Your Ultimate Guide To Medicare in Oregon

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Starting Medicare?

You are likely eligible if…

  • You’re turning 65.
  • You have been on Social Security Disability benefits for more than 24 months.
  • You have a chronic condition or end-stage renal disease.

How much is it?

  •  Most people don’t pay a monthly premium for Part A. 
  • The standard Part B premium is $144.60/month. Higher income earners may pay more.
  • The Part C and Part D monthly premium varies by plan.

When to Enroll?

  • Initial Enrollment Period (IEP): 7-month period. Begins 3 months before turning 65 and ends 3 months after your birthday month. 
  • Initial Coverage Election Period (ICEP): Some people delay starting Part B because they have insurance through a spouse or job. If you’re starting Part B because you delayed it when turning 65, the 7 month period begins 3 months before your Part B begins and ends 3 months after your Part B starts.
  • Open Enrollment Period (OEP): Jan 1 to Mar 31 – During this period, anyone on a Medicare Advantage plan can also make a one-time switch to another Medicare Advantage plan. **Special Note: If you delayed starting Medicare, this is the period for you to contact Social Security and file an application for a July 1st start date.
  • Annual Election Period (AEP): Oct 15 to Dec 7 – Plan details for the following year are released and you are able to choose your plan for the following year (starting January 1 st ). Doing nothing automatically keeps your current plan.
  • Special Enrollment Period (SEP): Anytime during the year (special circumstances must apply)

What is Special Election Period?

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 standard enrollment periods have ended. Some of those situations include: turning 65, moving to a different address, loss of coverage, qualifying for Extra Help, having a severe or disabling condition (Cardiovascular disease or diabetes and there’s a Medicare Chronic Care Special Needs Plan SNP available) or if you’re dual eligible: Medicare and OHP.

Medicare Advantage, also known as Medicare Part C

This is an alternative or replacement to Original Medicare, where you allow a private insurance company to administer your Medicare (instead of the Federal Government). You need to be enrolled in both Part A and Part B to qualify. This type of Medicare plan covers ALL benefits under Medicare Part A and Part B (they must by law) PLUS additional benefits such as dental, vision hearing, gym memberships, prescriptions, and many other features.

Medicare Advantage plans have a Maximum-Out-of-Pocket amount, which limits your total medical costs for the calendar year. This is an important financial protection NOT in Original Medicare.

Medicare Supplement, also known as Medigap

Medicare Supplements help cover deductibles, co-pays, and coinsurance that Original Medicare doesn’t pay for. Plan F is the most popular (and expensive) because it covers ALL of the deductibles, copays, and co-insurance. However, Medicare Supplement does not include dental, vision and hearing. These plans usually have higher premiums and you typically don’t have to stay within specific networks of doctors like many Medicare Advantage plans (you can use any doctor/provider that accepts original Medicare).

*Prescription Drugs are not included with Medigaps, so a Plan D or similar coverage must be purchased separately.

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