From its rugged coasts to its coursing rivers, Oregon abounds with natural and tranquil beauty. But no matter what part of the Beaver State you call home, making sure you have the right Medicare Oregon coverage is crucial to enjoying everything our beautiful state has to offer. Benzinga has done the work of reviewing and comparing the many different companies offering Medicare Advantage plans in Oregon and chose the top 5 that give you the best coverage and benefits at affordable rates.
The Best Medicare in Oregon:
- Best Overall in Oregon: Humana
- Most Affordable in Oregon: PacificSource
- Best for a Large Provider Network: Aetna
- Best for Low In- and Out-of-Network Costs: Moda
- Best for Comprehensive Coverage: Providence
What is Medicare?
Medicare is a government-sponsored health insurance program for individuals 65 and older. Your contribution to Medicare is taken out of your paycheck as a percentage before you receive it. To simplify the process and offer the widest range of coverage, Medicare is broken down into 4 parts.
Part A: Part A covers hospital care and may also cover a limited amount of time in hospice care or a specialized nursing facility. This may extend to home health care as well. Similar to health insurance that you may get through your employer or a private company, Medicare only covers a certain portion of the bill. You’re responsible for part of the cost as well as the deductible you’ve selected before your Medicare benefits become active.
Part B: Medicare Part B covers nonhospital-related expenses, which include physician visits and blood tests. Medicare typically covers the full cost of blood and lab tests but you’ll be responsible for paying your deductible until your Medicare Part B benefits take over. It can also cover outpatient care that doesn’t require a stay in the hospital.
Part C: Part C is a variety of Medicare that is offered by private companies contracted with the Centers for Medicare and Medicaid Services to bundle Parts A and B along with other benefits like hearing screenings, vision and dental benefits. Enrolling in Medicare Part C is optional.
Part D: Medicare Part D plans cover prescription drug costs. Like Part C plans, they’re offered by private companies and each one has different coverage levels and payment options. For example, some offer a $0 deductible while others have a deductible amount and a flat copay amount. Enrolling in Part D is optional.
Legalities of Medicare in Oregon
Medicare is regulated by the Centers for Medicare and Medicaid Services and is overseen by the U.S. Department of Health and Human Services. Of each paycheck 1.4% is put into FICA, the Federal Insurance Contributions Act, while another 1.45% is contributed by your employer (you pay both percentages if you are self-employed).
You don’t have to wait until you turn 65 to enroll in Medicare. You can start 3 months before or 3 months after you turn 65. You’ll want to enroll as soon as you can so that you don’t have to wait to enjoy the benefits the moment you become eligible.
Types of Medicare Advantage Plans
To help make the transition to Medicare easier, plans are broken down similarly to traditional health insurance policies like HMO and PPO plans. These are designed to simplify the process and keep health insurance affordable.
HMO: Health maintenance organization (HMO) plans coordinate care using a primary care physician who is responsible for the majority of your care and a network of participating hospitals and specialists. If you need to see a specialist, you’ll need to get a referral from your primary care physician first. There are some exceptions to this rule, however, such as if you need out-of-area urgent care or emergency care. If you get treatment outside of the HMO, you may have to pay the full amount. There’s less paperwork to deal with and prescription drugs are generally covered by HMO policies.
PPO: PPO plans also take advantage of cost savings by having a preapproved network of participating providers. Unlike an HMO, however, you don’t have a primary care physician and you don’t need a referral to see a specialist. Prescriptions are generally covered but there’s more paperwork involved, especially if you go outside of the PPO network. If that’s the case, you’ll need to file a claim with the PPO to be reimbursed for some of the expense.
How to Sign Up for Medicare in Oregon
Keep in mind that signing up for Medicare in Oregon isn’t the same process as signing up for a Medicare Advantage Plan or a Medicare Supplement Plan. The Centers for Medicare and Medicaid Services note the following steps for enrollment:
- If you’re already collecting Social Security benefits or Railroad Retirement Board benefits when you turn 65, you’ll automatically be enrolled in Medicare Part A.
- If when you signed up for retirement benefits and enrolled in Medicare Part B, you’ll also automatically be enrolled in this part of Medicare.
- If you live outside of the U.S. or D.C., you’ll automatically be enrolled in Medicare Part A but will need to manually enroll yourself in Part B.
Generally speaking, enrolling in Medicare Part A is automatic. There are some cases where you’ll need to enroll manually, including:
- If you aren’t receiving retirement benefits and are within your enrollment period, you can enroll in Medicare only and defer your retirement benefits to a later time.
