Medicare Plan Options
You’re automatically enrolled in the government’s Original Medicare program when you first join Medicare, so you may want to consider whether basic hospital and medical insurance is enough for your needs. For additional coverage, such as vision, dental, fitness, and prescription drugs, you may want to sign up for a private insurance plan from Oregon’s Medicare Advantage program. If you stay in Original Medicare, you have the option of adding on a stand-alone prescription drug plan and supplemental insurance to help pay for out-of-pocket costs.
Original Medicare insures you for medically necessary services to diagnose, treat, and prevent illnesses. This coverage is administered in two parts. Part A hospital insurance covers your inpatient stay in a hospital or skilled nursing facility and some home health care services. Part B medical insurance helps pay for visits to a doctor or specialist, blood tests, diagnostic imaging, ambulance, and durable medical equipment, such as wheelchairs. Under Original Medicare, you typically pay monthly premiums, annual deductibles, and coinsurance or copays for services received.
Medicare Advantage Plans
Once enrolled in Original Medicare Parts A and B, you have the option to switch to a Part C Medicare Advantage Plan in your service area, as long as you’re enrolled in Medigap. These plans are available through private insurers under contract with the government and cover the same services as Original Medicare. Medicare Advantage Plans also cover additional expenses, such as eyeglasses, hearing aids, dental care, gym memberships, prescription drugs, and transportation to medical appointments. Insurers have the flexibility to offer any mix of approved benefits. There are four broad types of Medicare Advantage Plans: HMO, PPO, PFFS, and SNP. Premiums, deductibles, and cost-sharing vary by individual plan.
Medicare Prescription Drug Coverage Plans
Medicare Part D refers to prescription drug coverage, which helps pay for the medication a doctor prescribes to treat an illness or condition. Although drug coverage is optional, you may be subject to a penalty if you don’t sign up when you first qualify. This penalty is usually charged as a monthly penalty when you join a drug plan later. You can sign up for drug coverage through some Medicare Advantage Plans or a standalone Part D prescription drug plan that supplements Original Medicare. You must meet your plan’s annual drug deductible before the plan begins paying its portion of your medication. All drug plans must meet a basic level of coverage but may differ in the generic or brand-name drugs they cover, cost-sharing, and pharmacies you can use.
Medicare Supplement Insurance Plans
Original Medicare helps cover a portion, but not all, of your health care expenses. You must still pay deductibles, coinsurance, copays, excess charges, and out-of-country emergency care, for example. Some insurance providers offer Medicare Supplement Insurance, or Medigap plans, to help pay for these out-of-pocket expenses. Medigap plans in Oregon are standardized by letter (A to D, F, G, K to N). Plans within each letter category offer the same coverage to help you better compare policies. You may only enroll in Medigap if you’re receiving Medicare through Original Medicare.
Medicare in Oregon by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|467,867||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Oregon
Medicare can be an effective way to save money on health care as long as you understand your plan’s rules and aren’t surprised by unexpected costs or services that aren’t covered. If you need assistance in understanding how Medicare works, reach out to some of these agencies in Oregon to help you make informed decisions.
Senior Health Insurance Benefits Assistance (SHIBA)
SHIBA is a statewide program providing free Medicare information to Oregon residents. If you’re enrolling in Medicare or considering changing plans, you can call and speak with counselors about eligibility, benefits, enrollment periods, and income-related benefits. You can also attend free webinars and group presentations related to Medicare by registering on the SHIBA website.
Contact Information: Website | 800-722-4134
Aging and Disability Resource Connection (ADRC)
ADRC is the Area Agency on Aging for Multnomah County and administers the SHIBA program locally. The agency serves residents in cities, such as Portland, Fairview, Gresham, Troutdale, Maywood Park, and Wood Village. ADRC offers free counseling to help you compare Medicare plans, file claims, make appeals, and connect to other community resources as needed.
Contact Information: Website | 503-988-3646
Oregon Medicare Savings Connect
If you’re having difficulty affording Medicare, you may qualify for assistance with Part B and D premiums, copays, and deductibles. Staff at Oregon Medicare Savings Connect can help you review your eligibility based on gross income and apply for benefits if you qualify. Services are free and confidential and include translation if necessary.
Contact Information: Website | 855-447-0155
Learn More From Our Sources
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Medicare Advantage Plans | Last accessed June 2021
- Medicare | Your Guide to Medicare Prescription Drug Coverage | Last accessed June 2021
- Medicare | Medicare Supplement Insurance – Getting Started | Last accessed June 2021