Understand Medicare in Oregon

Medicare, the United States federal medical insurance program, provides coverage for almost 500,000 people in Oregon who qualify for Medicare.  You can get Medicare if you’re 65 or older or have a qualifying disability.

Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income.  There are 78 Medicare Advantage Plans in the state that are an alternative to Original Medicare.  Learn more about your Medicare options in Oregon.

Medicare Plans in Oregon

Compare ratings of Oregon’s Medicare plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars 5 out of 10
Blue Cross Blue Shield 4.5 stars A A+ Not rated Sixth out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of ten
Kaiser 5 A A- 4.5 to 5 stars First out of 10
Providence 5 Not rated F 4 stars Not ranked
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Medicare Plan Options in Oregon

Residents of Oregon have just two Medicare plans to choose from. Seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Oregon’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.

Original Medicare (Parts A and B) Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
  • Original Medicare is a good choice if you want flexibility in choosing and accessing providers that accept Medicare anywhere in the U.S.
  • There is no cap on what you could spend for out-of-pocket expenses, and you must purchase drug coverage separately, so it’s a better choice for you if you don’t need much in the way of health care or prescription drugs.
  • If you don’t purchase a Medigap policy to supplement Original Medicare when you are first eligible, you may not be able to purchase one or may have to pay higher premiums, depending on your health status.
Medicare Advantage Plans (Part C) Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
  • Medicare Advantage is a good choice if you want to have all of your health care and drug benefits bundled together in one plan and if you don’t mind being restricted in your choice of providers to save on costs.
  • There is a cap on what you can spend for out-of-pocket Medicare-covered expenses.
  • You also have access to services that Medicare doesn’t cover, like routine dental and vision exams.
Medicare Prescription Drug Coverage Plans (Part D) Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
  • Part D is a good choice if you have Original Medicare, or if you have a Medicare Advantage Plan ― not a health maintenance organization (HMO) or preferred provider organization (PPO) ― that doesn’t have prescription drug coverage.
  • You pay a penalty if you wait to enroll in a Part D plan, unless you have creditable coverage from an employer-sponsored group plan.
  • If you don’t require medications now, you can enroll in a low-premium Part D plan to avoid late enrollment penalties later.
Medicare Supplement Insurance Plans (Medigap) Some Oregon seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
  • Medigap is a good choice if you have Original Medicare and want help paying for out-of-pocket expenses you incur when you access your Part A and Part B benefits.
  • You pay a monthly premium, and most copays and coinsurance costs are covered.
  • If you have significant health care needs, want the freedom to see any Medicare provider without network restrictions, a Medigap plan offers predictable coverage and costs for Medicare-covered care.
  • Medigap doesn’t cover prescription drugs or other benefits like dental and vision.

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 $499 per month*

Plan B: $170.10 per month**

$7,816 -23.00%

*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

Getting support can help when you’re making Medicare decisions. Oregon has numerous locations where enrollees can receive help through the Oregon Health Plan (OHP). OHP provides health coverage for low-income state residents.

Senior Health Insurance Benefits Assistance (SHIBA)

The Oregon Senior Health Insurance Benefits Assistance (SHIBA) is a statewide program that provides free Medicare information to seniors and their family members living in the state. Counselors will walk you through enrollment or changing plans, and can help you compare Medicare plans to find the best coverage option for you. SHIBA also conducts free webinars and presentations on Medicare topics.

Contact information: Website | (800) 722-4134

Aging and Disability Resource Connection (ADRC)

The Aging and Disability Resource Connection (ADRC) administers the SHIBA program within Multnomah County, serving residents in Fairview, Gresham, Maywood Park, Portland, Troutdale and Wood Village. ADRC provides free Medicare counseling. You can get help comparing plans, filing claims or connecting to other local resources.

Contact information: Website | (503) 988-3646

Oregon Medicare Savings Connect

Oregon Medicare Savings Connect provides financial assistance to residents who struggle to pay for their Medicare Part B or Part D premiums, copays or deductibles. Eligibility for Oregon Medicare Savings Connect is income-based and all services are free and confidential.

Contact information: Website | (855) 447-0155

Oregon Area Agencies on Aging

Supported by the Oregon Department of Human Services, there are 16 local Agencies on Aging throughout Oregon state. Each office acts as an advocate for local seniors and helps to develop community-based long-term care services for older adults in the area. It provides services to seniors living within the county, including free Medicare counseling.

Contact information: Website | (503) 945-5600

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Certified Senior Advisor (CSA)Ⓡ

As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.

Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.

A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.

As a CSAⓇ, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.

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