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:
|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 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:
|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.
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**
*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