As your independent health plan consultant, Health Plans in Oregon can compare Medicare health, supplemental, and prescription plans from dozens of private health insurance companies.
Medicare in Oregon by Numbers
Let us take a quick overview of Medicare Enrollment as of 2019 in Oregon:
- Nearly 20% of the population is enrolled in Original Medicare, that is around 835,000 beneficiaries, 14% of which is qualified by age.
- Around 45% of the beneficiaries are enrolled in a Medicare Advantage Plan
- In 2017, Medicare spent an average of $7,510 per Original Medicare, making it amongst the three low-cost nations in 2017, alongside Alaska and Hawaii.
- Oregon has a strong protection program for Medigap enrollees, making them eligible to switch plans annually and a guaranteed issue coverage for disabled beneficiaries under the age of 65.
Since 2006, Health Plans in Oregon:
- Offers free annual Medicare insurance reviews
- Helps you by considering premiums, deductibles, co-pays, co-insurance, and all options
- Ensures you can take advantage of it by choosing the right plan
New to Medicare?
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 or other chronic conditions may be eligible
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 helps 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 Qualifications by Parts
Who is eligible for Original Medicare?
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.
I paid less than 10 years, do I qualify for a premium-free Part A? Even if 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 have not completed 40 quarters, you can still qualify for a tax credit. This chart shows you how much credit you will get:
|0 – 29||$437.00|
|30 – 39||$240.00|
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.
Medicare Costs 2019
You may consult us for further information and quotes.
|Part A||Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”). If you buy Part A, you’ll pay up to $437 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.|
|Part A hospital inpatient deductible and coinsurance||You pay:|
– $1,364 deductible for each benefit period
– Days 1-60: $0 coinsurance for each benefit period
– Days 61-90: $341 coinsurance per day of each benefit period
– Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
– Beyond lifetime reserve days: all costs
|Part B premium||The standard Part B premium amount is $135.50 (or higher depending on your income).|
|Part B deductible and coinsurance||$185 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (dme)|
|Part C premium||The Part C monthly premium varies by plan.|
|Part D premium||The Part D monthly premium varies by plan (higher-income consumers may pay more).|
Timeline of Medicare Enrollment Period in Oregon:
- 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
- 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
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.
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 MAKE SURE I AM ELIGIBLE FOR MEDICARE?
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
What to do next?
To most people, Medicare is very confusing and hard to understand. Don’t worry, we got your back.
- Learn more about how and when to enroll in Medicare, Medicare Advantage or Medigap by checking our website www.healthplansinoregon.com
- Give us a call at 503-998-6169, we can help you find and enroll in a plan that is right for you.