Medicare in Oregon
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 coverage as Parts A and B along with additional services like Part D prescription drug coverageMedicare 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 standalone Medicare Part D prescription drug plans 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.
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.
- You have end stage renal disease (ESRD) and require kidney dialysis or have received a kidney transplant.
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Is Medicare 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 premium-free, but you will still pay a share for services as you receive them. Other parts of Medicare have premiums, but what you pay will be based in part on your income level.
How Much Does Medicare Cost in Oregon?
Medicare Type
Medicare Part A
- 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
- Everyone pays the Part B premium. Part B also has an annual deductible and coinsurance for medical services.
Medicare Part C
- 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
- 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
- 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.
What Medicare coverage is right for my specific situation?
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 benefits, vary depending on where you live.
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 depends on your state and ZIP code.
Can I bundle multiple benefits into one plan?
What Does Medicare Advantage Cover?
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 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 depending 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 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 Parts of Medicare?
The parts of Medicare include:
- Medicare Part A covers inpatient care and hospitalization.
- Medicare Part B covers outpatient care and medical equipment.
- Medicare Part C, or Medicare Advantage plans, combine Parts A and B with additional coverage like Part D, hearing, vision, and dental.
- Medicare Part D is prescription drug coverage that 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, can help cover your out-of-pocket costs.
What Medicare Advantage Plans are Available in Oregon?
There is a variety of Medicare Advantage plans offered in Oregon by 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 through 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.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 838,497 people are enrolled in Medicare Part A and B in Oregon. The total number of beneficiaries enrolled in Medicare Advantage increased from 409,855 to 434,102 year over year. Medicare Advantage participation in Oregon went from 50.24% to 51.77% 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.
838,497 Beneficiaries with Part A & Part B
434,102 Medicare Advantage Beneficiaries
51.77% Medicare Advantage Participation Rate
52.45% Female
47.55% Male
89.62% Non-Hispanic White
1.00% African American
3.81% Hispanic
5.57% Other/Unknown
19.76% Eligible for Medicaid
0.89 Average HCC Score
$8,488.39 Actual Per Capita Costs
14.76% Hospital Readmission Rate
25.06% % of Beneficiaries with an Emergency Department Visit
409,855 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
50.24% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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 Division of Insurance
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
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
https://shiba.oregon.gov/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
1-503-373-2085
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 a GoHealth insurance agent that is licensed in Oregon about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration 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
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status