OREGON MEDICARE PLANS AND OPTIONS
Medicare Basics
Medicare Advantage
Medicare Supplements
Prescription Drug Plans
Dental, Vision, Hearing
STEP 1: Enroll in Original Medicare
Medicare Part A: Hospital Coverage
ENROLLMENT
ELIGIBILITY
• US citizen or legal resident for at least 5 consecutive years
• And is either 65 years or older, or younger than 65 with a qualifying disability, or any age with a diagnosis of end-stage renal disease or ALS
COVERAGE
• General hospital care (hospital stay and nursing)
• Skilled nursing facility care
• Hospice care
• Home health services
THINGS TO KNOW
You are responsible for the Part A deductible for each benefit period of $1484 (2021). In addition to this deductible, you may also be responsible for daily co-insurance after the first 60 days. Original Medicare does not pay for everything and there is no limit on your annual out-of-pocket costs.
Medicare Part B: Doctor & Outpatient Coverage
ENROLLMENT
If you are receiving social security, enrollment in Part B is usually automatic and your premium is deducted from your social security. If you are not receiving social security, you can sign-up by contacting the social security office. The standard monthly premium for Medicare Part B is $148.50 (for 2021). This may be higher depending on your income.
ELIGIBILITY
Same as Medicare Part A
COVERAGE
• Doctor visits
• Outpatient medical services
• Some preventative care
• Emergency room services
• Durable medical equipment for use at home
• Mental health care (outpatient)
THINGS TO KNOW
Before your Part B coverage starts paying a share of your costs, you must first pay your annual deductible ($203 for 2021), after which Medicare generally covers 80% of covered services and you pay 20%. Keep in mind, your 20% co-insurance does not have a “cap” or “stop loss”. There is no annual limit that you can be billed for. This is where a Medicare Advantage Plan or Medicare Supplement can help with out-of-pocket costs.
STEP 2: Medicare Part C:
Medicare Advantage Plans
Medicare Part C or Medicare Advantage plans are offered by private insurance companies, and combines Medicare Part A and Part B into one plan. These plans offer additional benefits, like prescription drug coverage.
ENROLLMENT
You are eligible for enrollment during your initial enrollment period (3 months prior and after turning 65), unless you qualify for special enrollment. The next time you are able to enroll is during Open Enrollment, Oct 15–Dec 7 (effective Jan 1).
COVERAGE
ALL Medicare Advantage plans:
• All Part B benefits
(except Hospice Care already covered by Original Medicare)
MANY Medicare Advantage plans: (may include additional benefits)
• Prescription drugs
• Dental
• Vision
• Hearing
• Wellness programs
Medicare Part D:
Prescription Drug Coverage
ENROLLMENT
You are eligible for enrollment during your initial enrollment period (3 months prior and after turning 65), unless you qualify for special enrollment. The next time you are able to enroll is during Open Enrollment, Oct 15–Dec 7 (effective Jan 1).
THINGS TO KNOW
Prescription drugs are not covered by Original Medicare. It is recommended to enroll in a separate Part D prescription plan, or a Medicare Advantage plan that includes prescription drug coverage. If you do not enroll in a prescription plan when first eligible for Medicare, your monthly premiums may be higher due to late enrollment.
Medicare Supplements (Medigap)
ENROLLMENT
You can buy a Medicare Supplement insurance plan any time after your turn 65 or join Medicare Part B. During your Open Enrollment Period for Medicare Supplements (6 month period that begins the first day of the month in which you are 65 years or older and enrolled in Medicare Part B) you cannot be denied a Medicare Supplement Plan. After this period, you are able to apply for a plan but could be denied or charged a higher premium based on your health history.
THINGS TO KNOW
Medicare Supplement plans do not include prescription drug coverage. It is recommended you enroll in a separate, Part D prescription drug plan. Contact your local broker to determine what plan is best for you.
WHAT’S A BROKER
Brokers/agents are compensated by a commission from the various companies we offer, allowing us to have a non-biased approach when enrolling you in the plan that fits your individual needs. We are not contracted with just one carrier, but many carriers that offer Medicare plans. Your premium does not cost any more or less if you utilize an agent. This is simply an optional advantage you have access to— at no additional charge.
Whether you are turning 65, or updating your current Medicare policy—Garner’s Insurance is here to walk you through the process.