In Oregon, Medicare offers various options, including Original Medicare, Medicare Advantage, and Part D.
Medicare plans in Oregon follow all federal guidelines for healthcare coverage for people ages 65 years or older or with qualifying disabilities or medical conditions.
However, coverage specifications, additional benefits, and plans may vary. It is important to review all the options that are available in Oregon.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare has two parts: Part A and Part B.
- Part A: Part A is hospital insurance that covers inpatient hospital care, skilled nursing facilities, home healthcare, and hospice care.
- Part B: Part B is also called medical insurance and covers outpatient care and services. This coverage includes:
- doctor services and services from other healthcare providers
- home healthcare
- durable medical equipment, such as walkers, wheelchairs, and hospital beds
- preventive services, such as screenings, vaccines, and yearly wellness visits
Learn more about Original Medicare.
Medicare Advantage (Part C) is an alternative to Original Medicare provided by Medicare-approved private insurance companies.
Medicare Advantage plans offer the same coverage as Original Medicare. They also often include prescription drug coverage (Part D) as well as additional benefits that Original Medicare does not cover, such as:
- dental
- vision
- hearing
- fitness program memberships
Various companies offer Medicare Advantage plans in Oregon, including:
- Aetna
- Cigna
- Humana
- Kaiser Permanente
- Regence Blue Cross Blue Shield
- UnitedHealthcare
- Wellcare
Plans vary by county. Individuals can find plans in their area by searching their zip code using the Medicare online tool.
Read about Original Medicare vs. Medicare Advantage.
Medicare Part D covers prescription drugs also provided by Medicare-approved private insurance companies.
Many Medicare Advantage plans include prescription drug coverage. Individuals with certain Advantage plans that do not have drug coverage and those with Original Medicare can purchase a Part D plan from one of the insurers. purchase a Part D plan from one of the insurers.
Learn more about Medicare Part D.
Medicare eligibility
To be eligible for Medicare, a person must meet the following requirements:
- Be 65 years old or older or have certain disabilities or medical conditions, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
- Be a United States citizen or a legal resident of the United States.
Individuals with Original Medicare can purchase extra Medicare supplement insurance (Medigap) through private insurance companies.
Medigap plans help cover expenses that are associated with Original Medicare, including:
- coinsurance
- copayments
- deductibles
Some of the companies that offer Medigap plans in Oregon include:
- Humana
- Cigna
- State Farm
- Mutual of Omaha
- UnitedHealthcare
- USAA
People can check which plans are available in their area by searching their zip code in the Medicare online tool.
People living in Oregon may wish to consider some factors when choosing a Medicare plan, including:
- Doctor choice: Many Medicare plans have a network of doctors and other healthcare professionals. Before choosing a plan, a person may wish to check that their current doctor is in the plan’s network.
- Services covered: All Medicare plans must provide the same coverage as Part A and Part B. However, people may want to consider additional benefits that may be important to them, such as gym memberships, vision, and dental.
- Healthcare needs: If a person has certain health conditions, such as diabetes or HIV, they may wish to look into Special Needs Plans, which are specially tailored to individual needs.
- Out-of-pocket costs: Monthly premiums are not the only costs to consider when choosing Medicare plans. People are also responsible for copayments, coinsurance, and deductibles.
Learn about Medicare plans.
Individuals who have questions about Medicare in Oregon can contact:
- Senior Health Insurance Benefits (SHIBA) at 800-722-4134
- Medicare at 800-633-4227 or via online chat 24/7
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Oregon residents have various Medicare options, including Original Medicare, Medicare Advantage, and Medigap.
For questions about Medicare, individuals can contact SHIBA, or they can contact Medicare directly.
