October 6, 2016
Medicare Part D in Oregon is government-sponsored private insurance designed to help Medicare beneficiaries cover prescription drug costs. Each Medicare Part D Prescription Drug Plan in Oregon has different costs, depending on your place of residence and zip code, but in general, most plans require you to pay a monthly premium, annual deductible, and copayment or coinsurance.
As a Medicare beneficiary in Oregon, you may be receiving health coverage through Original Medicare, Part A and Part B, or a Medicare Advantage (Medicare Part C) plan without drug coverage. If so, it may be a good idea for you to add prescription drug coverage to your benefits by enrolling in a stand-alone Medicare Part D Prescription Drug Plan. Medicare Part D Prescription Drug Plans are provided by private insurance companies contracted with the Centers for Medicare & Medicaid Services (CMS) to offer prescription drug coverage to Medicare beneficiaries. To sign up for a Medicare Part D Prescription Drug Plan in Oregon, as in the rest of the U.S., you must have Medicare, Part A and/or Part B. You also must live in the Oregon service area of the Medicare Part D Prescription Drug Plan you select.
Medicare Part D Prescription Drug Plans share some common characteristics. Each Medicare Part D Prescription Drug Plan in Oregon has its own formulary, which is a list of covered prescription drugs. The formulary may change at any time. If enrolled, you will receive notice from your plan when necessary. Typically a Medicare Part D Prescription Drug Plan groups the medications in its formulary into coverage categories called “tiers.” Each tier has a designated out-of-pocket cost (e.g., copayment or coinsurance amount) for the medications within the tier. The top tier includes the most expensive drugs, while the bottom tier lists the less expensive medications. If your physician determines that a drug in a higher tier is medically necessary for your treatment instead of a similar drug in a lower tier, you or your physician can ask your plan for a tiering exception, allowing you to benefit from a lower copayment for a higher tier prescription drug.
In most cases, Medicare Part D Prescription Drug Plans in Oregon allow you to choose between brand-name drugs and generic drugs. The Food and Drug Administration (FDA) defines generic drugs as having the same active ingredients as brand-name drugs, at the same strength, dosage, and method of administration. The FDA requires generics to be tested as having the same results as brand-name drugs. However, generic drugs often cost less than their brand-name counterparts, meaning that you could end up paying less for your prescription drugs by selecting the generic option. Note that if your generic drug is unavailable, your Medicare Part D Prescription Drug Plan may allow you to replace it with a similar generic drug used to treat the same condition instead of paying more for the brand-name drug. Make sure to discuss all prescription drug options with your physician.
If you sign up for a Medicare Part D Prescription Drug Plan in Oregon, you must remain enrolled in Medicare, and pay any Part A premium (if you’re not entitled to premium-free Medicare Part A coverage) and/or Part B premium in order to keep your Medicare coverage. You may also have to pay a premium to your Medicare Part D Prescription Drug Plan.
You may sign up for a Medicare Part D Prescription Drug Plan in Oregon during your Medicare Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. In addition, if you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D Prescription Drug Plan in Oregon during the time period from three months before until three months after your 25th month of disability.
Another time you may sign up for Medicare Part D in Oregon is during the Annual Election Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 each year. If you are already enrolled in a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan, you can change Medicare Part D Prescription Drug Plans during this time.
If you enrolled in a Medicare Advantage plan without prescription drug coverage mistakenly, you may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage with Prescription Drug plan (MAPD) during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year. If you disenroll from Medicare Advantage during this period and return to Original Medicare, Part A and Part B, you can add a stand-alone Medicare Part D Prescription Drug Plan through February 14 as well.
Generally, it’s advisable to enroll in a Medicare plan that provides prescription drug coverage when you are first eligible for Medicare. Otherwise, you may have to pay a late-enrollment penalty if you enroll later and you were without creditable drug coverage (prescription drug coverage at least as extensive as Medicare Part D) for 63 days or more after your Initial Enrollment Period ends. The penalty is calculated using 1% of the national base beneficiary premium and the number of full months you were eligible for Medicare Part D but didn’t enroll. This amount is then added to your Medicare Part D monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
You are likely to have choices in your selection of a Medicare plan that provides prescription drug coverage in Oregon. Depending upon where you live and what other choices you’ve made about your Medicare coverage, one of these two types is likely to be a good fit. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may select to work in conjunction with Original Medicare, Part A and/or Part B, to help cover costs for prescription drugs. A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into a single plan, offering at least the same coverage as Original Medicare (with the exception of hospice care, which remains covered under Part A), and sometimes additional benefits for a single premium.
Medicare plans offering prescription coverage in Oregon have different costs. Premiums, deductibles, copayments, and coinsurance are likely to vary. Also formularies, the lists of covered prescription drugs, may vary. So it’s important to check to see if your medications are on the plan’s formulary and, if so, on which tier.
If you are currently enrolled in a Medicare plan that provides prescription drug coverage, it’s a good idea to review your coverage each year to be aware of any changes in benefits. Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans in Oregon are allowed to change their premiums, copayments, deductibles, and formularies each year. You will receive notice of these changes in the Annual Notice of Changes and Evidence of Coverage the plan mails you in the fall before the new benefits are effective the following January 1st. You may want to compare plans every year during the Annual Election Period to make sure you are choosing the coverage that best meets your needs. To assist you in this research, you may enter your zip code in the eHealth Plan Finder located on this page.
Access the following pages for more information about Medicare in Oregon: