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Medicare Supplement Plans in Oregon

Medicare Supplement plans in Oregon help seniors pay out-of-pocket expenses left over after Original Medicare pays its portion on a claim. These Medicare Supplement plans, which are also called Medigap plans, are available to any Oregon Medicare beneficiary who is enrolled in Medicare Part A and Part B.

Overview of Medicare Supplement Plans in Oregon

Private insurance carriers provide Medigap policies to Medicare beneficiaries in Oregon. A Medigap plan fills the gap between what Original Medicare covers and the copayments, deductibles, and coinsurance that is the responsibility of seniors. When you sign up for a Medicare Supplement plan in Oregon during your initial enrollment period, you have what is called guaranteed-issue rights. Guaranteed issue means that an insurance company cannot deny you coverage, require medical underwriting, or charge you a higher premium based on your health condition. A Medigap plan covers only one person; married couples must buy a Medicare Supplemental plan for each spouse.

Medicare Supplement plans do not include prescription drug coverage, so you will have to buy a separate Medicare Prescription Drug Plan. These prescription drug plans are often referred to as Medicare Part D.

Like in the other 49 states, Medigap plans in Oregon supplement, not replace, Medicare Part A and Part B. To keep your Medicare Supplement plan in Oregon valid, you must stay enrolled in Medicare Part A and Part B.

Medicare Supplement Plans in Oregon: Enrollment Statistics

Oregon has 36 counties. Following are the five largest based on population:

  • Multnomah
  • Washington
  • Clackamas
  • Lane
  • Marion

Oregon’s population is more than 4.142 million. Of those, nearly 17 percent are age 65 or older. The average retirement age is 63. Here are some other Medicare-related facts:

  • In 2015, there were 754,402 Medicare beneficiaries in Oregon.
  • In 2015, 31.7 percent of Oregon’s Medicare beneficiaries had a Medigap plan.
  • Plan F is the most popular.
  • Plan N and Plan G are the second and third most popular plans.

How Are Rates Calculated for Medicare Supplement Plans in Oregon?

When choosing a Medigap plan to supplement your Original Medicare, it is important to consider how an insurance company will calculate your premium in the future. In Oregon, there are three ways to price Medigap plans:

  • Community-rated

    All policyholders pay the same premium.

  • Attained-age rated

    Your premium will increase as you age.

  • Issue-age-rated

    Your premium is based on your age when you buy the policy, but it is not affected by your age in the future.

Most of the Medicare Supplement plans in Oregon are calculated using the attained-age pricing method.

Available Medicare Supplement Plans in Oregon

There are 10 Medigap policies available in Oregon: Plans A, B, C, D, F, G, K, L, M, and N. Each plan letter offers the same benefits throughout the state.

Although each Medigap plan letter features the same benefits, the benefits are different among the plans.

  • Plan N

    provides basic coverage

  • Plan F

    is the most comprehensive

  • Plan G

    does not cover Medicare Part B deductibles

When you compare Medicare Supplement plans, you need to consider several things to make sure you get the coverage that best matches your needs:

  • Current health condition
  • The frequency of doctor and/or emergency room visits
  • Ability to pay coinsurance, copayments, or higher deductibles

Individuals under age 65 who meet specific criteria for disability or end-stage renal disease may also qualify for a Medicare Supplement plan in Oregon. If an insurance provider sells Medigap plans in Oregon, the provider must offer at least one plan to Medicare beneficiaries who are under age 65. Providers are not allowed to charge a higher premium for under-65 policies compared to policyholders older than 65.

How Does A Medicare Supplement Plan Cover Prescription Drugs?

A Medicare Supplement plan in Oregon does not cover prescription drugs. To get prescription drug coverage, a Medicare beneficiary must buy a separate stand-alone Part D policy.

Medicare Supplement Plans in Oregon: When Can I Enroll?

To take advantage of the most options, the best time to buy a Medicare Supplemental plan is during your Medigap open enrollment period. This initial enrollment period is a six-month time frame that starts on the first day of the month that you meet two conditions:

  • You are age 65 or older
  • You enrolled in Medicare Part B

When you buy a Medicare Supplement plan in Oregon during your initial enrollment period, insurance companies cannot charge you a higher premium based on health problems or require you to undergo medical underwriting. Carriers also cannot deny you coverage for a pre-existing condition, although they can require a waiting period before covering a pre-existing condition.

Typically, after your Medigap open enrollment period ends, you can still buy Medigap insurance, but you might be subject to medical underwriting, and you might also have to pay a higher premium if you have a pre-existing condition. Insurance providers also are allowed to deny you coverage completely if you are outside of your initial enrollment period.

However, Oregon residents get additional protection through the Medicare Supplement birthday rule in Oregon. Under the birthday rule, you have a 30-day open enrollment period each year to switch policies without having to undergo underwriting. This 30-day window starts on your birthday and allows you the opportunity to take advantage of a more competitive rate.

The one criteria to take advantage of the Medicare Supplement birthday rule in Oregon is that you must switch to a policy that offers the same or less coverage than your current policy. If you have Plan F, which provides the broadest coverage, you can change to a less expensive Plan F or any of the other nine Medicare Supplement plans. If you have Plan C, you can only switch to a less expensive Plan C, Plan B, or Plan A.

Can I Use My Medicare Supplement Plan from Oregon in Other States?

One of the best advantages of a Medicare Supplement plan is its portability. If you are traveling, you can use it anywhere in the United States as long as the healthcare facility or doctor is signed up with Original Medicare. If you move to another state, you can take your Medigap plan with you, although the premium might change because of the new location.

Oregon Medicare Resources:

Oregon’s Division of Financial Regulation

Switching Medigap Plans