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.
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.
There are enrollment timeframes and qualifications for Medicare Supplement plans in Oregon. Medicare Supplement insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the plan, unless you enroll during your initial open enrollment period or you qualify for a “guaranteed issue”.Your open enrollment period begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B.(Some states may offer plans for people under age 65 and enrolled in Part B.)
In most cases, you have guaranteed issue rights for the following:
- You lose other health care coverage.
- You are in your Medicare Advantage trial period and change your mind.
- Oregon “Birthday Rule” allows you to switch from one Medigap plan to another with same or lesser benefits, for 30 days starting on your birthday.