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Oregon Medicare Enrollment 2019 [All Questions Answered]

By March 8, 2019 No Comments

What are the different Medicare Enrollment periods in 2019?

If you’re turning 65 or over 65 or under 65 but on disability for at least two year, you may qualify for Medicare. It’s very important to know the different Medicare Enrollment periods to prevent lapse of coverage or paying for penalties.  

Medicare Enrollment Period OregonMedicare Initial Enrollment Period (IEP) happens on your 65th birthday: three months before your 65th birthday, the month of that birthday and three months after (7 months total). This means that if you turn 65 in May, you can enroll in Medicare Part B in February, March or April, and if you do, it will become effective May 1st. If you enroll in May, it’ll kick in June 1; in June, on Aug. 1; in July, on Oct. 1; and in August, on Nov. 1 — because, that’s how it is.

You can…

  • change or enroll on a new Medicare Advantage plan
  • enroll on a stand-alone prescription drug plan
  • enroll on a Medicare Supplement with a guaranteed issue. You have 6 months of open enrollment which starts the same month that your Medicare part B starts. If you missed this enrollment period, you can be charged a higher premium or turned down. Neither Medicare or Medigap cover prescriptions so you have to enroll on a stand alone drug plan.

>>> Click to view ‘The Basics of Medicare’ Video.

Medicare Annual Open Enrollment Period (AEP / Medicare Open Enrollment). Open enrollment runs annually from October 15 to December 7.

  • You can change or enroll on a new Medicare Advantage plan
  • You can also go back to Original Medicare and enroll on a stand-alone Prescription drug plan from a Medicare Advantage plan
  • If you have a Medicare Advantage, you may switch to Original Medicare. Here you can enroll on a stand-alone prescription drug plan and enroll on a Medicare supplement
  • You may also change and enroll on a Medicare Advantage if you’re on Medicare Supplement.

Medicare Special Enrollment Period. This is when you may qualify to enroll in a plan or change the plan you may be currently enrolled in, even when Annual Enrollment Period has ended.

  • You can change or enroll on a new Medicare Advantage plan
  • You can also go back to Original Medicare and enroll on a stand-alone Prescription drug plan from a Medicare Advantage plan
  • If you have a Medicare Advantage, you may switch to Original Medicare, enroll on a stand-alone prescription drug plan and enroll on a Medicare supplement
  • You may also change and enroll on a Medicare Advantage if you’re on Medicare Supplement.

Medicare Part B Special Enrollment Period

If you declined Medicare Part B because you either couldn’t afford the premium or didn’t want it, you have to wait during General Enrollment Period between Jan 1- March 31 every year to enroll on part B. Your part B will take effect on July of the same year you applied. The part B premium in 2019 costs $135 per month. If you sign up after your Initial enrollment, you may have to pay a late enrollment penalty (LEP) of 10%. This is for each full 12-month period when you don’t have Part B but were eligible to sign up.

If you refused Medicare Part B because you had group insurance through work or spouse’s insurance, you may sign up as early as the following month.

Penalty won’t apply if you have creditable coverage when you first eligible for Medicare.

Here’s a the Medicare Part B enrollment form.

Here are some of the situations that will help you qualify for Medicare Special Enrollment Period (SEP):

You…

  • moved to a different address
    • tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.
    • When you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.
    • If you were released from jail, you can join a Medicare Advantage Plan or Medicare Prescription Drug Plan. Please note that your chance to join lasts for 2 full months after the month you’re released from jail.
  • lost of your current coverage
  • no longer eligible for Medicaid
  • left coverage from your employer or union or Medicare plan
    • Here, you can also join a Medicare Advantage Plan or Medicare Prescription Drug Plan. Your chance to join lasts for 2 full months after the month your coverage ends.
  • involuntary lose other drug coverage
  • are being eligible for both Medicare and Medicaid
    • You can join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage, anytime.
  • qualify for extra help with your Medicare prescription drug coverage
    • You can join, switch, or drop Medicare prescription drug coverage. You can join anytime and you coverage will begin the first day of the month after you qualify for Extra Help or ask to join a plan.
  • have a severe or disabling condition such as cardiovascular disease or diabetes
    • You can join a Medicare Chronic Care Special Needs Plan (SNP) if it’s available. You can join anytime, but once you join, your chance to make changes using this SEP ends.
  • can switch to a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Medicare Prescription Drug Plan
    • The 5-star rating SEP can only be used one time during the plan year. If a Medicare Prescription Drug Plan (Part D) or Medicare Advantage plan with a 5-star rating is available in your area (call us for inquiries within Oregon), you can use the 5-star Special Enrollment Period (SEP) for a once-a-year opportunity to switch from your current Medicare plan to a Medicare plan with the “5-star” quality rating. The 5-star SEP is available to you at any time during the plan year.

