Oregon Medicare Guide

Get free advice and support from licensed Oregon Medicare Advisors. Schedule a consultation or give us a call today at (888) 604-0055. 

In this guide, learn the basics you need to know about Medicare in Oregon to make the right Medicare decisions, save money, and get more value.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Oregon

• Medicare Eligibility and Enrollment Steps

• Oregon Medicare Advantage Plans

• Oregon Medicare Supplement Plans

• Oregon Medicare Part D (Prescription Drug) Plans

• Get help paying for Medicare in Oregon

A Snapshot of Medicare in Oregon

There are 902,000 Medicare beneficiaries in Oregon, making up 21% of Oregon’s total population. 16% of Oregon’s Medicare beneficiaries also receive benefits from the state’s Medicaid program.

Enrollment in Medicare Advantage vs. Original Medicare in Oregon

Medicare beneficiaries have options, and one of them is between Original Medicare and Medicare Advantage. In Oregon, 51% of Oregon Medicare beneficiaries stay on Original Medicare and 49% enroll in a Medicare Advantage plan.

Oregon Medicare Eligibility and Enrollment Steps

All US citizens over the age of 65 are eligible for Medicare. You’re also eligible if you’re under 65 but have certain disabilities like ALS or End-Stage Renal Disease.

Oregon Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

If you age into Medicare by way of turning 65, you’re eligible to enroll during your Initial Enrollment Period (IEP). Your IEP is unique to your birth month. It begins three months before the month you turn 65, includes your birth month, and ends three months after. Some people choose to delay enrollment in Part B because they’re still working. If you do this, just be sure you’ll be eligible for a Special Enrollment Period when you stop working, or you may incur a late enrollment penalty. 

2. Compare additional coverage options

The first option Medicare beneficiaries have is between Original Medicare and Medicare Advantage. From here, depending on which path you choose, you have additional choices to make. If you stay on Original Medicare, you can choose to add a Medicare Supplement plan and/or a prescription drug plan. If you enroll in a Medicare Advantage plan, there are an average of 43 plans to choose from (plan availability varies by county). These choices are incredibly important, and the wrong choices can cost you thousands of dollars! We’ll explain these options in more detail later in this guide, but we’re also here to help! If you have questions about your options or want advice to help you make the best decisions for your individual needs, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed Oregon Medicare Advisors. 

3. Get the most value from Medicare

Making the right Medicare choices from the start is important, but continuing to review your coverage and your healthcare needs is too! Every year Medicare has an Open Enrollment Period from October 15 - December 7. During this time, those enrolled in Medicare Advantage and prescription drug plans have an opportunity to switch plans without consequence. Because these plans change every year and your healthcare needs may too, it’s a good idea to shop around. In some cases, people are able to save thousands of dollars! 

Oregon Medicare Advantage Plans

There are 97 Medicare Advantage plans available in Oregon, but insurance carriers, pricing, and availability vary by county. For example, Multnomah County, OR has 50 Medicare Advantage plans from 12 different insurance carriers and Jackson County has 31 plans offered by 8 insurance carriers (in 2023).

Medicare Advantage plans are popular among some Medicare beneficiaries because they bundle together different parts of Medicare (Part A, Part B, and often Part D). They also generally have added benefits, like dental, vision, and hearing coverage and fitness perks. Many Medicare Advantage plans also have $0 premiums, and 70% of Medicare Advantage enrollees are on zero-premium plans. Unfortunately, it’s commonly misunderstood that Medicare Advantage plan holders must still pay their Part B premiums, so these plans aren’t “free.” 

Still, more coverage and benefits at no (or a low) additional cost sounds fantastic! So, why doesn’t everyone choose Medicare Advantage? Medicare Advantage have big downsides, including:

• Limited networks

• Preauthorization requirements

• Higher out-of-pocket (when compared to Original Medicare + Medicare Supplement)

Oregon Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement plans pair with Original Medicare. Medicare Supplement (also called Medigap) plans fill the gaps in coverage. Specifically, they help cover the 20% of costs that Original Medicare doesn’t cover. 

Compared to Medicare Advantage plans, Medigap plans have some big benefits:

• No networks - you can see any doctor who accepts Medicare nationwide

• No prior authorization requirements for covered services

• Lower out-of-pocket costs

When you enroll in a Medigap plan matters, and the best time to enroll in a Medigap plan is during the first six months that you have Part B coverage. This is your Medigap Open Enrollment Period, and during it, you are guaranteed acceptance into any Medigap plan, regardless of your health history. Insurance companies are actually not allowed to ask you about your health! Outside of your Medigap Open Enrollment Period, insurance companies will likely ask you questions about your health history, and they can deny your application. 

Oregon is one of a handful of states with a Medigap Birthday Rule. This rule allows current Medigap plan holders to switch to another Medigap plan each year on their birthday, and for 30 days after. If Medigap plan holders choose to switch to a plan with equal or lesser benefits compared to their existing policy, insurance companies cannot ask health history questions or establish a coverage waiting period. 

Oregon Part D Plans

Part D provides prescription drug coverage because Original Medicare doesn’t. Oregon Medicare beneficiaries can get Part D coverage either through a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 24 Oregon Part D plans, but each county will have different pricing and availability. 

Even if you don’t need prescriptions when you first enroll in Medicare, we recommend finding low-cost Part D coverage to avoid the Part D enrollment penalty.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Oregon Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Oregon

Oregon Medicare enrollees with low income and resources can apply for three programs to get help paying for Medicare-related costs.

Oregon Medicaid

Medicaid is a joint federal and state program that helps US citizens with low income and resources pay for medical expenses. Each state is responsible for running its Medicaid program, and so each one operates a little differently. 

Oregon has specific Medicaid benefits for people who are 65+, blind, or have a disability. The state also offers long-term care services. To see if you qualify and apply, you can reach out to your local Oregon Department of Human Services agency or the Area Agency on Aging here. 

Medicare Savings Programs

Oregon’s Medicaid program also has Medicare Savings Programs that can help low-income individuals pay for Medicare-related expenses. Oregon has four of these programs, and each has different eligibility requirements and benefits:

• Qualified Medicare Beneficiary Program (QMB)

• Qualified Disabled Working Individual Program (QDWI)

• Specified Low-Income Medicare Beneficiary Program (SLMB)

• Qualified Individual (QSMF benefit)

Learn more about these four Medicare Savings Programs here.

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps low-income individuals pay for costs associated with Medicare prescription drug coverage.

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Oregon

• Oregon pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you may still be eligible! Talk to one of our licensed Oregon Medicare Advisors to get free support for determining if you qualify and submitting an application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.