About Medicare

Find A Medicare Plan

Medicare was established in 1965 and is a U.S. Government Administered Health Insurance Program for:

  • People Age 65 and older
  • People under age 65 with certain disabilities
  • People of all ages with kidney failure requiring dialysis or a transplant

If you are new to Medicare plans, give us a call at 503-906-5210.  We specialize in Medicare plans for both Oregon and Washington residents so you don’t have to.  For those of you that would like a brief overview, here are the basics:

Original Medicare has two parts:

  • Medicare Part A (Hospital Insurance)
  • Medicare Part B (Medical Insurance)

Original Medicare was not intended to cover everything.  It has premiums, deductibles, co-insurance costs, and no out-of-pocket maximum.  It does not cover routine vision, hearing, dental, or prescription drugs.

The following parts are available through private insurance companies:

  • Medicare Part D (Prescription Drug)
  • Medicare Part C (Combines Part A & Part B & most plans include Part D)

These plans may have premiums, copays and/or co-insurance, and deductibles.  Medicare Part C plans have a maximum out-of-pocket limit and may cover routine vision, hearing, and/or dental.

Medicare Advantage Plans in Oregon

The Centers for Medicare/Medicaid Services does not allow quoting for Medicare Advantage Plans on line.

Please fill out our secure form and one of our Agents will contact you to answer all of your Medicare Advantage questions, and any other Medicare questions you have.

Although Original Medicare provides critical coverage for many healthcare services, some services and treatments are not covered. Original Medicare does not have a yearly cap on expenses. Medicare Advantage Plans, also referred to as Medicare Part C, are offered by private insurance companies and include the services of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and most plans also include Part D (prescription drug coverage). A Medicare Advantage plan must provide coverage for all the same services covered by Original Medicare, including emergency care and urgent care. In addition, a Medicare Advantage plan in Oregon has a yearly out-of-pocket maximum to provide a financial safety net. In Oregon, Medicare Advantage plans may also provide coverage for other services not included in Original Medicare such as routine dental, vision, hearing, and health and wellness programs.

Medicare Supplements or Advantage

Medicare Advantage Eligibility Requirements

In order to be eligible to enroll in a Medicare Advantage plan, you must have Medicare Part A & Medicare Part B, live in the plan’s service area, and not have End Stage Renal Disease (kidney failure).

  • Anyone entitled to Medicare Part A
  • Is enrolled in Medicare Part B
  • Permanently resides in the service area of the plan
  • Does not have End Stage Renal Disease
When Can You Enroll?

There are timeframes for enrollment in to Medicare Advantage and Prescription Drug Plans.

Initial Enrollment Period

Begins three months before and ends three months after the month of the individual’s Medicare eligibility date (typically 65th birthday). The beneficiary can choose any type of plan during the Initial Election Period (IEP).

Open Enrollment Period (or Annual Election Period)

October 15th to December 7th

Every year, Medicare has an open enrollment period when you can make a change using your annual election period. Since all plan contracts are annual, there may be changes. Between October 15th and December 7th you can make a new plan choice.

Medicare Advantage Disenrollment Period (MADP)

January 1st to February 14th

Medicare created this timeframe to help protect people that may have enrolled in a plan without knowing the details, so they give them the option to return to Original Medicare and enroll in a Stand Alone Part D, if they choose.

Special Election Period (SEP)

In some cases you will have the right to change your coverage without waiting until the next annual election period. The following are a few common Special Election Periods:

  • Moved Outside of the Plan Service Area
  • Voluntary/Involuntary Loss of Employer Group Coverage
  • Qualify for or Loss of both Medicare and Medicaid
  • Qualify for or Loss of Low Income Subsidy
  • Qualify for Special Needs Plan
  • Enrolling into a Plan with 5 Stars

