Medicare in Oregon

Oregon has strong protections for Medigap enrollees

Resources for Oregon beneficiaries

State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.

In Oregon you can reach SHIP at 1-800-722-4134 or online here.

Snapshot of Medicare in Oregon

Total Medicare enrollment in Oregon

835,111 people were enrolled in Medicare in Oregon as of September 2018. That’s 19.9 percent of its total population, compared with about 18 percent of the United States population enrolled in Medicare.

Read about Medicare’s open enrollment period and other important enrollment deadlines.

In terms of raw numbers, there are 59.9 million Americans enrolled in Medicare. Alaska has the fewest Medicare beneficiaries at 96,641 and California (which has about an eighth of the country’s population within its borders) has the most at 6.2 million (15 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare. Northern Mariana Islands had just 2,358 Medicare enrollees in 2018; but Puerto Rico had 739,058, which is higher than the enrollments in 20 states.

Medigap protections for Oregon residents

Oregon has a rule to ensure that Medigap enrollees aren’t stuck with their plan forever, regardless of their health status. And the state also guarantees access to Medigap plans for Medicare beneficiaries under age 65.

Medicare is a federal program, so most of its regulations are done at the federal level, including the standardization of Medigap plans. Federal rules allow newly-eligible Medicare beneficiaries a six-month window during which they can purchase any Medigap plan sold in their area, on a guaranteed-issue basis. But that rule only applies to people who are 65 years old. In other words, people enrolled in Medicare under the age of 65 (due to a disability, having end-stage renal disease or ALS), do not have federally guaranteed access to Medigap plans.

And federal law only grants Medicare enrollees one window of opportunity to buy a Medigap plan, when they first enroll in Medicare (under federal guidelines, there are also seven limited circumstances when you can get a new Medigap plan without medical underwriting). There’s no annual open enrollment period for Medigap, the way there is for Medicare Advantage and Medicare Part D. People who want to switch to a different Medigap plan are generally subject to medical underwriting, so healthy people can switch plans, but those with pre-existing medical conditions may not be able to do so.

To address this, Oregon implemented a “birthday rule” in 2013 that allows Medigap enrollees an annual opportunity to switch to a plan with equal or lesser benefits during the 30 days following their birthday. The new plan is guaranteed issue during that window.

Oregon also allows Medicare beneficiaries under age 65 a six-month window (after enrolling in Medicare Part B) during which they have a guaranteed-issue right to a Medigap plan. Eligible enrollees can select a Medigap plan with no medical underwriting during a six month window after they enroll in Medicare Part B, and the premium cannot exceed the premiums that are charged to enrollees who are 65

Breakdown of the aged vs. disabled

Individuals who qualify by virtue of their age alone make up 86 percent of Oregon Medicare recipients. The other 14 percent are on Medicare as the result of a disability.  Kentucky had the highest percentage of Medicare recipients whose eligibility was based on a disability (24 percent), followed by AlabamaMississippi, and Arkansas at 23 percent and West Virginia at 22 percent. Hawaii had the smallest percentage of disabled enrollees at 10 percent, followed by New Jersey at 13 percent and North and South Dakota at 12 percent each.

Medicare spending per recipient

In 2015, Medicare spent an average of $6,956 per Original Medicare beneficiary in Oregon. This is significantly lower than the national average of $9,171 per enrollee. The cost analysis does not include enrollees with Medicare Advantage coverage, and it also standardizes the data to eliminate geographic differences in payment rates.

Medicare spending overall

In total spending on Medicare, Oregon ranks #23 with $6.5 billion in total Medicare spending in 2014, out of $581 billion in Medicare spending nationwide. With the largest and smallest numbers of recipients, itʼs no surprise that California accounts for $64.8 billion of overall Medicare spending while Medicare spending for Alaska residents only totaled $741 million.

Medicare Advantage in Oregon

Medicare Advantage offers Americans health benefits through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but the plans are run by private insurers that have more limited provider networks than Original Medicare. And although Medicare Advantage plans do have caps on out-of-pocket costs (unlike Original Medicare on its own), the out-of-pocket exposure is generally more than a person would have if they purchased a Medigap plan and Part D plan to supplement Original Medicare. There are pros and cons with both options.

378,491 of Oregon’s Medicare beneficiaries had Medicare Advantage plans as of September 2018. That’s 45 percent of the state’s total Medicare population, as opposed to about 36 percent of Medicare beneficiaries nationwide selecting Medicare Advantage coverage.

Stand-alone Medicare Prescription Drug plans

Oregon had 265,051 Medicare beneficiaries enrolled in stand-alone prescription drug plans as of September 2018. The state has 26 plans with premiums ranging from $15 to $117 per month.

Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.

For those under 65 in Oregon

Are you under 65 years of age? We have information on Oregon health insurance and the Oregon health insurance marketplace at our health insurance site.