Oregon Medicare Supplement Plans (Medigap)
Medicare beneficiaries in Oregon are eligible for a Medicare Supplement Plan which provides added coverage for the out of pocket (OOP) expenses associated with Traditional Medicare.
Private insurance companies offer these Medigap Plans and help to fill the, “gap”, of what’s not covered by straight Medicare. This includes the coverage of deductibles, copayments and coinsurance.
Traditional Medicare and the corresponding Medigap Plans will be broken down here for for you. So you can better understand how the different insurance policies work in Oregon.
Oregon Medicare Plans Explained
- Hospital Coverage – Part A: This includes hospitalizations and any inpatient procedures, labs, diagnostic testing/imaging and in patient IV and oral medications.
- Outpatient Coverage – Part B: is your outpatient coverage including doctor visits, outpatient procedures, labs, diagnostic testing and durable medical equipment (DME).
- Medicare Part C aka Medicare Advantage, is private health insurance replacing the benefits covered by Traditional Medicare Parts A and B.
- Medicare Part D is your prescription drug coverage.
In addition to the 4 Medicare parts there is the Medigap insurance. Represented by 10 different letter plans, the insurance benefits with each policy help to provide additional coverage outside of straight Medicare. It also helps to save on OOP costs.
What Benefits Does Medicare Include in Oregon
Your Medicare coverage, whether inpatient or outpatient, is only covered at 80%. This leaves you, the Medicare beneficiary, responsible for the remaining 20% not covered.
This is where a Medigap Plan comes in handy as it covers the, “gap”, not covered by straight Medicare. There are various supplement plans. Depending on your individual health care needs, they can help with the OOP expenses not covered by original Medicare.
Our insurance agents can help find the perfect combination of insurance coverage for you.
How to Qualify for Oregon Medicare Supplement Plans
Medigap Plans have a couple of requirements:
- You must be at least 65 years of age
- Currently enrolled in Medicare Part B
There is an Open Enrollment Period (OEP) to obtain a Medigap Plan that starts the three months prior to your 65th birthday and continues for a total of 7 months.
Failing to enroll during your OEP will result in a Part B penalty. This will increase your premium by 10% for each full 12-month period you went without coverage.
As of 2018 the monthly premium is $134.00 a month. This can quickly add up so you want to enroll as soon as you become eligible for federal Medicare coverage.
Oregon Medicare Benefits for the Disabled under 65
If you currently receive Social Security Disability benefits, have End Stage Renal Disease (ESRD) or certain Railroad Retirement Benefits, after 24 months you’re automatically enrolled in Medicare Parts A and B.
Federal law does not require insurance carriers to offer Medigap Plans. Oregon residents however, have access to the Medicare Supplement Plans as the state law requires coverage.
Call today and one of our licensed insurance agents can help provide more information on plans available to disabled Oregonians.
How to Sign Up for Medicare Supplements in Oregon
There is an Open Enrollment Period (OEP) in which it is the best time to enroll for supplemental insurance coverage. This period begins the 1st day of the month after turning 65 and requires you to already be enrolled in Medicare Part B.
For example, if your birthday was July 29th and your Medicare Part B effective date was September 5th, then your OEP begins October 1st. You have then have a total of 7 months to enroll in a Medigap Plan.
During your OEP you are given something called a Guaranteed Issue (GI) right. The luxury of the GI is that regardless of any pre-existing medical conditions, the insurance carriers cannot deny you coverage.
Furthermore, they aren’t allowed to increase your premium rates based on any previous or current health issues. To avoid coverage denial and forgo the underwriting process you MUST enroll during your GI.
Oregon is also unique in the fact they have a, “birthday rule.” This rule allows you to change your Medigap policy within 30 days of your birthday. The policy change is guaranteed but they require a plan with either the same or lesser benefits.
Medigap Premiums in Oregon
Each state uses their own individual insurance companies to provide insurance coverage. Your monthly premiums are determined by several different factors. This includes age, sex and location.
For example, an 81 year old gentleman residing in Beaverton will have a different premium rate than a 67 year old lady in Portland.
Other determining factors are which pricing method they use. They have the choice of 1 of 3 different options which are: community rated pricing, issue-age rated pricing, or attained-age-rated pricing. To learn more about these methods click here for more info.
