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Medicare in Oregon

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Medicare in Oregon by Numbers

Let us take a quick overview of Medicare Enrollment as of 2022 in Oregon:

  • In Oregon, just about 903,000 people are signed up for Medicare and up 2% from 2020.
  • About 458,000 stayed with this basic level of coverage.
  • Nearly 447,000, or about 50%, enroll in Medicare Advantage.
  • 274,000 enrolled in Part D plans.

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 by choosing the right plan

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 or other chronic conditions may be eligible

Medicare Overview

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 

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 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.

Medicare Costs 2022

In 2022, Medicare beneficiaries 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

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 $499 each month in 2021. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $499. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $274.
Part A hospital inpatient deductible and coinsurance You pay: $1,556 deductible for each benefit period Days 1-60: $0 coinsurance for each benefit period Days 61-90: $389 coinsurance per day of each benefit period Days 91 and beyond: $778 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 Increase by up to $21.60 on Monthly Premium for Part B, which may cost $ 170.10 compared to 2021. Part B premium increase will be somewhat offset by the 5.9 percent increase in Social Security's annual cost-of-living adjustment (COLA) Those with Medicare and are Social Security beneficiaries will have their premium deducted from their monthly check.
Part B deductible and coinsurance $233. 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 The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. varies by plan.
Part D premium The Part D monthly premium varies by plan (higher-income consumers may pay more).
Accessible Insulin Cost By 2022, enrollees will sign up for Part D "enhanced" plan that is participating in a CMS program. This limits the cost of insulin to $35/month. Those with Original Medicare and Medicare Advantage plans can sign up for this.
Mental health coverage via telehealth Medicare pays significant attention to TELEHEALTH during this pandemic. In 2022, Medicare will cover for mental health visits outside of the rules during the pandemic. ( mental health telehealth visits provided by rural health clinics and federally qualified health centers will be covered)

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 plan, you must have enrolled on both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Most Medicare Advantage plans available in Oregon cost from $0 to more than $200 premium per month. In 2022, the average premium monthly is $39.77. Medicare Advantage plans offer additional health care benefits including routine hearing, vision, dental, gym membership and some OTC (over-the-counter card).

Option 3: Medicare Supplement Insurance ( Medigap )

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:

  • 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

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 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. Give us a call at 503-928-6918. Our assistance is at no cost to you.

Get free help from your local, licensed, certified, 5 star reviews and well experienced licensed insurance agent​.

*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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