Attention, Oregon seniors: are you approaching the age of 65? Are you planning to, or are you currently enrolled in the Federal Medicare program? If so, then you’ve come to the right place. In this article, we aim to discuss Traditional Medicare (a shorthand term for Medicare Parts A and B), its coverage gaps, and what you can do to protect yourself with supplemental Medicare coverage.
Coverage and Benefits
But first, let’s go over the basics. Traditional Medicare is a government sponsored form of health insurance available to retirement-age seniors once they turn 65 years of age. Part A covers most of your medical needs should you require hospital care, and Part B covers most of your medical treatment conducted outside of a hospital. Part B requires an annual deductible and a monthly premium based on your estimated income. Part A might be free – if you have a significant work history. Without a minimum of 10 years employment experience (or 40 quarters), you will be required to pay upfront fees in exchange for access to your Medicare Part A benefits.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
When it comes to Medicare, everything starts with Medicare Part A. Part A benefits are mostly associated with hospital stays, treatments therein, and end-of-life care. Next, there’s Part B. Medicare Part B covers things like doctor visits, outpatient care, and medical supplies, among other things. You will have to pay premiums in order to receive both Part A and Part B benefits. If you decide to enroll in and accept Medicare, you must pay your Part A premiums. In some cases, Part B is optional. But not always.
After Medicare Part A & B comes Medicare Part C. Medicare Part C is actually a private insurance policy; it is not managed or issued by the federal government. However, the federal government legally requires private insurance companies to offer the exact same benefits in a Medicare Advantage policy as exist in Medicare Parts A & B. You won’t need to pay premiums for Medicare Part B (or Medicare Part A) if you choose Medicare Part C; but you will have to pay premium costs for your plan. If you decide to enroll in Medicare Part D, drug prescription coverage, you will have to accept Medicare Part B and pay those premiums as well.
The Variety of Oregon Medicare Plans
In total, there are around 653,905 Oregon residents currently enrolled in Medicare. Of those, approximately 43% (or 281,178 people) have supplemented their Medicare coverage with a Part C Medicare Advantage policy. An additional 98,482 beneficiaries are covering their Original Medicare coverage gaps with a Medigap supplement policy (15% of seniors). There is also an additional 274,640 – more than a quarter of a million people who are enrolled in the Medicare program – who either aren’t protected against Medicare coverage gaps, or have an alternative form of supplemental coverage that is neither Medigap, nor Medicare Advantage.
Do you know your Medicare enrollment status? If not, you can find out by clicking this link with Medicare enrollment resources such as enrollment dates, eligibility, and more.
Should Oregon Residents Consider Purchasing Supplemental Coverage?
Well, if you’d like to protect yourself from thousands of dollars in unnecessary medical bills, then the answer to that question is “yes”. At the very least, it is certainly worth looking into, even if you don’t feel that a supplemental coverage policy is right for you at this time. Just look at the following expenses that can pile up if you are depending on Original Medicare alone for your healthcare needs:
|Medicare Part A Costs||Medicare Part B Costs|
The costs outlined in the chart above are often referred to as “Medicare coverage gaps”. These gaps, as you can see, could leave you responsible for some substantial medical bills if you aren’t prepared. But supplemental coverage will cover these costs for pennies on the dollar. And you can have more money in your pocket to live out your golden years in style.
Oregon healthcare costs have been steadily rising over the past few years. And this trend is only going to continue – especially for the elderly, whose healthcare is the most expensive of all. Protecting yourself in these expensive times is difficult, but not impossible. You just have to take an honest inventory of your healthcare needs and purchase the coverage which best suits you.
Original Medicare is a wonderfully affordable healthcare option for seniors, but it isn’t perfect. It’s easy to make it less imperfect if you choose the right type of supplemental coverage. One such option is Medicare Supplement insurance, otherwise known as Medigap. These are smaller plans sold by private companies which only cover the gaps in Original Medicare coverage – nothing more. The plan comes with its own relatively low monthly premium, and there are 10 different standardized plans to choose from no matter what state you live in.
It’s important to be mindful of Original Medicare coverage gaps because those expenses can sneak up without warning. And they will be very costly. Extended hospital stays, for example, are not covered by Medicare – but they are covered by Medigap. Another way in which Medigap helps supplement your Medicare Is by protecting you from the unpredictable insurance costs and other fees from Medicare Part B. As good of an option as it is, however, it is not the only one. And you should definitely look into all of your options before you make a final decision.
Medigap is one option for supplementing Medicare Parts A & B. But Medicare Advantage is another one. Either involves purchasing coverage from a private entity in order to cover some or all of your medical needs. But they are by no means created equal. There are many differences between the two that you need to know in order to get the best deal for yourself.
Oregon Medicare Supplement Plans
Medigap policies are small, cost-effective health insurance plans which are specifically designed to protect against many of the gaps present in Traditional Medicare. The federal government has worked hand in hand to design ten specific plans which give you exactly as much coverage as you need, so that you aren’t paying extra in premium costs for unused coverage. Regardless of what state you live in, from Oregon to Kentucky, the benefits you sign up for are identical. But the provider you choose, as well as the overall expense, will change from one region to another.
Take a look at what each of these 10 plans have to offer you:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$87||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$86||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$82||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$118||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$80||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$81||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$109||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$61||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$45||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$73||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Oregon Medicare Advantage Plans
You may have also heard of another option for Oregon Medicare Plans: Medicare Part C. Mostly referred to as Medicare Advantage, it works a lot like a private health insurance policy. When you sign up for Medicare Advantage, a private health insurance company takes over control of your Original Medicare benefits. This means that the government is no longer responsible for managing or paying out for Medicare Parts A and B. Also keep in mind that you may be forced to switch doctors when switching to a Medicare Advantage policy. This is due to the highly restricted provider networks which Medicare Advantage is sometimes known for.
