Medicare in Oregon

In this article...
  • Ensure you're covered with all the benefits you're eligible for. Start with this guide to Medicare in Oregon, which highlights the plans you can choose from and covers some enrollment timelines.

What Oregon Medicare Plans Are Available?

Medicare is one of the most well-known insurance programs for seniors and those with disabilities. However, it is also one of the most complex due, in part, to the various components. Understanding how to sign up for Medicare in Oregon need not be a complicated proposition with a bit of assistance.

The Medicare program consists of several different components, each of which serves its own purpose. 

Part A: Part A coverage is the original piece of the Medicare program. It focuses on coverage for care provided in a hospital or facility setting. This includes traditional healthcare facilities, surgery centers, skilled nursing and hospice. Lab work may also be covered as is home health. 

Part A does not require premium payments for those who are eligible via their participation in the payroll tax system. However, those that did not pay into the system may purchase Parts A and B independently. 

Part B: Medicare Part B functions similar to employer-sponsored health insurance. Premiums are paid monthly and based on income brackets. Those eligible for Part B are required to sign up in the predetermined period or risk a penalty upon enrollment. The exception to this rule are those who had coverage and suddenly lost it. 

Part B covers preventative care through a primary care physician, specialist visits, home health and some additional components not covered by Part A. 

Part C: This portion of the program is also known as the Medicare Advantage plan. It replaces Parts A and B for those who choose an Advantage plan. These plans are administered by private insurance organizations. They are required to provide at least the same benefits as Parts A and B do, but many include extra coverage. This includes dental and vision coverage. The structure of the Medicare Advantage program will be familiar to those accustomed to coverage through a health maintenance organization (HMO) or preferred provider organization (PPO). 

Part D: Part D is also known as the prescription drug benefit program. It provides coverage administered by private companies as well and has a monthly premium. Those eligible must enroll as soon as they are allowed to do so or risk the same penalties as failing to enroll in Part B, with similar exceptions. 

Medigap: This insurance does exactly what it implies: fills in the gap for out-of-pocket healthcare expenses. Medigap covers coinsurance, copays and other costs associated with medical services that Medicare doesn't fully cover. 

Roughly 889,000 citizens are enrolled in Medicare programs in Oregon, with 13% of those under age 65. Around 47% of Medicare enrollees in Oregon have an Advantage plan. There are 29 companies providing the Part D plan, which ranges in cost from $6 to $125 in monthly premiums (depending on income). 

Who Is Eligible for Oregon Medicare?

Eligibility for Medicare begins at age 65, though the program will automatically enroll those eligible for Medicare and other benefits 4 months prior. The only other caveat for seniors is participation in payroll taxes through traditional employment at some point in their lives. 

Other means of eligibility in a Medicare program include younger individuals that have disabilities or a chronic healthcare condition, both of which require designation by the Social Security Administration. 

How Do I Enroll in Medicare in Oregon?

Those eligible for enrollment in Medicare in Oregon can sign-up 3 months prior to the month when they turn 65 and in the three months after that month. With the exception of special circumstances (such as the loss of employer-sponsored insurance), a penalty is levied against those that sign up outside of this period. 

There is a fall enrollment period from October 15 through December 7 where you can elect Medicare coverage or change your coverage. Coverage for those who enroll during this period starts on January 1. If you want to change your Medicare Advantage plan elections you can do so during the Medicare Advantage enrollment period from January 1 through March 31 each year.

Sign up takes place via the Social Security Administration online at www.SocialSecurity.gov or via phone (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m. Those enrolling can also visit their local Social Security Administration office to get assistance signing up in person. 

Contact Information for Oregon Medicare, Medicaid and Insurance Help

Those in need of assistance with Medicare can call the Senior Health Insurance Benefits Assistance (SHIBA) program at (800) 722-4134 or email shiba.oregon@oregon.gov

If you are worried about the total cost of health care and don't think you can afford a Medicare supplement plan, consider looking into Oregon Medicaid. The Oregon Prescription Drug Program also offers some information on resources to help you pay for prescription drugs. 

You can also visit the website for Oregon's Division of Financial Regulation to learn more about insurance in the state.