Medicare is a federal health insurance program that provides coverage to individuals who are 65 years or older, have a qualifying disability or those with end stage renal disease. Medicare coverage is broken down into different parts that cover different types of medical expenses. In Oregon, there are various Medicare options available, and it can be challenging to navigate through them. This guide aims to provide a comprehensive overview of the Medicare plan options in Oregon, including the different parts of Medicare, Medicare Advantage plans, Medicare Supplement plans, and how to enroll in Medicare.
Understanding the Different Parts of Medicare
Medicare is divided into four different parts, each covering different medical expenses. Understanding each part is crucial to discover your Medicare plan options in Oregon.
Original Medicare
Original Medicare consists of Part A and Part B, which provide basic fee-for-service insurance. Part A covers hospital stays, skilled nursing facilities, lab tests, and hospice care. Part B covers doctor’s visits, home health care services, and some preventive care. With Original Medicare, you must pay a deductible and a share of the fees for inpatient or outpatient visits. While this option provides flexibility in choosing providers, there is no cap on out-of-pocket expenses, and you need to purchase drug coverage separately.
Medicare Advantage Plans
Medicare Advantage Plans, also known as Part C, offer an alternative to Original Medicare provided by private insurance companies. These plans offer additional coverage, including prescription drugs, dental and vision care, and adult day care services. However, you may need to use network providers, receive referrals for specialists, and obtain prior authorizations for treatment and medications.
Some of the top Medicare Advantage plans available in Oregon include:
- Kaiser Permanente Senior Advantage
- Providence Medicare Advantage Plans
- Regence BlueCross BlueShield of Oregon Medicare Advantage
- Health Net Medicare Advantage
- Humana Medicare Advantage
Medicare Prescription Drug Plans
Part D Medicare prescription drug coverage can be added to Original Medicare, and most Medicare Advantage policies include it automatically. It is provided by Medicare-approved private insurers and requires a deductible and a copay for each prescription drug.
Medicare Supplement
Medicare Supplement Insurance Plans, or Medigap, fill in the gaps of Original Medicare coverage, including copays and excess charges. However, you cannot have a Medigap plan and a Medicare Advantage Plan at the same time. Medigap offers predictable coverage and costs for Medicare-covered care and is a good choice for those with significant healthcare needs who want the freedom to see any Medicare provider without network restrictions.
Some of the top Medicare Supplement plans available in Oregon include:
- AARP Medicare Supplement Plans
- Mutual of Omaha Medicare Supplement Plans
- Cigna Medicare Supplement Plans
- UnitedHealthcare Medicare Supplement Plans
- Blue Cross Blue Shield of Oregon Medicare Supplement Plans
How to Enroll in Medicare in Oregon
Enrolling in Medicare in Oregon is easy and can be done online, by phone, or in-person. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Parts A and B. If you are not receiving Social Security benefits, you can enroll in Medicare during your initial enrollment period, which is three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday. You can also enroll in Medicare during the annual enrollment period, which runs from October 15th to December 7th each year.
To enroll in a Medicare Advantage plan or Medicare Part D plan, you must have Medicare Parts A and B and enroll during the annual enrollment period. You can also enroll in a Medicare Advantage plan during the initial enrollment period or during a special enrollment period if you have a qualifying life event such as moving or losing your current coverage.
Click here to know the Medicare enrollment periods
What are my Medicare plan options in Oregon if im losing my Medicaid?
Medicaid is a health insurance program designed to offer coverage to low-income families and individuals. The program is administered by each state. However, it is possible to lose Medicaid coverage, even after being approved for it.
Reasons for losing coverage may include
- exceeding the income limit,
- failing to report changes in family status,
- the end of a pregnancy,
- receiving gifts or inheritance,
- or relocating to a state with different income limits.
If you find yourself in any of these situations and have lost your Medicaid coverage, there are options available to you.
Assistance is still available to you even if you don’t meet the criteria for Medicaid. You may be eligible for a Medicare Savings Program that can help you pay for Medicare-related expenses such as premiums, deductibles, and copayments for Parts A and B, depending on the specific program requirements in your state. Your eligibility for these programs is determined based on your income and assets, which may vary depending on the state you live in.
Moreover, you may also qualify for additional support through the Extra Help program, which assists with Part D premiums and copayments. This program has higher income limits compared to Medicaid and is expanding to include even more people with higher income levels by 2024.
Frequently Asked Questions
1.How much does Medicare cost in Oregon?
The cost of Medicare varies depending on the specific plan you choose. Most people do not have to pay a premium for Medicare Part A. The monthly premium for Medicare Part B is based on income. Medicare Advantage plans and Medicare Part D plans have different costs depending on the plan and the insurance company.
2.How do I qualify for dual eligibility?
Medicaid is a state-run program that provides health insurance coverage for certain low-income individuals and families. Each state has its own eligibility criteria, but generally, you may qualify for Medicaid if you have limited income and resources.
3. Can I still get help with Medicare expenses if I don’t qualify for Medicaid?
Yes, you may still be eligible for assistance with Medicare expenses through a Medicare Savings Program, which helps participants pay for Medicare Part A and Part B premiums, deductibles, and copayments. You may also qualify for the Extra Help program, which provides help with Part D premiums and copayments.
Conclusion
Navigating Medicare options in Oregon can be overwhelming, but understanding the different parts of Medicare, Medicare Advantage plans, and Medicare Supplement plans can help you make an informed decision. When selecting a plan, it is important to consider your medical needs and the costs associated with each plan. By enrolling in Medicare, you can ensure that you have access to the medical care you need as you age.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
*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.
