Medicare in Oregon

Medicare is a federal health insurance program that’s open to those aged 65 and over, along with younger individuals who have qualifying conditions. This program provides comprehensive coverage through two parts, including Part A hospital coverage and Part B medical coverage. Neither part includes prescription drug coverage, but beneficiaries can add this by enrolling in a Part D plan.

Part A pays for hospital stays, as well as nursing home care, home health care and hospice. In most cases, beneficiaries don’t pay for this coverage, as long as either they or their spouse paid Medicare taxes for at least a decade. If they don’t qualify for free coverage, they may have to pay a monthly premium of $278 or $506. Part B pays for medical expenses outside of an inpatient hospital setting, including preventative care, certain medical equipment and routine services, such as vaccinations. The typical monthly premium for this coverage is $164.90, although some people with higher incomes pay more.

In 2023, approximately 924,975 people in Oregon qualified for Medicare coverage. This is an increase of 1.94% of people who were eligible for coverage in 2022, and it accounts for about 21.4% of the state’s population of 4.24 million people. Nationally, the number of people eligible for Medicare coverage grew by 2.66% between 2022 and 2023.

The Medicare program also includes Medicare Advantage Plans. These plans are serviced by private health insurance companies that comply with Medicare’s rules and contain all the benefits of Original Medicare’s Parts A and B coverage. However, because many of these plans include prescription drug, vision and dental benefits, they’re a popular option among many Oregon residents. In 2023, about 53% of eligible Medicare beneficiaries have a Medicare Advantage Plan, with 494,747 people statewide carrying this coverage. This is an increase of 6.11% over the number of Medicare Advantage enrollees reported in 2022. By comparison, the number of people enrolled in Medicare Advantage nationwide increased by 9.75% between 2022 and 2023.

This Oregon Medicare guide educates seniors on coverage options, Medicare Advantage, top plans, prescription drug coverage, Medigap, and essential resources for making informed health insurance choices.

Options for Medicare Coverage in Oregon

Original Medicare provides standard coverage, which is suitable for many older adults. However, there are occasions where individuals require additional coverage. Oregon’s seniors have several health insurance options, helping them select the best policy for their health care needs. As well as the regular Medicare program, private insurance firms offer extra options or alternate plans.

Original Medicare (Parts A & B)

In Oregon, as well as in the rest of the nation, Original Medicare is administered by the Centers for Medicare & Medicaid Services, and it’s open to those aged 65 and over. This program is a fee-for-service program, meaning that individuals pay for services as they receive them.

Beneficiaries must pay an annual deductible before their coverage kicks in. In 2023, the deductible for Part A is $1,600 each time the individual is admitted to the hospital. The Part B annual deductible is $226. For both parts, Medicare pays 80% of the medical bills, and beneficiaries are responsible for the rest.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage, or Medicare Part C, is an alternative way to receive Original Medicare’s Parts A and B benefits. There are four common plan types, including health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service plans (PFFs) and special needs plans (SNPs). While each plan is legally required to provide all the benefits in Original Medicare, many plans have additional benefits, such as $0 deductibles, annual out-of-pocket limits and prescription drug, vision and dental insurance. In Oregon, over half of those who qualify for Medicare have opted for a Medicare Advantage Plan.

Who Should Consider Medicare Advantage

Part C plans might be well-suited for older adults who:

• Need extra health care coverage beyond the benefits provided by Original Medicare
• Are comfortable receiving managed care
• Are typically in good health and want lower premiums
• Would appreciate greater control over their annual health care costs

The Top 10 Medicare Advantage Plans in Oregon 

Oregon seniors can choose between many highly rated Part C plans. The below table lists the top providers based on the number of people enrolled in each plan. It also shows available plan types and typical monthly costs. More details about Part C plans are provided on the Medicare Advantage Plans in Oregon page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Oregon

Understanding the numerous Medicare and private health insurance options can be challenging, and enrollment processes can feel overwhelming. Luckily, Mississippi’s aging individuals can access assistance from several programs and agencies. Resources aim to help individuals understand their options and find the best coverage for their needs. Advisors assist seniors compare plans, understand benefits and costs, enroll for coverage, identify fraud and appeal adverse decisions.