The Top Medicare Supplement Plans in Oregon
There are 10 Medicare Supplement Plans represented by letters. The supplement plans are sold by the various insurance carriers. No matter what state you live in, the letter plan benefits stay the same, the only difference is carrier cost. The top 3 letter plans are Plans F, G and N.
The most popular of the letter plans, Plan F, includes deductible coverage for Medicare Part A & Medicare Part B. It also includes coverage on coinsurance, copays, skilled nursing care and coverage for any Medicare Part B Excess charges. Which physicians in Oregon are allowed to charge.
Additionally, it has the added benefit of emergency foreign travel coverage. Plan F also a high deductible version that offers the same benefits with just a higher deductible and lower premium cost.
Plan G is the second most popular plan as it has the same great benefits as Plan F just minus the $183.00 Medicare Part B deductible.
And lastly, Plan N, which also is similar to Plan F, just without Medicare Part B deductible or excess fee coverage. With Plan N there is a small copay for physician office and ER visits but the premium is cheaper than the others.
Oregon Medicare Advantage Plans
Also offered by private insurance carriers, there are Medicare Advantage Plans. These plans come in HMO and PPO form. They’re oftentimes referred to as a Medicare Replacement Plan. They take over for Medicare Part A and Medicare Part B as your primary coverage.
Some plans even include additional benefits like vision, dental and prescription drug coverage. While obviously this can be appealing, the Advantage Plans also come with certain coverage limitations which you can research more about here.
Additionally, unlike straight Medicare, with Medicare Advantage Plans you cannot enroll in a Medigap Plan. And while typically cheaper than Medigap Plans your OOP costs will run higher overtime. Seniors in Oregon generally opt for Medigap instead as they end up providing greater savings in the long run.
Oregon Prescription Drug Plans for Medicare
As previously mentioned, Medicare Part D coverage provides prescription medication benefits. Being that there is no prescription drug coverage with either Original Medicare or the Medigap Plans, a Medicare Part D Plan (PDP) makes it affordable to obtain otherwise costly medications.
Like Medicare Part B, there is a penalty for failing to obtain a PDP during the initial enrollment period (IEP). Your IEP lasts a total of 7 months. After that, the penalty is added to your premium and based on however long you went without PDP coverage.
For most seniors, the best comprehensive coverage comes from carrying both Medicare Parts A and B, a Medigap Plan and a Part D Prescription Plan.
How Do I Apply for a Medicare Supplemental Plan in Oregon
For help applying for Oregon Medicare Supplement Plans, you can fill out the online forms here or call us on our 800 number above.
As always, our services are 100% free. Our licensed insurance agents are available to help and answer any questions you may have. They make obtaining a Medicare Supplement Plan easy!
Oregon Medicare Resources
There are Medicare savings programs available for both Traditional Medicare and the Medicare Supplement Plans. As most seniors and disabled individuals are on a fixed income, the free counseling as well as financial aid they provide is of great benefit.
Each state has assistance which can be found on the the State Health Insurance Assistance Programs (SHIP) website. In Oregon you can visit oregonshiba.
Oregon Medicare Facts
In 2015, 19% of the total population in the state of Oregon were receiving Medicare benefits, that’s over 750,000 beneficiaries in total. 2013, 15% of beneficiaries were disabled, the other 85% attained the age of 65. In that same year, the total amount of beneficiaries diagnosed with ESRD totaled over 4,000.
- Does Medicare cover inpatient drug rehab in Oregon? Medicare Part A will cover a portion of your inpatient drug rehabilitation. Medicare Part B will cover a portion of your outpatient drug rehabilitation. Both may come with coverage limitations which can affect what certain services can be provided. A Medigap Plan can help offset some of these services and their treatment costs.
- How to get a new Medicare card in Oregon? To replace a lost, stolen or destroyed Medicare replacement card you will need to contact Social Security.
- Which Medicare plan is the same as the Oregon Health Plan? The Oregon Health Plan (OHP) is the state of Oregon’s Medicaid program careoregon.org.
- Does the Portland Clinic take Medicare? Yes however, only if you are an existing patient may you continue treatment through their clinic. They are not accepting new Medicare patients. For more information, click here.