You Still Have Medicare

If you enroll in a Medicare Advantage plan, you still have Medicare and must continue to pay your Medicare Part B premium (and Part A premium if you have to pay one). You also have the same rights and protections as Original Medicare. The companies that offer Medicare Advantage Plans receive a fixed amount each month from Medicare to administer your coverage. In order to be contracted with Medicare, they must follow specific rules established by the Center for Medicare and Medicaid Services (CMS). Although each plan receives the same amount for administering your coverage, the plans may charge different amounts for premiums and other out-of-pocket costs and they may have different networks of doctors and hospitals. They also may have different rules for how you can obtain treatment – for instance, whether or not you need a referral to see a specialist or whether you’re required to see specific doctors or go to specific hospitals. These plans are annual contracts and may change every year. You will be notified by October 1st about the changes to the plans for the upcoming year so you can add, drop, or switch plans if necessary. Our agents schedule annual reviews with their clients so they can compare all of their options each year to make sure they are in the plan that works best for their needs.

Medicare Supplements

 

Although Original Medicare provides critical coverage for many healthcare services, beneficiaries are responsible for deductibles and co-insurance and there is no cap to your yearly expenses. Medicare Supplement insurance – sometimes referred to as “Medigap” insurance – can help cover these costs. Supplemental insurance is sold by private companies and covers some or all of the Original Medicare deductibles and co-insurance.  When you are enrolled in a Medicare Supplement plan in Oregon, Original Medicare is your primary insurance, and your supplement will pay secondary.

More Coverage

Looking for dental, vision, or additional hospital coverage?
All plans are not created equal. We can help you determine which plans include routine dental and vision, and whether you may need more coverage.

Dental

Maintaining good dental health is about more than looking and feeling good. Multiple studies have linked dental problems like decay and gum disease to more serious health complications including heart disease. Yet despite the important role of proper and regular dental checkups and preventive care, seniors often find themselves faced with few options when it comes to dental insurance coverage.

Hospital Indemnity

Many men and women who have Medicare don’t realize how limited their hospitalization benefits actually are until they’re discharged and receive a bill. Original Medicare typically offers coverage for only a portion of the treatments and services received during an average hospital stay. As a result, many patients are left facing substantial bills that need to be dealt with during a period of time when they should be focused on recovery. That’s when having a hospital indemnity policy in place can really help.

Life Insurance

Life insurance is an important part of your financial plan – so important that many financial advisors consider it the cornerstone of a successful financial strategy. Why is it considered so important? Because today’s options allow life insurance policies to be extremely flexible, which means they can be designed to meet a wide variety of goals.

Long Term Care

Long-term care insurance can play an important role in helping to ensure you don’t become a financial burden on your loved ones. Also called LTC, long-term care insurance provides benefits that help cover the costs of a variety of medical services if you become ill or disabled and are unable to care for yourself, including in-home care, nursing home care, and even adult daycare.

Annuities

Annuities are investment products that are designed to provide you with a regular source of income to help you live more comfortably during retirement. Depending on your goals and your financial profile, an annuity can be designed specifically to meet your needs so you can relax, knowing you have a source of income that you won’t outlive.

New To Medicare

Are you new to Medicare plans in Oregon?

If you are new to Medicare plans, give us a call at 503-682-1878 or toll-free 866-682-1878.  We specialize in Medicare plans for both Oregon and Washington residents so you don’t have to.  For those of you that would like a brief overview, here are the basics:

Original Medicare has two parts:

  • Medicare Part A (Hospital Insurance)
  • Medicare Part B (Medical Insurance)

Original Medicare was not intended to cover everything.  It has premiums, deductibles, co-insurance costs, and no out-of-pocket maximum.  It does not cover routine vision, hearing, dental, or prescription drugs.

The following parts are available through private insurance companies:

  • Medicare Part D (Prescription Drug)
  • Medicare Part C (Combines Part A & Part B & most plans include Part D)

These plans may have premiums, copays and/or co-insurance, and deductibles.  Medicare Part C plans have a maximum out-of-pocket limit and may cover routine vision, hearing, and/or dental.

