Medicare in Oregon: Who Qualifies, Costs, and More

Numerous people across the country use Medicare to pay for medical costs. If you live in Oregon, you can have access to a variety of policies once you become eligible. With Medicare, you can get coverage for things like medication and doctor’s visits. Even if you live on a fixed income, there are ways to help you save on healthcare costs.

Enrolling in Medicare can be an easy process, but you may still have questions. You may not be sure how to apply or how much Medicare costs. Below are answers to some of the most common questions about Medicare in Oregon.

Does Oregon Have Medicare? 

Medicare is available to everyone in Oregon who is older than 65, or individuals under 65 with a qualifying disability. The state has an estimated 2.7 million people with a Prescription Drug plan and approximately 4.4 million people with a Medicare Advantage plan.

Original Medicare includes Part A and Part B. Part A includes the care you would receive at a hospital, nursing facility, or home health care. Part B covers the expenses of outpatient services. This includes doctor visits, preventative services, and medical equipment.

The next section of Medicare is Part C or Medicare Advantage. Part C is a full replacement for Original Medicare and provides additional benefits. You would get similar coverage as Parts A and B as well as additional services like dental coverage. 
Medicare Part D provides coverage for prescription drugs, and you can buy it as part of Original Medicare or an Advantage plan. Medication can be expensive, but Part D can help to offset some of these costs.

Medigap is supplemental insurance to cover the remaining expenses that Original Medicare does not cover. Examples include copayments, deductibles, and medical assistance outside the United States. Most states label Medigap plans with letters, such as Plan G or Plan K, and you might see a Plan N where you live. You can apply through a private insurance company. Oregon allows beneficiaries to sign up for Medigap and offers about 12 plans.

How Much Does Medicare Cost in Oregon? 

The amount you pay in total for Medicare depends on which plan you choose. With Part A, most people do not have to pay monthly premiums. To qualify for premium-free Part A, you need to have paid Medicare taxes for a certain number of years. You also had to have worked, but you can qualify if a spouse paid taxes instead. If you buy Part A, the monthly premium is $471 in 2022. There is no free premium option for Part B. The standard cost is $148.50 every month, but the expense is subject to change every year. The premium may increase for those with higher incomes. Part B also has a deductible of $203.

Medicare Advantage costs differ based on the insurance provider. Some people do not have to pay any monthly premiums, but other plans can charge you. Some policies have limits on out-of-pocket expenses each year. The copayments can vary as well. It’s important to compare Medicare Advantage plans and talk to individual providers to understand any costs you may incur.

Expenses for Part D are different in each state. Residents in Oregon need to pay an average of $42.74 for monthly premiums. The average deductible is $342.93. You should review each plan to ensure your insurance remains within your budget.

How Do You Qualify for Medicare in Oregon?

Here are the requirements to qualify for Medicare:

• You must be a U.S. citizen. If you are not a citizen, then you need to be a permanent legal resident.
• You must be 65 or older or have a qualifying disability.
•  You receive or are able to get benefits from Social Security or the Railroad Retirement Board. You need to have entitlement to them for a minimum of 24 months. 
• Additionally, specific medical conditions, like ALS (Lou Gehrig’s disease) can qualify you for federal insurance.

If you want to sign up for Medicare Advantage, you need to be a citizen or lawful resident. Since policies vary for each location, it is necessary to reside in the service area of the plan you wish to join.

How Do I Apply for Medicare in Oregon?

If you meet the requirements, you can receive Medicare automatically. Applying for disability or retirement benefits from Social Security also serves as an application for health insurance. You can get premium-free Part A once you are approved. If you have been receiving Social Security benefits for four months, you will be signed up for Medicare as well. Otherwise, you would have to wait for the enrollment period to start. Most people can join during the initial enrollment period. It starts three months before your 65th birthday and ends three months after. You can sign up later during the general enrollment period, but you might need to pay a late penalty fee.

You have a few different plans to choose from when you decide to enroll in Medicare. The quickest method is to view the online application on the Social Security Administration's (SSA) website. The process usually takes about 10 minutes to complete, but you need to make an account to sign up. Alternatively, you can reach out to Social Security by phone. Another option is to find your local Social Security office. You can visit in person to enroll in Medicare. To get Part B, there is a form you can mail or fax to your local office. If you have Medicare and want to switch to an Advantage plan, you can do so on the insurance provider's website.

Can You Have Medicare and Medicaid in Oregon?

Like Medicare, Medicaid is a federally funded healthcare insurance program. Coverage is available to low-income adults, pregnant women, children, those with disabilities, and older adults. Medicaid helps pay for healthcare bills if someone cannot afford other medical insurance options. Oregon's Medicaid program is called the Oregon Health Plan. When a beneficiary is able to get Medicare, they might wonder if they can have both types of coverage plans. When some people become eligible for Medicare, they could lose their Medicaid benefits. However, it is possible for you to qualify for both types of coverage.

In Oregon, the Medicaid program usually pays for the services that Medicare does not, such as vision and mental health. It covers some of the copayments and deductibles as well. Many people receive their Medicaid benefits through a Medicare Savings Program. There are a few different types, and they have income limits that you cannot exceed. Once you qualify for Medicare in Oregon, an eligibility specialist needs to re-determine if your income still makes you qualified for Medicaid.

Contact Us to Learn More About Medicare in Oregon

Medicare plans in Oregon have been helping residents pay for the care and treatment they need for years. When it comes time to enroll, you should look through the different plans available to you. It is important to determine which policy will work best for you.

You can find and compare Medicare plans online or contact us for assistance. Contact a licensed insurance agent to learn more.