Medicare in OregonDid you know that Medicare Automatic Enrollment happens to some people?

Yes, that’s right.

  • You are automatically enrolled in Original Medicare (Medicare Part A & Part B) if you are receiving retirement benefits from Social Security Administration or Railroad Retirement Board before you turn 65. This means that Medicare coverage will automatically start on the first day of the month that you turn 65.
  • You are also automatically enrolled on Original Medicare (Medicare Part A & Part B) if you are receiving disability benefits from Social Security Administration or Railroad Retirement Board for at least 2 years (regardless of your age). This means that you’re automatically enrolled in Original Medicare after 2 years of receiving your disability benefits. However, if you are receiving your disability benefits due to amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you no longer have to wait until after 2 years. This is because you will be automatically enrolled in Medicare on the first month that your disability benefits start.
  • For everyone else, you will need to fill out all the required paperwork, call or go to Social Security office to enroll in Medicare.

Another thing is…

You can sign up for Medicare before 65.

Here are some of the conditions that would allow you to qualify or apply for Medicare before you turn 65:

  1. End-stage renal disease
    Those who suffer from end-stage renal disease are typically eligible for Medicare regardless of age. In order to qualify, your kidneys must no longer work. Moreover, you must need regular dialysis or have had a kidney transplant. In addition, you must have a work history that’s long enough to qualify under Social Security, the Railroad Retirement Board program, or as a government employee. Alternatively, if you are the spouse or dependent child of a worker who has a long enough work history, then you can use that worker’s record as your basis to claim Medicare benefits.

    Medicare benefits for those with end-stage renal disease last until 12 months after they stop dialysis treatments or 36 months after having a kidney transplant. However, coverage is extended if they restart dialysis or get a kidney transplant within 12 months of stopping dialysis or within 36 months of a previous kidney transplant.

    2. Amyotrophic lateral sclerosis (Lou Gehrig’s disease)  Medicare before 65
    Those who suffer from amyotrophic lateral sclerosis, better known as Lou Gehrig’s disease, can qualify for Medicare benefits. For this disease, Medicare coverage is linked to eligibility for Social Security disability benefits. Once you’ve started receiving disability payments from Social Security or the Railroad Retirement Board, then you can get Medicare benefits in that same month.

    Until July 2001, ALS sufferers had to follow the same rules that those with disabilities did. As you’ll see below, that included a waiting period before Medicare was available. However, the law change created this exception for ALS that allows benefits to kick in right away.

    3. General illnesses, injuries, or disabilities
    Those who have severe illnesses, injuries, or disabilities that keep them from earnings above certain income thresholds can qualify for Medicare. This is if they meet the standards for Social Security disability benefits. In general, that requires that the disability be long term in nature. This means that you are not able to do the work as you did before or adjusts to other types of work because of your medical condition. Disabilities that are expected to last less than a year don’t qualify for Social Security and therefore don’t trigger early Medicare eligibility.

    Once you’ve started receiving Social Security disability benefits, you’ll have to wait 24 months before you get Medicare eligibility. However, once you start getting Medicare, you can stay on the program even if you go back to work as long as you are still medically disabled.

Who can directly help you with all these sign-ups for Oregon Medicare Enrollment?

To know more about Medicare enrollment information and other areas of Medicare, consult your local agent for free. Health Plans In Oregon has over a decade of being a licensed Medicare Health Plan Consultant. Our help is at no cost to you. Feel free to call us at 503-998-6169 for any questions or to request face to face meet up. You can also send an email to info@healthplansinoregon.com to get help.

— Health Plans In Oregon | 14631 SW Millikan Way, Beaverton, OR 97006

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