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Medicare in Oregon

Learn about Medicare in Oregon: Getting started with basics

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Rachael Zimlich, RN, BSN.

Key Takeaways

  • Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). in Oregon is not free, but most Medicare beneficiaries qualify for premium-free Part A coverage. Part B requires a monthly premium.

  • You may also choose to sign up for a Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan, which offers the same coverages with Parts A and B along with additional services like Part D prescription drug coverageMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and dental care.

  • Oregon residents can also choose from 29 stand-alone prescription drug programs under Medicare Part D if they keep Original Medicare.

  • Medicare has specific enrollment periodsThe enrollment period is the time in which you can sign up for a new health insurance plan. when you can sign up, drop, or change your plan.

 

Oregon may have gotten its start as part of the wild west, but you don’t have to worry about pioneering new frontiers when it comes to healthcare in your later years or times of need.

Residents who are aged 65 and up or qualify for disability benefits have several Medicare plans to choose from based on their health and financial situation. GoHealth agents licensed in Oregon can help you choose a plan that meets your needs.

How Do You Qualify for Medicare in Oregon?

If you are a U.S. resident aged 65 or older, or qualify for Social Security benefits due to a disability, you can enroll in Medicare. Circumstances that allow you to be eligible for Medicare before age 65 include:

  • Securing a disability designation from the Social Security Administration or the Railroad Retirement Board for at least 24 months before enrollment.

Medicare is a federal healthcare program, so eligibility rules are the same in every state. Plans offered in Oregon include Medicare Part A  to cover hospital and inpatient medical care, and Part B  to cover preventive care and outpatient services.

Is Healthcare Free in Oregon?

Some parts of Medicare might not cost you, but it depends on how long you worked and paid into the Medicare system through your taxes. Medicare Part A is usually called the “premium-free” portion, but you will still pay a share for services as you receive them. Other parts of Medicare have premiums that apply, but what you pay will be based in large part on your income level.

How Much Does Medicare Cost in Oregon?

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Medicare Type

Medicare Type

Typical Costs

Medicare Part A

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Medicare Part A

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Most people don’t have to pay the Part A premium because they paid taxes for at least 10 years. However, Part A still has a deductible and coinsurance.

Medicare Part B

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Medicare Part B

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Everyone pays the Part B premium. Part B also has an annual deductible and coinsurance for medical services.

Medicare Part C

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Medicare Part C

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Medicare Part C plans vary in cost based on the insurance carrier and the plan you choose. You must enroll in Part A and Part B before you can enroll in Part C.

Medicare Part D

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Medicare Part D

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Medicare Part D costs vary from plan to plan. Part D can be added to Original Medicare or might be bundled with a Medicare Advantage plan. If you have trouble paying for your medications, you may qualify for Extra Help to cover some or all Part D costs.

Medigap

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Medigap

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Medicare supplement (Medigap) plan costs vary from plan to plan. Three states — Wisconsin, Minnesota and Massachusetts — have a different set of standardized plans. You pay a monthly premium with Medigap.

Medicare Type

Medicare Type

Medicare Part A

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Medicare Part B

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Medicare Part C

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Medicare Part D

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Medigap

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Typical Costs

Typical Costs

Most people don’t have to pay the Part A premium because they paid taxes for at least 10 years. However, Part A still has a deductible and coinsurance.

Everyone pays the Part B premium. Part B also has an annual deductible and coinsurance for medical services.

Medicare Part C plans vary in cost based on the insurance carrier and the plan you choose. You must enroll in Part A and Part B before you can enroll in Part C.

Medicare Part D costs vary from plan to plan. Part D can be added to Original Medicare or might be bundled with a Medicare Advantage plan. If you have trouble paying for your medications, you may qualify for Extra Help to cover some or all Part D costs.

Medicare supplement (Medigap) plan costs vary from plan to plan. Three states — Wisconsin, Minnesota and Massachusetts — have a different set of standardized plans. You pay a monthly premium with Medigap.

Is Oregon Health Plan covered by Medicare?

Oregon Health Plan is the state’s Medicaid plan for low-income individuals or people with special healthcare needs. Medicaid is another public health insurance program that is state-specific. People in low-income groups or with special healthcare needs may qualify for coverage under both Medicare and Medicaid. People who fall into this category are called dual eligible.

Is There Medicare in Oregon?

U.S. citizens in every state have access to Medicare because it is a federal public health insurance program. There are requirements to be eligible, including age or disability level, but if you meet this criteria, you can use Medicare in any state—including Oregon. Medicare Advantage plans, which are private insurance plans that combine basic Medicare services with additional programs, vary by state.

What is Medicare in Oregon?

Medicare in Oregon offers coverage for medically necessary inpatient and outpatient health care services. Like every state, everyone is entitled to receive Original Medicare, or Medicare parts A and B, when they turn 65, or if they meet other health-specific criteria. Additional programs, like prescription drug plans, are also part of the Medicare portfolio, but availability and pricing of these plans may vary by state, or even zip code.