However, there are some good sides to signing up with a Medicare Part C plan. For one, some customers appreciate its simplicity. Instead of trying to juggle Traditional Medicare and a private Medigap supplement policy, all of your benefits come from one source. And your benefits are legally protected; according to federal law, no company can offer you an Advantage policy which offers less coverage than Original Medicare. They can only offer you equal or greater coverage. And sometimes this coverage comes in the form of dental or vision extras. However, they also come with associated costs.
Medicare Advantage plans deliver care to their members through either a PPO or an HMO network. These Preferred Provider or Health Maintenance Organizations must be utilized in order to receive care for anyone signed up with an Advantage plan. Getting care outside your network could end up costing you.
Medigap vs. Medicare Advantage in Oregon
Sadly, these differences are many and they can be quite confusing. You’ll still be mostly dealing with the federal government when it comes to your health benefits if you maintain your Original Medicare coverage alongside a Medigap plan. Your Medigap policy only comes into play when it comes to the gaps in Medicare coverage benefits. For better or worse, these plans no longer offer people the option to help with prescription drug coverage.
There is a total of 10 Medigap plans for you to choose from. You can only choose one, but each plan is designed to be comprehensive for various needs. Plans like F and G are the most comprehensive, but they tend to have higher premiums. One of the best things about Medigap plans is their simplicity. You only get the coverage you need to cover the Medicare gaps. Nothing more. So, there’s a great opportunity to save money.
In some ways, Medigap plans are almost the exact opposite of Medicare Advantage. As we touched on earlier, Medicare Advantage is a private health insurance replacement of Medicare Parts A & B. In order to properly cover Original Medicare gaps, you may have to purchase additional coverage on top of the standard policy. Of course, there can be advantages to this. You can purchase additional coverages such as prescription drugs, dental, or vision, too. These types of coverage are unfortunately not available on any Medigap plan.
But it’s not all sunshine and roses when it comes to Medicare Advantage. Unlike Medicare and Medigap, you will have to submit yourself to a pre-approval process. Your Medicare Advantage insurance company has the legal right to regularly review and change the benefits you receive, as well as your premiums and other insurance costs. Their networks tend to be more limited, so you’ll have to be careful about which doctors or hospitals you visit, especially when you are traveling.
Below is a chart which we hope can help clear up some of the confusion between these two plans. Of course, if you still have questions, we are here to help. Simply contact one of our operators and we can help guide you through the process. We are ready and waiting to assist you.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Some seniors may not need to pay a monthly premium at all because the government will subsidize 100% of this cost. But if your Medicare Advantage company estimates that your medical expenses will cost more than what the government is going to pay, the rest of that premium will be charged it to you.||Medigap will require you to pay one low monthly premium no matter which plan you choose. But more comprehensive plans will also pay certain Medicare premiums and coinsurance costs for you.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||If the government subsidy is less than the monthly premium your provider wants to charge, you will have to pay the difference. Some lucky seniors don’t have to pay a monthly premium at all.||You will pay one low monthly premium for all of your benefits, including things like travel insurance, extended hospital stays, and certain Medicare Part B expenses.|
|What will the plan cover?||Medicare Advantage starts by offering identical benefits as are offered by Original Medicare. You may choose to purchase extra coverage if you wish, but you will have to pay for it in kind.||Plans F and G will cover 100% Original Medicare coverage gaps, including certain co-pays and co-insurance costs. But the less covered you purchase, the cheaper your monthly premium will be.|
|Is it easy to budget my health care expenses?||The healthier you are and the less frequently you use your Medicare Advantage insurance, the easier it will be for you to come up with a healthcare budget.||The out-of-pocket expenses associated with Medigap are rare, especially if you have a very comprehensive plan. It is rare to see your monthly premium increase, but it will only happen if the government charges more for Original Medicare premiums.|
|Is my plan guaranteed? Or can it be cancelled?||There are fewer guarantees with Medicare Advantage compared to Medigap. Your plan can be cancelled at any time with Medicare Advantage because it is run by a private company.||You can count on your plan to be around for as long as you pay your premiums, or as long as the company remains financially solvent.|
|Do I have to clear a pre-approval or pre-certification process?||You will have to pass some sort of pre-approval process in order to get a Medicare Advantage plan. The healthier you are, the less you will have to worry about passing.||As long as you qualify for Original Medicare, you will qualify for a Medigap insurance policy.|
|Am I limited to specific doctors or hospitals?||Limited networks help keep Medicare Advantage costs down, but they will narrow your selections of doctors and hospitals considerably.||Medigap, you get to choose from the full network of doctors and hospitals that currently accept Medicare.|
|What type of plan is best for me?||Younger, healthier seniors who have an abundance of choice when it comes to doctors and hospitals near them might be able to save a decent amount of money with Medicare Advantage. It also offers dental, vision, and other extra coverage for seniors who need it.||Older seniors who are not in perfect health and have fewer medical choices can see some real benefits from a Medigap policy, even if you need to purchase separate supplemental prescription drug coverage.|
Additional Medicare Resources in Oregon
If you still have questions about Medigap policies or Medicare Advantage, there is plenty of information out there. By using the directory on this page, you can connect with local experts on Medicare and insurance which can help you in your search. They will be more than happy to assist you with any questions or concerns you may have.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.