Guide to Oregon Medicare

There are roughly 856,000 Medicare beneficiaries across the state of Oregon. That’s nearly 22% of the entire state’s population! 371,000 beneficiaries are enrolled in Medicare Advantage, 260,000 in Part D plans, and 214,000 are enrolled in Medigap. With all of these options, it’s easy to get overwhelmed, which one is right for you?

• What Does Medicare in Oregon Cover?
• Types of Oregon Medicare Plans
• Oregon Medicare Advantage Plans
• Oregon Medicare Supplement Plans
• Part D Plans in Oregon
• Cost of Medicare in Oregon
• Oregon Medicare Eligibility
• Can I Have Medicaid and Medicare in Oregon?
• Senior Programs in Oregon
• How to Apply for Medicare in Oregon

Your journey to Oregon Medicare starts with Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance). Part A covers services like hospital stays, nursing homes, hospice, and home health services. Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and x-rays. Once you enroll in Original Medicare, you are eligible for other types of plans like Medicare Advantage, Medicare Supplements, and Part D.

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Original Medicare is regulated by the federal government and is the same regardless of which state you live in. After you enroll in Original Medicare, you can start searching for plans specific to Oregon and your zip code. You should consider enrolling in some type of prescription drug coverage to avoid a late-enrollment penalty down the road. Part D and Medicare Advantage plans can provide prescription drug coverage.

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Oregon Medicare Advantage plans cover certain services that Original Medicare does not. Without an MA plan, you would otherwise need to pay for these benefits out-of-pocket. Some of the most popular Medicare Advantage benefits include hearing, dental, and vision coverage. Some plans even offer a monthly over-the-counter drug allowance, non-emergency transportation, and group fitness classes like SIlver & Fit. These plans are offered through private insurance companies and will vary in price based on carrier, benefits, and location. To learn more about Oregon Medicare Advantageplans in your area, click here or call 833-438-3676.

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Would you rather pay a small monthly premium in return for financial benefits that work alongside Original Medicare? Medicare Supplement plans can do just that! They help cover costs like premiums, deductibles, coinsurance, copayments, and other health-related costs. There are ten types of Medicare Supplement plans to choose from and each plan offers a different level of coverage. Depending on the plan you select, benefits can include:

• Part A coinsurance and hospital costs
• Part B coinsurance and copayments
• Blood work copays (up to three pints)
• Hospice coinsurance and copayments
• Skilled nursing facility coinsurance
• Part A deductible
• Part B deductible
• Part B excess charges
• Foreign emergency travel

Medicare Supplements are mostly the same regardless of which carrier you enroll with. However, pricing will still vary. A licensed agent can show you all of the plans that are available in your area, so you know you are enrolling in the plan with the best price. Click here or give us a call at 833-438-3676.

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Part D plans work alongside Original Medicare to provide prescription drug coverage. Your coverage will consist of a deductible, initial coverage phase, coverage gap, and catastrophic coverage phase.

Your coverage will not start until you reach your deductible ($415 in 2019), but some plans may waive, reduce, or lower your premium up-front.  Once the deductible is met, you will enter the initial coverage phase and be responsible for a copay until you reach your spending limit ($3,820 in 2019). After this point, you are considered to be in the “donut hole”, but don’t worry, the donut hole is going away in 2020. When you are in the phase, you will be responsible for 37% of generic drug prices and 25% of brand-name drug prices. This will continue until you reach the catastrophic coverage phase ($5,100 in 2019). After this point, you will only be responsible for 5% of your total drug costs for the rest of the year. To learn more about Part D in your area, click here or call 833-438-3676.

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Original Medicare has the same costs regardless of where you live in the U.S. You will get Part A premium-free as long as you have worked and paid Medicare taxes for 40 quarters. If you worked less than 40 quarters, you will be responsible for the following:

• 30-39 quarters = $240/month
• Less than 30 quarters = $437/month

The standard Part B premium for 2019 is $135.50, but it can vary based on your income. The costs for a Medicare Advantage, Medicare Supplement, or Part D plan will vary based on location, plan, and benefits. To learn more about plans in your area, click here or call 833-438-3676.

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Most people qualify for Medicare by aging-in at age 65. However, if you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you qualify for Medicare regardless of your age. Another way to qualify is through SSDI (Social Security Disability Insurance). If you have been receiving SSDI for 24 months, you’ll be automatically enrolled in Medicare during your 25th of benefits. If you have questions regarding your eligibility, click here or call 833-438-3676.

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Medicaid and Medicare are two different programs and are easily confused. Medicare is designed for older adults over 65 and people with certain disabilities. Medicaid is designed for low-income individuals and families. It is possible to qualify for both programs, in fact, there are more than 120,000 beneficiaries enrolled in both programs throughout Oregon.

People who are enrolled in both Medicare and Medicaid become eligible for a Dual Special Needs Plan (DSNP). These plans provide extra benefits, lowers costs, and a Special Enrollment Period (SEP). SEPs are great because they allow you to make changes to your plan during any time of the year!

If you qualify for a DSNP, you may also qualify for Medicare’s prescription drug program, Extra Help, or other Medicare Savings Programs. Extra Help can help you save up to $4,000/year on prescription drugs, and Medicare Savings Programs help cover other health-related costs like deductibles, coinsurance, and copayments.

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The Oregon Agency on Aging has several programs throughout the state that are available to seniors, caregivers, and people with certain disabilities. These programs include:

Abuse: The Abuse Prevention Program helps educate on signs of abuse for older adults over 65 or individuals with physical or mental disabilities. Abuse can include physical abuse, neglect, and financial exploitation.

Caregiver: The Caregiver Support Program supports caregivers so they can maintain their care and continue to keep older adults in their home as long as possible and helps caregivers with stress management, training, and education.

Aging: The Healthy Aging Program focuses on physical, emotional, and mental health. This program creates communities and groups that focus on socialization and maintaining proper health as you age.

Legal: The Legal Assistance Program helps provide information and representation for legal issues like housing, guardianship, long-term care, abuse, and age discrimination.

Employment: The Senior Community Service Employment Program helps provide employment to those with low-income and over 55 years old. They provide community service opportunities and job training.

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You can apply for Oregon Medicare through Social Security. Visit their website (www.SocialSecurity.gov), give them a call (1-800-772-1213), or visit your local office to enroll. If you are interested in enrolling in a Medicare Advantage, Medicare Supplement, or Part D plan, one of our licensed agents can help. Click here or give us a call at 833-438-3676.

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