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.
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)
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.
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.
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:
|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|
You may have also heard of another option for Medicare plans in Oregon: 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.
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$336||Providence Medicare Choice (HMO-POS)||Health Only||$28.00||$0|
|$468||Kaiser Permanente Senior Advantage Basic (HMO)||Health and Drug||$39.00||$0|
|$714||Providence Medicare Extra Part B Only + RX (HMO)||Health and Drug||$59.50||$0|
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||HumanaChoice H6609-070 (PPO)||Health Only||$0.00||$0|
|$804||Moda Health PPO (PPO)||Health Only||$67.00||$0|
|$900||Legacy Health Medicare, powered by Moda Health (PPO)||Health and Drug||$75.00||$0|
Some of the most important answers to frequently asked questions about Medigap, Medicare Advantage, and the differences between the two can be found in the table below:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
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.
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