Medicare Plan Explained

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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.

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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

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 to do 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 Costs 2019

You may consult us for further information and quotes.

Part AMost 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 coinsuranceYou 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 premiumThe 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 premiumThe Part C monthly  premium varies by plan.
Part D premiumThe Part D monthly premium varies by plan (higher-income consumers may pay more).
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 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

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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.