Medicare, the federal healthcare plan for seniors, is available to most people when they turn 65. It consists of Medicare Part A and B, known as Original Medicare. This program helps cover your regular medical costs, such as doctor visits.
However, Original Medicare doesn’t cover all of your medical expenses. You’ll still have to pay deductibles and copayments, for instance. Medicare Supplement plans in Oregon are additional insurance from private insurance companies that can help cover these out-of-pocket expenses. Also known as Medigap policies, Medicare Supplement plans are standardized and named by letters A through N.
What You Need to Know
Medigap policies help cover out-of-pocket expenses not covered by Original Medicare.
Medicare Supplement Insurance plans in Oregon are available after you turn 65 and enroll in Medicare Part B.
Prescription drugs aren’t covered by Medicare Supplement plans. You’ll still need a Medicare Part D plan for prescription drug coverage.
When Can You Enroll in Medigap?
If you’re eligible for Original Medicare, you can enroll in a Medigap policy after you’ve enrolled in Medicare Part B. There are several points when you can enroll in Medicare Supplement plans in Oregon, depending on your situation:
- Medigap Open Enrollment Period (OEP): You first become eligible to enroll in Medicare Supplement during the six months after you turn 65 and enroll in Medicare Part B. This is the best time to sign up for a Medigap policy. Insurance companies can’t reject your application, make you wait for care, or charge you higher prices because of your health. This means you’ll get the most access to plans at the best prices.1
- Outside Open Enrollment Period: You can join a Medigap policy outside your OEP, but you’ll likely have to go through medical underwriting. Insurance companies are allowed to impose waiting periods or charge you more based on any health issues. You could also be denied coverage over preexisting conditions.
- Guaranteed Issue: In certain circumstances, you can enroll in Medigap outside of your OEP with no coverage restrictions. Known as a guaranteed issue right, this lets you purchase a Medicare Supplement plan in Oregon without being charged higher prices or being denied coverage because of your health.2
- Special Enrollment Period: You could have a guaranteed issue right to buy a Medigap policy if you:
- Enrolled in a Medicare Advantage plan and decide to switch back to Original Medicare during the first 12 months
- Move out of the service area of your Medicare Advantage plan
- Get your health coverage from a group plan that is ending
When to Sign Up
The best time to sign up for a Medigap policy is during your Open Enrollment Period.
What Are the Most Popular Medicare Supplement Plans?
Over 158,000 Medicare beneficiaries in Oregon are enrolled in Medigap policies. The most popular is Medicare Supplement Plan F with over 100,000 enrolled. Other popular plans include Medigap Plan G, which has over 32,000 enrollees, and Medigap Plan N with over 14,000 enrollees.3
- Plan F: Plan F pays for your Medicare Part A and B deductibles. This plan also covers Medicare Part A coinsurance for hospice care, office visits, and care at a skilled nursing facility. You won’t be able to join Plan F if you become eligible for Medicare after January 1, 2020.
- Plan G: This plan offers similar coverage to Plan F, except that it won’t cover your Medicare Part B deductible.
- Plan N: Another popular plan, Plan N covers your Medicare Part A deductible and Part A and B coinsurance. It doesn’t cover Medicare Part B excess charges or the Part B deductible.
Each lettered Medicare Supplement plan offers the same benefits across insurance companies.
How Do You Choose a Medicare Supplement Plan?
The benefit of Medicare Supplement plans in Oregon is that plans are standardized. You can easily compare the coverage of each plan to find which is right for you. When you know which plan you want, you can shop around to find the insurance company that offers the best price or additional benefits.
Be sure to consider all of the coverage you need when shopping for Medigap policies. Some plans, for example, include coverage for foreign travel to help pay for unexpected medical costs when traveling. You’ll likely also want to purchase a Medicare Part D plan to cover your medication costs since Medigap won’t cover prescription drugs.
How Much Do Medigap Policies Cost in Oregon?
There are three methods insurance companies use to determine premium prices:
- Community-rated: Everyone on the plan pays the same price.
- Issue-age-rated: Premiums are based on your age when you enroll, but don’t increase as you get older.
- Attained-age-rated: Your premiums will go up as you get older.4
Let’s say you live in Portland. You could pay between $27 and $158 per month for a high-deductible Plan G. The regular Plan G could cost between $117 and $737 per month. This is in addition to the standard Medicare Part B premium of $148.50 per month.5
Who Sells Medicare Supplement Plans in Oregon?
You can purchase Medigap policies from private insurance companies, but not all carriers offer every plan. Your provider options can also vary by location. Carriers of Medicare Supplement Insurance plans in Oregon include:
What If You Want to Change Your Medigap Policy?
You can switch your Medigap policy at any time. Remember that you may face restrictions if you don’t have a guaranteed issue right outside of your OEP. To switch, you’ll have to apply for a new plan. If accepted, you’ll have to contact your existing insurance company and cancel your coverage.
What Are Alternatives to Medicare Supplement?
Medicare Advantage (MA) plans in Oregon, also called Medicare Part C, are a common alternative to Medicare Supplement plans. MA plans don’t supplement Original Medicare. Instead, an MA plan replaces Medicare coverage with a private health plan.
MA plans commonly use HMO or PPO provider networks to lower costs. Your MA plan may include coverage for additional benefits like vision and dental care as well as prescription drug coverage.
What Are Medicare Resources in Oregon?
- Senior Health Insurance Benefits Assistance (SHIBA): Oregon’s SHIBA program provides free resources on Medicare for seniors. You can get unbiased counseling services to help you find and enroll in coverage.
- Oregon Division of Financial Regulation: This is the state department responsible for regulating the insurance industry in Oregon. It offers programs and resources to help insurance customers avoid fraud.
- Oregon Health Plan (Medicaid): Medicaid is a federal program run by each state. It’s designed to help low-income seniors and those with certain disabilities get free or low-cost health coverage. You’ll have to meet eligibility requirements to qualify.
If you think a Medigap policy is right for you, start comparing plans before your Open Enrollment Period begins. This gives you time to choose an insurance company without missing the benefits of your OEP.