Medicare plays a key role in providing health and financial security to beneficiaries residing in Oregon. With more than 879,000 Oregon beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Oregon. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Oregon?

Medicare covers most Oregon residents who are 65 or older, and it also covers disabled Oregon residents. In general, Medicare enrollment in Oregon works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Oregon Medicare Advantage (Part C), Medicare Supplement (Medigap) Insurance and Medicare Prescription Drug Plans (Part D)

463,207

Original Medicare Plans
(Part A and B)

415,867

Medicare Advantage & Other Health Plans

275,919

Stand-alone Medicare
Part D (Drug plans)

879,074

Total Medicare Beneficiaries
in Oregon

Oregon Medicare Advantage Plans (Part C)

More than 46% of Oregon Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Oregon who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 121 Medicare Advantage plans are available in Oregon. The average monthly Medicare Advantage premium changed from $54.03 in 2019 to $47.94 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Oregon.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 415,867 beneficiaries enrolled in Medicare Advantage and other plans in Oregon. More than 46% of Oregon Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Depending on your county, Oregon Medicare beneficiaries can select from between five and 37 Medicare Advantage plans. Medicare Advantage plans are available in all of Oregon’s 36 counties.

Oregon Medicare Supplement (Medigap) Insurance Plans

Oregon’s strong consumer protections for Medigap enrollees include opportunities such as the chance to switch plans and guaranteed-issue coverage (without higher premiums) for disabled beneficiaries under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

There are currently 48 insurers that offer Medigap plans in Oregon.

Oregon has a “birthday rule,” which provides Medigap enrollees the opportunity to compare prices and apply for a new Medigap plan. The birthday rule starts on your birthday and ends 30 days later. From there, the new plan is then guaranteed-issue coverage during that window. Oregon also provides Medicare beneficiaries under age 65 a six-month window after they’ve enrolled in Medicare Part B. The beneficiaries then have a guaranteed-issue right to a Medigap plan with no medical underwriting. Additionally, the premium cannot exceed the premiums that are charged to enrollees who are 65 years old.

Oregon Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 275,919 Medicare beneficiaries in Oregon enrolled in stand-alone Part D prescription drug plans and 393,517 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in Oregon, with premiums ranging from about $15 to $117 per month. About 24% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Oregon

  • Oregon’s Senior Health Insurance Benefits Assistance (SHIBA) is a statewide network of trained volunteers who educate and advocate for people of all ages who have Medicare. Their five state employees, plus more than 200 certified volunteer counselors, help you understand your rights and Medicare insurance choices. SHIBA’s volunteers keep your information confidential. As part of the Oregon Health Insurance Marketplace of the state Department of Consumer and Business Services, volunteers provide assistance at no charge to you. The federal Centers for Medicare and Medicaid Services funds and guides this program and similar programs in other states.
    Contact: Call 1-800-722-4134 or complete the online contact form

  • Oregon Senior Medicare Patrol (SMP): SMP volunteers work in their communities to provide education to Medicare and Medicaid beneficiaries, their family members, and their caregivers about preventing health care fraud and abuse. The SMP seeks to empower beneficiaries through increased awareness and understanding of health care programs to protect them from the economic and health-related consequences of Medicare fraud, errors, and abuse. The Oregon SMP provides services around the state through partnerships with the Senior Health Insurance Benefits Assistance (SHIBA) program, the Office of the Long-Term Care Ombudsman (LTCO), and the Association for Oregon Centers for Independent Living (AOCIL).
    Contact: Call 1-855-673-2372 or contact your local Aging and Disability Resource Connection (ADRC).

  • YWCA of Greater Portland’s Senior Services Program offers a wide range of information and support to seniors, with an emphasis on low-income seniors over the age of 60 years. Their aim is to empower seniors to maintain healthy and independent lives in the safety and comfort of their own homes.
    Contact: Call (503) 294-7400, email [email protected], or visit the corporate office at 4610 SE Belmont St., Portland, OR 97215.

  • Oregon’s Services for Seniors and People with Disabilities office is part of the state’s Department of Human Services (DHS) and provides information on state medical programs including Medicare and the Prescription Drugs Assistance Program. Through the office’s website, seniors can apply for benefits and access information on services such as in-home support, reporting abuse, caregiver support, and disability benefits.
    Contact: Call 503-945-5600

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Oregon. Our process makes it easier for you to access your Medicare eligibility in Oregon so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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