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Medicare in Oregon

Learn about cost, coverage and plans, to get started with Medicare in Oregon

Reviewed by: Eboni Onayo, Licensed Insurance Agent. Written by: Andrew Hall.

Key Takeaways

  • Medicare in Oregon is available to legal U.S. residents aged 65 and older.

  • Medicare Part A and Part BOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all 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). cover hospital and medical coverage.

  • Medicare AdvantageMedicare Advantage 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). provides Part A and Part B administered by private insurance. Original Medicare provides Part A and Part B issued by the federal government.

  • Most Medicare Advantage plans include 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.. You can add a Part D plan to Original Medicare to cover prescription drug needs.

 

The Beaver State is home to the deepest lake in the U.S. and more than four million residents. Wildlife and natural beauty are abundant in this great state.

If you’re one of the more than four million Oregonians and nearing 65 or older, staying healthy will ensure you don’t miss any of Oregon’s lowlands, plateaus, mountains, or the Pacific. To get you up to speed with Medicare, we answer your questions about Medicare in OR.

How Does Medicare Work in Oregon?

The most common ways to receive Medicare in Oregon are Original Medicare (Parts A and B) and Medicare Advantage (Part C). What’s the difference between Original Medicare and Medicare Advantage? Here’s a quick comparison:

Original Medicare (Parts A and B)

Part A and Part B cover most of your hospital and medical services. Original Medicare lets you see any doctor in the U.S. that accepts Medicare.

  • Out-of-pocket costs can be high.
  • You need to purchase a separate plan for prescription drugs (Part D).
  • You can add supplemental coverage (Medigap) to help with extra costs., hearing, vision and dental. You can see any doctor that accepts Medicare.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Keep reading for more information on Medicare plans in Oregon, including enrollment periods, costs, and more.

What is the Best Medicare Advantage Plan in Oregon?

If you are searching for the “best” Medicare Advantage Plan in Oregon, you will first need to understand your health needs and which plans to cover them. There’s not a one-size-fits-all plan that’s better than others. To help find the “best” for you, compare the four kinds of Medicare Advantage plans in Oregon and how they work:

  • Health Maintenance Organization (HMO): In an HMO, a primary care physician refers you to specialists within your provider network.
  • Preferred Provider Organization (PPO): PPOs still use primary care physicians but offer some flexibility to see out-of-network doctors and specialists.
  • Private Fee-for-Service (PFFS): FFS plans pay your doctors and other providers separately for each service you receive.
  • Special Needs Plans (SNPs): SNPs cater to patients living with certain health conditions and/ or other specific criteria. [1] D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.

How Much Does Medicare Cost in Oregon?

The cost of Medicare in Oregon is typically set by Medicare in premiums, deductibles, coinsurance and copays. Each of these costs varies with different plans, so the plan you choose to meet your health needs and services will determine Medicare’s cost in Oregon for you. Here’s some helpful cost information to get you started.

Medicare in OR: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 for each hospital benefit period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in OR: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in OR: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

 

What Are the Qualifications for Medicaid in Oregon?

There are several requirements to be eligible for Medicaid in Oregon. Typically, Medicaid benefits are for Oregonians that are legal U.S. citizens, residents, or legal aliens with qualifying low-income. Oregon has resources available for adults, pregnant women, kids, families, and seniors.

How Do You Qualify for Medicare in Oregon?

To be eligible for Medicare in Oregon, you must be a legal U.S. citizen or resident aged 65 and older. You can be eligible for Medicare in Oregon if you’re under 65 and meet one of the following criteria:

  • You’ve received Social Security benefits due to disability for 24 months
  • You’ve drawn Railroad Retirement Board (RRB) benefits for 24 months
  • You’ve been diagnosed and living with Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD)

When should I enroll in Medicare in Oregon?

You should enroll in Medicare during your initial enrollment period (IEP). Your IEP lasts seven months and begins three months before the month of your 65 birthday. Other Medicare enrollment periods provide an opportunity to revise your plan as your needs change.

  • Initial Enrollment Period (IEP)
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

What Are the 4 Types of Medicare?

Your health needs may be covered by Medicare Part A (hospital), Part B (medical), Medicare Advantage (Part C), and Part D prescription drug coverage. If you are an Original Medicare member, you also have the option to Medicare Supplement insurance, known as Medigap.

Original Medicare

Original Medicare in Oregon provides Part A and Part B. This plan covers most of your health needs.

  • Part A: helps cover your hospital stays, which may include inpatient services at nursing homes, skilled nursing facilities, some home health, and hospice care.
  • Part B: Provides coverage for your preventive and medically necessary services

Medicare Advantage

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Medicare Prescription Drug Plan

Medicare Part D is stand-alone drug coverage. You can add Part D to Original Medicare separately. Some Medicare Advantage plans in Oregon include prescription coverage.

Medicare Supplement Insurance (Medigap)

You can purchase a Medigap plan to help you cover cost gaps. Your Medigap plan can help you pay deductibles, premiums, copay and coinsurance.

What is the Best Medicare Plan to Have?

The best Medicare plan for you could be Original Medicare or Medicare Advantage. But you must be sure that the plan you choose covers your health needs. Here are some resources from GoHealth to help you get started with Medicare in Oregon:

  • Pros and Cons: Learn how to choose between Original Medicare and other Medicare insurance plans and decide which option is right for you.
  • Enrollment Checklist: Gather information like doctor names, prescription drugs, and any information needed for your health coverage.
  • Medicare Star Rating System: See how plans stack up against each other.
  • Pro Tips: Check here for pointers and ways to make the decision-making process more straightforward.
  • Call GoHealth: Still have questions about Medicare plans in Oregon? The licensed insurance agents at GoHealth will walk through your options and offer the honest answers you need. Call us at 1-855-792-0088.

What is the Downside to Medicare Advantage Plans?

Fact is, Medicare Advantage in Oregon won’t work for everyone. If you’re deciding between that and Original Medicare, here are the main characteristics people often consider:

  • Original Medicare often has higher out-of-pocket costs, but there are no network restrictions. This means more flexibility to see any doctor that accepts Medicare.
  • Medicare Advantage offers a smaller network of doctors you can see, but costs are often lower. Medicare Advantage plans often include services not provided by Original Medicare, including prescription drugs (Part D).

If you still have questions about Medicare plans in Oregon, the licensed insurance agents at GoHealth can help. As impartial resources, they’ll show you your options and answer your questions. Give GoHealth a call today to see what Medicare plans in Oregon will work for you.

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

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.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

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Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.