Medicare Advantage Plans in Oregon

Although Original Medicare provides critical coverage for many healthcare services, some services and treatments are not covered. Original Medicare does not have a yearly cap on expenses. Medicare Advantage Plans, also referred to as Medicare Part C, are offered by private insurance companies and include the services of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and most plans also include Part D (prescription drug coverage). A Medicare Advantage plan must provide coverage for all the same services covered by Original Medicare, including emergency care and urgent care. In addition, a Medicare Advantage plan in Oregon has a yearly out-of-pocket maximum to provide a financial safety net. In Oregon, Medicare Advantage plans may also provide coverage for other services not included in Original Medicare such as routine dental, vision, hearing, and health and wellness programs.


Medicare Advantage Eligibility Requirements

In order to be eligible to enroll in a Medicare Advantage plan, you must have Medicare Part A & Medicare Part B, live in the plan’s service area, and not have End Stage Renal Disease (kidney failure).

  • Anyone entitled to Medicare Part A
  • Is enrolled in Medicare Part B
  • Permanently resides in the service area of the plan
  • Does not have End Stage Renal Disease

When Can You Enroll?

There are timeframes for enrollment in to Medicare Advantage and Prescription Drug Plans.

Initial Enrollment Period

Begins three months before and ends three months after the month of the individual’s Medicare eligibility date (typically 65th birthday). The beneficiary can choose any type of plan during the Initial Election Period (IEP).

Open Enrollment Period (or Annual Election Period)

October 15th to December 7th

Every year, Medicare has an open enrollment period when you can make a change using your annual election period. Since all plan contracts are annual, there may be changes. Between October 15th and December 7th you can make a new plan choice.

Medicare Advantage Disenrollment Period (MADP)

January 1st to March 31st
During this Open Enrollment Period (OEP), beneficiaries enrolled in a Medicare Advantage plan (MA-PD or MA-Only) can make a one-time switch to another Medicare Advantage plan (with or without Prescription Drug coverage,) or return to Original Medicare, with the option of enrolling in a Stand Alone Part D plan.

Special Election Period (SEP

In some cases you will have the right to change your coverage without waiting until the next annual election period. The following are a few common Special Election Periods:

  • Moved Outside of the Plan Service Area
  • Voluntary/Involuntary Loss of Employer Group Coverage
  • Qualify for or Loss of both Medicare and Medicaid
  • Qualify for or Loss of Low Income Subsidy
  • Qualify for Special Needs Plan
  • Enrolling into a Plan with 5 Stars

 


Different Types of Medicare Advantage Plans

There are several different types of Medicare Advantage plans.

You Still Have Medicare

 

If you enroll in a Medicare Advantage plan, you still have Medicare and must continue to pay your Medicare Part B premium (and Part A premium if you have to pay one). You also have the same rights and protections as Original Medicare. The companies that offer Medicare Advantage Plans receive a fixed amount each month from Medicare to administer your coverage. In order to be contracted with Medicare, they must follow specific rules established by the Center for Medicare and Medicaid Services (CMS). Although each plan receives the same amount for administering your coverage, the plans may charge different amounts for premiums and other out-of-pocket costs and they may have different networks of doctors and hospitals. They also may have different rules for how you can obtain treatment – for instance, whether or not you need a referral to see a specialist or whether you’re required to see specific doctors or go to specific hospitals. These plans are annual contracts and may change every year. You will be notified by October 1st about the changes to the plans for the upcoming year so you can add, drop, or switch plans if necessary. Our agents schedule annual reviews with their clients so they can compare all of their options each year to make sure they are in the plan that works best for their needs.

Many people prefer the options offered by Medicare Advantage Plans; others may prefer Original Medicare coverage with a Medicare Supplement.

