Medicare in Oregon

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Medicare Plans in Oregon

Around 20% of the state’s total population that is 835, 111 people in Oregon have been enrolled in Medicare plans. Out of these around 14% of Medicare beneficiaries are under age 65. Medicare is a federal healthcare program designed for individuals who qualify by age, disability, or due to end-stage renal disease or amyotrophic lateral sclerosis. People looking to enroll in Medicare must be a U.S. citizen or have legally and permanently resided in the country continuously for five years. Oregon Medicare beneficiaries once enrolled in Medicare can shop around for the best-priced Medicare plans available in their state. Medicare Program is run by the federal agency, the Centers for Medicare & Medicaid Services, which is part of the U.S. Department of Health and Human Services. The Medicare plans comprises of four parts, Medicare Part A (Hospital insurance), Medicare Part B(Medical Insurance, Part C(Medicare Advantage) and Part D(Prescription Drug Coverage). Medicare Part A and Part B together form Original Medicare and besides these four options Medicare also has Medicare Supplement plan, which is designed to fill the coverage gap in Original Medicare.

Original Medicare

Original Medicare is the federal government program offering hospital and medical coverage to eligible beneficiaries. Oregon residents already receiving Social Security Administration or Railroad Retirement Board (RRB) benefits automatically get enrolled in Original Medicare and residents who don’t qualify for automatic enrollment need to sign up manually with the SSA or RRB. In Oregon there are 463,407 beneficiaries enrolled in Medicare Part A or Part B. Individuals who have worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes while working don’t have to pay a monthly premium for Medicare Part A. However, individuals are required to pay a monthly premium for Medicare Part B. Medicare Part A coverage include hospital and inpatient care which beneficiaries receive after hospitalization like skilled nursing facilities, along with hospice care whereas Medicare Part B coverage include outpatient services like doctor visits, medical therapies, preventative services, home health care, and durable medical equipment.

Medicare Part C or Advantage Plan

Medicare Part C or Advantage plan is an alternative way of receiving Original Medicare benefits through a private insurance company having contracts with Medicare. Medicare Part C plans provide the same coverage as Original Medicare along with some additional benefits like routine vision, dental and hearing services. Medicare Part C plans do not have standardized set of benefits, instead beneficiaries in Oregon receive coverage depending upon which Medicare Advantage plan a beneficiary chooses among the Part C plans available in their area. Medicare beneficiaries must have Medicare Part A and Part B to sign up for a Medicare Advantage plan in Oregon. There are different types of Medicare Advantage plans available in Oregon like, Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO), and Private Fee-for-Service plans. Residents or Oregon need to check the Part C plan available in their area because not every Medicare Advantage plan is available in each county of Oregon, and even their costs vary. Enrollees of Medicare Advantage plans need to keep in mind that they also have to pay coinsurance, copayments, and deductibles and they also need to pay their Medicare Part B premium.

Medicare Advantage Prescription Drug Plans

Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug plans that allow enrollees to have all Medicare coverage in a single policy. Each of this plan has its own list of prescription drugs that it covers, which is known as formulary and this formulary varies from one plan to other. In Oregon around 361,523 people are enrolled in a Medicare Advantage Prescription Drug plan in 2018. These plans are available through private insurance companies having contract with Medicare.

Medicare Part D Plans

Medicare beneficiaries who wish to obtain prescription drug coverage can opt for Medicare Part D plan in Oregon, which is a government sponsored plan available through private insurance companies. Beneficiaries in Oregon receiving health coverage through Original Medicare can add prescription drug coverage to their benefits by enrolling in a stand-alone Medicare Part D Prescription Drug Plan. About 612,800 Medicare beneficiaries in Oregon were enrolled in a Medicare Part D prescription drug plan in 2018.To sign up for this plan, enrollees must have Medicare Part A and Part B and they must live in the plan service area. Every Medicare Part D plan has its own list of covered prescription drugs called formulary. So, before signing for this plan, individuals are advised to first check the plan formulary to ensure that the drugs used by them are included in the plan’s list chosen by them. Individuals can enroll in this plan during their Medicare Initial Enrollment Period, which begins three months before they turn 65, includes their birthday month, and ends three months after their birth month. If individuals are enrolled in Medicare due to a disability, they can enroll in this plan during three months prior and three months later after their 25th month of disability. Besides this, individuals can enroll during the Annual Election Period, which runs from October 15 to December 7 each year.

Medicare Supplement Plans

Medicare Supplement or Medigap plans in Oregon are available through private insurance companies and are designed to help individuals fill the gap between Original Medicare coverage and expenses. Out-of-the-pocket expenses related to Original Medicare like copayments, coinsurance, deductibles, can be paid with the help of Medicare Supplement plans. In Oregon there 10 standardized Medicare Supplement plans available, where every plan is identified by letter A, B, C, D, F, G, K, L, M, and N. Plan of the same letter offer the same benefits, though its cost may vary depending upon the location and the insurance company offering the plan. Individuals looking to enroll in these plans should keep in mind that these plans are meant just to supplement the Original Medicare and not replace it. Beneficiaries have to remain enrolled in Original Medicare for their Part A and Part B coverage and they must be paying their Part B premium. People can sign up for these plans during their Medigap Open Enrollment Period, which begins the first day of the month in which they turn 65 and enrolled in Medicare Part B. The enrollment period for Medigap plans last for six months and during this time they enjoy guaranteed-issue rights. This means they can enroll in any Medigap plan offered by any insurance company of their area, without being denied coverage because of pre-existing conditions

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