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
In 2009 there were 653,905 Medicare beneficiaries in Oregon, which is 16.9 percent of its total population. That compares with 16 percent of the United States population enrolled in Medicare.
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 21 percent each. Those with the lowest percentage are Alaska (9.5 percent) and Utah (10 percent). In raw numbers, Alaska has the least recipients at 69,301 and California (which has about an eighth of the country’s population within its borders) has the most at a little over 5 million (13 percent of its population).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 83 percent of Oregon Medicare recipients. The balance — 17 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (28 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 12 percent, followed by North and South Dakota at 14 percent each.
Medicare spending per recipient
Medicare pays about $8,247 annually per enrollee in Oregon. Growth in per-enrollee spending in Oregon from 1991 to 2009 has been about 6.4 percent.
In terms of spending per recipient, about 20 states spend $10,000 or more per recipient. (Medicare spends the most per beneficiary — $11,903 — in New Jersey and the least per enrollee — $9,576 — in Montana. South Carolina and Nebraska lead in per-enrollee spending growth at 7.4 percent, and Pennsylvania‘s growth per enrollee has been the least at just over 5 percent.
Medicare spending overall
In total spending on Medicare, Oregon ranks #30 with $5 billion per year. With the largest and smallest numbers of recipients, itʼs no surprise that California accounts for $50.6 billion of overall Medicare spending while Alaska spends only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).
Medigap in Oregon
Medigap is the only form of private coverage for Medicare beneficiaries that has no federally-mandated annual open enrollment period. Medigap plans are guaranteed issue during a six month window that starts when you turn 65 and enroll in Original Medicare. During that time, enrollees can purchase any Medigap plan available in their area, with no medical underwriting.
But once that enrollment period ends, seniors are often unable to switch plans, because in most states, purchasing a new plan can be impossible or prohibitively expensive due to medical underwriting (under federal guidelines, there are seven limited circumstances when you can get a new Medigap plan without medical underwriting).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have passed laws that make it easier for seniors to switch from one Medigap plan to another. Oregon implemented a “birthday rule” in 2013 that allows seniors – who are already enrolled in a Medigap plan – the opportunity to switch to any other Medigap plan with equal or lesser benefits, during a 30 day window following their birthday each year.
Oregon also allows disabled, under-65 Medicare beneficiaries to enroll in certain Medigap plans 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.
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 are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on its own program.
In 2014 in Oregon, 43 percent of all Medicare recipients chose a Medicare Advantage plan. Oregon ranks #3 among all states for insureds choosing an Advantage plan. Nationwide, 30 percent of Medicare beneficiaries enrolled in a Medicare Advantage program. A full 32 percent of urban dwellers choose them, compared to only 20 percent of rural dwellers, likely due to less access to plans.
Minnesota is the only state where more than half (51 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 22 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (by percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire with 6 percent, Vermont and Delaware (both with 7 percent) and Maryland squeaking in with 9 percent.
Stand-alone Medicare Prescription Drug plans
Oregon has 229,779 in stand-alone prescription drug plans. The state has 33 plans with premiums ranging from $13 to $143 per month. That amounts to 45 percent of all enrollees in Oregon having a stand-alone Rx plan compared to an average of 47 percent nationally. (Florida is highest with 52 percent.)
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