE Medicare Supplement plan. For an individual with Medicare Advantage plans still need to undergo the underwriting process when applying for Medigap (given that they don’t qualify for guaranteed- issues)

 

If you have Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), here are your choices:

  • You can change or enroll on a new Advantage plan
  • You can also go back to Original plan and enroll on a stand-alone Prescription drug plan from an Advantage plan
  • If you have Advantage plan, you can also switch to Original one, enroll on a stand-alone prescription drug plan and enroll on a Supplement plan.

Penalties

Medicare Part B Late Enrollment Penalty

If you do not sign up for Part B when you are first eligible, or if you drop Part B but enroll later, you may pay a late enrollment penalty:

  • Penalty in effect as long as you have it.
  • Monthly premium for part B may go up 10% each full 12-month period that you did not sign up for Part B but were eligible

Medicare Part D Late Enrollment Penalty

If you don’t sign up for Part D when you’re first eligible, you may pay a late enrollment penalty:

  • Penalty in effect as long as you have it.
  • Penalty calculated by multiplying 1% of the “national base beneficiary premium” times the number of full, uncovered months you were eligible but didn’t join a Prescription Drug Plan and went without other creditable prescription drug coverage.

How do I check my Medicare eligibility?

If you are someone fond of reading online, you may want to use the Check Your Eligibility tool at Medicare.gov. In addition, you can contact Social Security directly at 1-800-772-1213 or apply in person. Visit SSA.gov to find the closest location to you. 

FAQs on Medicare in Oregon

1. When can I enroll in Medicare in Oregon?

You can enroll in Medicare in Oregon during your Initial Enrollment Period, which begins three months before your 65th birthday and lasts for seven months.

2. What happens if I don’t enroll in Medicare when I turn 65?

If you don’t enroll in Medicare when you turn 65, you may face penalties and higher premiums for late enrollment.

3. Can I enroll in Medicare if I’m under 65 and have a disability?

Yes, if you have a qualifying disability, you may be eligible for Medicare regardless of your age.

4. How much does Medicare cost in Oregon?

The cost of Medicare in Oregon varies based on your income and coverage options. Most beneficiaries pay a monthly premium for Parts B and D, as well as deductibles and copayments for certain services.

Need help? Call Health Plans in Oregon:503-928-6918. Our assistance is at no cost to you.

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*By completing this form, you agree that an authorized representative or licensed insurance agent may contact you by phone,email,text, mail or face to face to answer your questions or provide additional information about your Medicare plan options. Not affiliated or endorsed by Medicare or any state or federal governmental agency.

Health Plans in Oregon is a website owned and operated by Insurance Marketplace Agency, Inc., a licensed health insurance agency doing business as Health Plans in Oregon. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. Health Plans in Oregon and our licensed agents are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877)486-2048), 24 hours a day/7 days a week or go to: medicare.gov.

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