- If you’re not eligible to receive retirement benefits, you will not be enrolled in Medicare Parts A and B. You can still sign up for them during your enrollment period, however, you may have to pay a premium.
Average Cost of Medicare Advantage Plans in Oregon
The amount you’ll pay for Medicare Advantage Plans in Oregon depends on the type of policy you select, such as an HMO or PPO, as well as any additional benefits you may want, like vision or dental. Below are some of the top choices for Medicare Advantage plans that can help you save money while giving you solid and reliable coverage.
| Plan Name | Company | Plan Type | Health & Drug Costs |
|---|---|---|---|
| Humana Honor | Humana | PPO | $0 Medicare Advantage (without drug coverage) monthly premium; does not include $144.60 Part B premium |
| PacificSource Medicare Essentials RX 27 | PacificSource Medicare | HMO | $55 Medicare Advantage (with drug coverage) monthly premium; does not include $144.60 Part B premium |
| Providence Medicare Compass + RX | Providence Medicare Advantage Plans | HMO | $99 Medicare Advantage with drug coverage monthly premium; does not include $144.60 Part B premium |
| Moda Health Central PPORX | Moda Health Plan, Inc. | PPO | $109.90 Medicare Advantage with drug coverage monthly premium. Does not include $144.60 Part B premium |
| Aetna Medicare Value Plan | Aetna | HMO | $0 Medicare Advantage with drug coverage monthly premium; does not include $144.60 Part B premium |
Best Medicare Insurance Providers in Oregon
We’ve carefully reviewed the Medicare policies offered by the best Medicare Advantage insurance companies in Oregon to help you choose the right type of insurance for your health needs and budget. See our top picks below.
- Medicare Advantage Plans
1. Best Overall in Oregon: Humana
Humana offers a variety of plans to fit a wide range of budgets and health care needs, earning it top marks from our reviews. Its customer reviews are solid and reliable, and many members remark on the high quality of care and coordination across all types of Humana plans, including HMO and PPO plans. Be sure to check out the health initiatives that Humana sponsors to help you save money on health and wellness products ranging from fitness equipment to therapeutic massages.
2. Most Affordable in Oregon: PacificSource
PacificCare offers a low out-of-pocket maximum in addition to many other benefits that make it a well-rounded and reliable choice for Medicare coverage. The company offers vision, dental and hearing benefits, as well as fitness benefits and telehealth options. If you travel, you’ll be glad to know that PacificSource also offers worldwide emergency health coverage. The plan does not cover prescription drugs, so unless you have secondary prescription drug coverage, you’ll pay the full cost for your prescription medications.
- Member support
3. Best for a Large Provider Network: Aetna
Aetna has one of the largest healthcare provider networks in Oregon and nationwide, making it a top choice if you’re looking for a Medicare Advantage company that has a considerable directory of participating providers. Aetna, like Humana, also offers a number of healthy living rewards and savings on fitness and other products. Aetna also offers vision and dental coverage options, making it a good choice if you don’t go to the doctor often but want the most flexibility to choose the doctor and hospital you go to.
4. Best for Low In- and Out-of-Network Costs: Moda
Moda may not have the expansive networks of Aetna and Humana, but it made our list because of its low in-network and out-of-network costs. In addition, the Moda website helps you get cost estimates, see real-time claims status, connect with healthcare providers from the comfort of home and search the provider directory instantly. Moda also offers a number of benefits at no additional cost, including preventive services and screenings for blood pressure, breast cancer, colon cancer, diabetes, depression and sexually-transmitted infections.
5. Best for Comprehensive Coverage: Providence
Providence plans are more expensive than many of the other options profiled here. However, if you have one or more chronic health conditions or you want the full spectrum of care at a reasonable rate, Providence is a great option. With Providence, members also get access to no-cost fitness centers, a 24-hour nurse advice line, virtual on-demand provider visits and much more. You can also sign up for vision, hearing and dental plans as a supplement to your health insurance coverage.
Affordable Medicare Advantage Plans in the Beaver State
It’s easy to feel overwhelmed when it comes to choosing a Medicare Advantage plan. Are you choosing the right coverage? Will you have access to your preferred doctor or hospital? What about prescription drug coverage? It’s a lot to decide, but we recommend getting a customized quote from each of the providers featured here. Health insurance plan costs can vary widely, but getting a quote tailored to your specific needs will cost you nothing. Learn more and decide with confidence how a Medicare Advantage plan fits your needs and budget.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.