Whether you’re shopping for Medicare plans in Oregon for the first time or are considering changing your current Medicare coverage, it’s important to first understand all your options.
Read on to learn about the different Medicare plans available in Oregon, enrollment timelines, and more.
Medicare is a national health insurance program managed by the federal government. It’s available to people age 65 and over, as well as those of any age who have certain disabilities or health conditions.
Parts A and B make up the original Medicare that you can get from the government. Over the years, the original Medicare program has expanded to include plans you can purchase from private insurers. These plans can add to or replace the coverage you get under original Medicare.
Part A is hospital insurance. It helps pay the costs of:
- inpatient healthcare services you get in a hospital
- a limited stay in a skilled nursing facility
- hospice care
- some limited home health services
If you or your spouse paid Medicare payroll taxes during your working years, you won’t need to pay a premium for Part A.
Part B helps pay the costs of outpatient care, such as services or supplies you receive from your primary doctor or a specialist, including preventive care. You do pay a premium for Part B. That amount depends on various factors, including your income.
Parts A and B cover many services, but there’s a lot that original Medicare doesn’t cover. There’s no coverage for prescription drugs, long-term care, or dental, vision, or hearing services.
Even with the services Medicare does pay for, coverage isn’t 100 percent. You’ll still have to pay significant amounts out of pocket when you see a doctor, such as copays, coinsurance, and deductibles.
You can expand your coverage by purchasing plans offered through private insurers. These include Medicare supplement, prescription drug, and Medicare Advantage plans.
Medicare supplement plans
Medicare supplement plans, sometimes called Medigap, add coverage to your original Medicare. They may help lower the amount you pay out of pocket when you seek care. They might also add dental, vision, long-term care, or other coverage.
Prescription drug plans
Part D plans are prescription drug plans. They focus solely on helping pay for the costs of medications.
Medicare Advantage (Part C) plans
Medicare Advantage (Part C) plans offer an “all-in-one” replacement to original Medicare plus supplemental coverage. Instead of having a combination of public and private plans, you can get a Medicare Advantage plan that includes a comprehensive set of benefits, including coverage for prescription drugs, vision and dental, long-term care, hearing, and more.
Plus, Medicare Advantage plans often include a lot of extras, such as discounts and health and wellness programs.
The following private insurance companies offer Medicare Advantage plans in Oregon:
- Aetna Medicare
- Atrio Health Plans
- Health Net
- Kaiser Permanente
- Lasso Healthcare
- Moda Health Plan, Inc.
- PacificSource Medicare
- Providence Medicare Advantage Plans
- Regence BlueCross BlueShield of Oregon
Plan offerings vary by county, so your options will depend on what’s available in the county where you live.
Medicare eligibility depends on your age or health status. You’re eligible to enroll if you’re:
If your Medicare eligibility is age-based, you can begin the enrollment process 3 months before the month of your 65th birthday. This is your initial enrollment period. It then lasts for 3 months after month in which you turn 65 years old.
It usually makes sense to enroll in at least Part A during the initial enrollment period, since you likely qualify to get Part A benefits without paying a premium.
If you or your spouse choose to continue working and continue to qualify for employer-sponsored coverage, you may want to put off enrolling in Part B or any supplemental coverage. In such cases, you’ll qualify for a special enrollment period later on.
You can make changes to an existing original Medicare plan or enroll for the first time in Medicare during the open enrollment period from October 15 to December 7.
There’s also a Medicare Advantage open enrollment period each year. At this time, you can switch coverage from original Medicare to a Medicare Advantage plan. The open enrollment period for Medicare Advantage plans is from January 1 through March 31.
When shopping for Medicare plans in Oregon, you’ll want to keep in mind that private insurance companies have more flexibility, so they can structure their plans in different ways.
For instance, some Medicare Advantage plans might be Health Maintenance Organization (HMO) plans, requiring you to select a primary care physician who oversees your care and must give you a referral if you need to see specialists.
Others may be Preferred Provider Organization (PPO) plans that offer you access to network providers of all specialties without a need for referrals.
Which type of plan makes sense for you? That depends on your individual circumstances and preferences. You may want to consider the following questions when weighing your options:
- How much is this plan going to cost me? How much are the premiums? Are there out-of-pocket costs when I see a doctor or fill a prescription?
- Will I have access to doctors and hospitals that are convenient for me? Does the network include providers I already have relationships with? Will I be covered if I need care while I’m traveling?
- What types of programs are included? Would these programs be helpful to me?
These resources can be useful if you’d like to learn more about Medicare plans in Oregon:
When you’re ready to take the next step toward enrolling in Medicare, consider these actions:
- Do some more research into your individual plan options. The list above can be a helpful starting point for looking into Medicare Advantage plans in Oregon. It might also be useful to connect with an insurance agent who can offer more personalized guidance.
- If you’re currently eligible to enroll, you can begin the process by completing the online application on the SSA website. The site even includes a checklist that details the information you’ll need to apply.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.