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If you are turning 65 years old, you may be wondering how Medicare works, what it covers, and how much it will cost you. Medicare beneficiaries living in Oregon (as elsewhere in the United States) generally can receive their Medicare benefits two ways:
Original Medicare, Part A (hospital insurance) and Part B (medical insurance), is available to United States citizens, and permanent U.S. residents for at least five continuous years, aged 65 or older. People younger than age 65 may be eligible for Medicare in Oregon (as in all states) if they have certain qualifying disabilities or medical conditions.
When you first become eligible for Medicare, you receive your notice regarding Original Medicare, the federal health benefits program.
In most cases, you’re automatically enrolled in Original Medicare, Part A and Part B, if you’re already receiving Social Security Administration (SSA) or Railroad Retirement Board (RRB) when you become eligible for Medicare. If you don’t qualify for automatic enrollment, you need to sign up manually with the SSA or RRB.
You generally don’t have to pay a monthly premium for Medicare Part A if you (or your spouse) worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes while working. Typically you pay a monthly premium for Medicare Part B.
Medicare Supplement insurance plans are also available in Oregon. If you decide to stay in Original Medicare (Part A and Part B), you may also chose to sign up for a Medicare Supplement (Medigap) insurance plan to help pay for Original Medicare’s out-of-pocket costs. Different plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. You will pay a monthly premium for a Medicare Supplement insurance plan, and the premium can vary among insurance companies offering the same basic benefits, so it may be wise to shop Medicare Supplement plans in Oregon to find the basic benefits you desire.
Original Medicare, Part A and Part B, provides only limited prescription drug coverage. Part A may cover medications you receive as treatment for the condition for which you are hospitalized; Part B may cover for infusions and medications administered by your doctor, generally in an outpatient setting. Medicare Supplement plans sold today in Oregon (and all states) don’t cover prescription drugs.
If you need coverage for prescription drugs you typically take at home, you can sign up for prescription drug coverage under Medicare Part D. It’s available from either a Medicare Advantage plan that provides drug coverage (called a Medicare Advantage Prescription Drug plan) or from a stand-alone Medicare Part D Prescription Drug Plan. In most cases, as a resident in Oregon, you may enroll in a Medicare Advantage Prescription Drug plan if you have Part A and Part B. The same is true in every state. You may typically enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Part A or Part B or both.
Every Medicare plan offering prescription drug coverage includes a formulary, or a list of drugs covered by that plan. Covered prescription drugs in the formularies may vary among plans and they may change. The plan will notify you of changes in its formulary, as necessary. The Centers for Medicare and Medicaid Services (CMS) reported that 22 Medicare Part D Prescription Drug Plans are available in Oregon in 2018. Because of the differences in cost and coverage among Medicare plans offering prescription drug coverage, you may want to compare plans where you live.
You may decide to enroll in a Medicare Advantage plan offered by a Medicare approved private insurance company. According to a publication from the Centers for Medicare & Medicaid Services (CMS), all Medicare beneficiaries living in Oregon have access to at least one of the Medicare Advantage plans available in the state in 2018. Because private, Medicare-approved insurance companies provide these Medicare plans, the cost, coverage and availability of plans may vary. You can compare plans available where you live to find a match for your needs (just enter your zip code where indicated on this page).
Medicare Advantage plans must provide at least the same amount of coverage as Original Medicare, Part A and Part B (with the exception of hospice care, which remains a Part A covered service). Medicare Advantage plans often have lower deductibles than Original Medicare, and often use copayments—a set dollar amount you pay for particular covered services. Also, Medicare Advantage plans often include additional benefits, like routine dental, vision, and hearing care, and prescription drug coverage.
To enroll in a Medicare Advantage plan in Oregon (as in any state), you must already be enrolled in Medicare Part A and Part B, continue to pay your Part B premium, and reside in the plan’s service area. You might not be eligible to enroll if you have end-stage renal disease, but call and check with the plan. You might need to use the doctors and hospitals that participate in the Medicare Advantage plan’s network to receive the full benefits of the plan.
Medicare beneficiaries in Oregon can get assistance with their Medicare-related questions from a number of state agencies. These include:
Senior Health Insurance Benefits Assistance (SHIBA) provides free counseling to people with Medicare and those who assist them. Trained counselors can help Oregon seniors in the selection of a Medicare Prescription Drug Plan, compare Medicare Advantage plans, compare Medicare Supplement plans, and help eligible people apply for Medicare Savings Programs, including Extra Help with Medicare prescription drug coverage.
Aging and Disability Resource Connection of Oregon helps state residents locate resources and services tailored to address the present and future needs of seniors and the disabled.
You may find the following information about Medicare coverage in Oregon of interest as you consider your Medicare coverage options.
According to a 2018 report from the Centers for Medicare & Medicaid Services (CMS):
Statistical data from the Centers for Medicare & Medicaid Services, “2018 MA Part D Landscape State-by-State Fact Sheet,” and “Medicare Enrollment Dashboard,“
Data in this article was checked when the article was written and might not be updated as newer data becomes available.
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The Formulary and provider network may change at any time. You will receive notice when necessary.
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