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Medicare in Oregon

October 6, 2016

As you get closer to age 65, you may start thinking about your future health insurance needs. Like many other Americans, you may realize that health insurance may be a primary concern and a major expense. This is the reason Medicare, the government-sponsored health insurance program, is often perceived as a significant benefit to older Americans. In Oregon, as in other states, qualifying U.S. citizens may be eligible to receive health coverage from Medicare when they turn 65 and those who qualify due to disability.

Original Medicare for Oregon beneficiaries

Original Medicare encompasses Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

To be eligible for Original Medicare, you must be 65 or older and a U.S. citizen or legal permanent resident of five continuous years or more. People who are younger than 65 may be eligible for Medicare if they have certain health conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or if they’ve collected disability benefits for 24 continuous months or more from the Social Security Administration (SSA) or the Railroad Retirement Board.

Most people enroll in Original Medicare during  the  Initial Enrollment Period.  This seven-month period  begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month.  You’re also allowed to enroll in Medicare during the annual General Enrollment Period, which runs from January 1 to March 31, but if you miss your seven-month Initial Enrollment Period, you will probably have to pay a late-enrollment penalty in the form of higher monthly premiums.

Premium-free Medicare Part A is available to many Oregon Medicare beneficiaries because they (or their spouses) have worked at least 10 years, contributing tax payments to Medicare and accruing Social Security benefits.  If you don’t have Social Security benefits, though, you may still be able to enroll in Medicare and pay a monthly premium.

Medicare Part A coverage includes the following services:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (non-custodial)
  • Hospice care
  • Home health services

Original Medicare includes medical insurance, under Medicare Part B. Most Oregon Medicare beneficiaries pay a Medicare Part B monthly premium. Under Medicare Part B, Medicare beneficiaries have coverage for many of the following kinds of services and supplies:

  • Physician services, including preventive care screenings
  • Radiology (X-ray) and Laboratory services
  • Outpatient services
  • Medicare-approved clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, or partial hospitalization)
  • Limited outpatient prescription drugs, such as chemotherapy medications administered by a doctor.

Medicare plan options in Oregon

You may choose to receive your Medicare benefits in Oregon from a Medicare Advantage plan, which is provided by private insurance companies approved by Medicare. A Medicare Advantage plan in Oregon, as in the rest of the United States, is required by the government to offer at least the same medical and hospitalization coverage as Original Medicare, Part A and Part B (except hospice care, which continues to be covered under Part A). Some Medicare Advantage plans also offer extra coverage not available under Original Medicare, like routine hearing, routine vision, or routine dental benefits. A common type of Medicare Part C plan is a Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage into a single private plan.

You must have Medicare Part A and Part B to sign up for a Medicare Advantage or Medicare Advantage Prescription Drug plan. Be aware that if you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you continue paying the Medicare Part B premium.

Medicare beneficiaries who want to stay enrolled in Original Medicare, a stand-alone Medicare Part D Prescription Drug Plan can work alongside your Original Medicare (Part A and Part B) benefits. Stand-alone Medicare Part D Prescription Drug Plans are offered by Medicare-approved insurance companies, and they are designed to help Medicare beneficiaries cover costs for prescription drugs. Costs for Medicare Part D Prescription Drug Plans in Oregon vary, but they generally require payment of a monthly premium, annual deductible, and copayment or coinsurance.

If you decide to stay with Original Medicare (instead of signing up for Medicare Advantage), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Medicare beneficiaries in Oregon have access to various Medicare Advantage plans, depending on the county in which they live. Therefore, you will probably want to  customize your search for plans based on your own health and prescription needs as well as your county of residence.

For more information about private Medicare insurance for Oregon beneficiaries, please see:

Oregon resources for Medicare beneficiaries

There are a number of resources designed to help Oregon Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

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