Medicare Supplement in Oregon

Medicare Supplement in Oregon

 

Medicare Supplement Plans in Oregon

Although Original Medicare provides critical coverage for many healthcare services, beneficiaries are responsible for deductibles and co-insurance and there is no cap to your yearly expenses. Medicare Supplement insurance – sometimes referred to as “Medigap” insurance – can help cover these costs. Supplemental insurance is sold by private companies and covers some or all of the Original Medicare deductibles and co-insurance.  When you are enrolled in a Medicare Supplement plan in Oregon, Original Medicare is your primary insurance, and your supplement will pay secondary.

  • Choosing a Policy

    Just like Medicare Advantage plans, Medicare Supplements in Oregon are regulated by state and federal laws to ensure consistency and also to protect consumers. Supplemental insurance is designated by letters A through N, and each “letter” policy is standardized, which makes it easier to compare policies.

    Medigap Benefits Medigap Plans
    A B C D F* G K L M N
    Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
    Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
    Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
    Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
    Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
    Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
    Part B deductible No No Yes No Yes No No No No No
    Part B excess charges No No No No Yes Yes No No No No
    Foreign travel exchange (up to plan limits) No No Yes Yes Yes Yes No No Yes Yes
    Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $4,940 $2,470 N/A N/A

     

    * Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,140 in 2014 before your Medigap plan pays anything.

    ** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

    *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.

    (Chart by Medicare.gov.)

     

    Oregon Medicare Supplement policies require the payment of Medicare Part B premium (and Part A premium if you have one). Every Medicare Supplement policy has a monthly premium and the premiums associated with the policies can vary among insurance companies. That means that different insurance companies may charge different premiums for the same policy. The cost of the premium may depend on where you live, your age, your gender, whether you smoke, medical conditions, and whether the insurance company offers any other discounts for paying electronically, or for more than one policy in the household, or if they have a high-deductible option. When comparing prices, be sure you’re comparing policies with the same letter designation – for instance, compare an A policy with another A policy, not an F policy.

    Each letter policy covers different amounts of the Original Medicare costs and has different copays and coinsurance, so you can choose the plan that works best for your needs and budget. Medicare Supplements do not have a network of doctors, you can go to any doctor that is willing to accept Original Medicare. In addition, some states offer an option known as Medicare SELECT. SELECT policies require subscribers to use specific healthcare providers and hospitals for non-emergency care, in order to obtain full coverage. Because of these restrictions, costs can be lower. Men and women who opt for SELECT policies have the right to switch to a standard Medicare policy within 12 months of enrolling for SELECT.

Prescription Drug Plans

Prescription Drug Plans in Oregon

Beginning January 1, 2006, a prescription drug benefit, called Medicare Part D, was made available. It was created to assist in making drug coverage more affordable for Medicare beneficiaries.  Medicare Prescription Drug Plans are available through private insurance companies that are contracted with Medicare. The Center for Medicare and Medicaid Services created the structure for the Part D plan and the insurance companies must adhere to their guidelines.

To Enroll or Not to Enroll

Some men and women who aren’t taking prescription medications may think they do not need to enroll in Part D when they become eligible for Medicare. However, if you delay signing up when you are first eligible, without other creditable drug coverage, you may incur a late enrollment penalty if you enroll later. You would then pay the penalty for as long you have prescription drug coverage. We recommend meeting with one of our agents prior to becoming Medicare eligible to make sure you are aware of your choices so you can avoid paying a penalty.

Two Ways to Get Prescription Drug Coverage

Currently, if you do not have other creditable drug coverage, there are two ways to obtain Medicare Part D:

  • Through Stand-Alone Medicare Prescription Drug Plans, or PDPs, which add prescription drug coverage to Original Medicare, as well as Medicare Medical Savings Account (MSA) plans, some Medicare Cost Plans and some Medicare Private Fee-for-Service (PFFS) plans.  These stand-alone PDP’s have a monthly premium and many have an annual deductible.
  • Through a Medicare Advantage plan that includes prescription drug coverage.

Each plan that offers Part D coverage has their own list of drugs that are covered and a tiered formulary that determines the cost of the copays and coinsurance for each drug. There is a network of pharmacies for each plan and some have preferred pharmacies that may offer even lower copays.