Is Medicare Advantage Part A or B?

A Medicare Advantage plan is a private insurance product sometimes referred to as Medicare Part C. This can be misleading, because Medicare doesn’t directly offer these plans. Private insurance companies offer Medicare Advantage plans. Part C combines Medicare Part A and Part B services along with other add-ons like prescription drug coverage, dental care, and hearing aid services. Part C allows you to sign up for all your services under one plan, instead of signing up for each plan on your own. There are many options for Medicare Advantage plans, and it depends on where you live. A GoHealth licensed insurance agent can help you find the right plan for you in your area.

What is the Best Medicare Plan in Oregon?

There is no “best” Medicare plan. There are many options available, whether you choose Original Medicare or a Medicare Advantage plan. A GoHealth licensed insurance agent can discuss your needs and help you find the right coverage for your situation. Be sure to consider your health in future years, and not just what your immediate healthcare needs might be.

What Are the Different Plans of Medicare?

There are a variety of Medicare plans available in Oregon. These include:

  • Medicare Part A, which covers inpatient care and hospitalization.
  • Medicare Part B, which covers outpatient care and medical equipment.
  • Medicare Part C, or Medicare Advantage plans, that combine Parts A and B with additional coverage like Part D, hearing, vision, and dental.
  • Medicare Part D, which is Medicare’s prescription drug program. This plan may be included in a Medicare Advantage plan, or added to Original Medicare.
  • Medigap, or Medicare Supplement insurance, which you can add on to Original Medicare only and can be used to help cover your out-of-pocket costs.

What is the Best Medicare Advantage Plan in Oregon?

This depends on what your needs are. There are many Medicare Advantage plans available based on your income, needs, and where you live. Talk to a GoHealth agent to review what plans are available in your zip code that best fits your needs.

What Medicare Advantage Plans are Available in Oregon?

There are more than 300 Medicare Advantage plans offered in Oregon by 15 different insurance companies. While you won’t be eligible for every plan, there should be at least several options available in the area you live. A GoHealth agent can help you find and compare your options.

What is the downside to Medicare Advantage plans?

Medicare Advantage plans let you pay one price for all your Medicare services in one plan, but there are some drawbacks to that convenience. Medicare Advantage plans may dictate where you receive coverage in terms of specific hospitals or provider networks. You can choose plans that charge higher premiums with lower deductibles and vice versa. You can change your Medicare Advantage plan if your needs change, but there are only specific periods each year when you can sign up, drop, or change your Medicare Advantage plan.

Medicare in Oregon by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 792,425 people are enrolled in Medicare in Oregon. The total number of beneficiaries enrolled in Medicare Advantage in Oregon is 395,530. The previous year, 377,757 enrolled in Medicare Advantage. Medicare Advantage participation in Oregon went from 49.19% to 49.91% year over year. If you’d like to dive deeper into how Medicare in Oregon breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Oregone>
792,425
Beneficiaries with Part A & Part B
395,530
Medicare Advantage Beneficiaries
49.91%
Medicare Advantage Participation Rate
52.30%
% Female
47.70%
% Male
0.89
Average HCC Score
$8,717.71
Actual Per Capita Costs
20.07%
% Eligible for Medicaid
29.25%
% of Beneficiaries with an Emergency Department Visit
15.06%
Hospital Readmission Rate
90.12%
% Non-Hispanic White
1.04%
% African American
3.59%
% Hispanic
5.24%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Oregon Medicare Resources & Contacts

Beneficiaries spend an average of $8,717.71 each year on Medicare in Oregon. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Oregon-based resources, like these, may be able to help:

Oregon Division of Insurance

1-888-877-4894

https://dfr.oregon.gov/pages/index.aspx

What should I know about the Oregon Department of Insurance?

If you have questions about your health insurance, contact the Department of Insurance.

 

Oregon Department of Human Services

1-800-699-9075

https://www.oregon.gov/oha/hsd/ohp/pages/apply.aspx

What should I know about ODHS?

If you have questions about health coverage and eligibility for coverage, contact Oregon’s Department of Human Services.

Senior Health Insurance Benefits Assistance Program

1-800-722-4134

https://healthcare.oregon.gov/shiba/medicare-65/pages/index.aspx

What Should I know about SHIBA?

If you are on Medicare or have a disability or end stage renal disease, contact SHIBA.

Oregon Department of Veterans’ Affairs

1-800-692-9666

1-503-373-2085

https://www.oregon.gov/ODVA/Connect/Pages/Connect.aspx

What should I know about ODVA?

If you are a veteran and have a question or concern about veterans’ health care benefits, contact ODVA.

Nationwide Resources

Speak with an insurance agent that is licensed in Oregon about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in OR, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

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