Oregon Medicare insurance offers coverage primarily to qualified citizens over the age of 65, but workers with certain disabilities may also be eligible. Even though this is a federally funded program, the state of Oregon also offers certain assistance packages to residents who are receiving Medicare benefits.
Original Medicare allows you to receive the core coverage benefits afforded by the program. This is made up of Medicare Part A for hospital insurance that covers services such as inpatient care, and Medicare Part B for medical insurance that includes coverage for treatments, medical supplies, and preventive services.
The Part A aspect of Original Medicare does not normally require payment of premiums. Part B usually does require premiums, but for the lowest income bracket (less than $85,000 per year) this premium is only for $134 a month. That’s a far cry from Oregon’s average monthly premium cost of $465 a month.
Both Part A and Part B of Original Medicare require you to pay for out-of-pocket Medicare expenses. These include deductibles, coinsurance, and copayments.
Some beneficiaries feel that the basic Original Medicare coverage has significant gaps, and to compensate for this, they can opt to get Medigap supplemental plans from private health insurance carriers which have Medicare approval. These plans will, however, come with a premium requirement that is separate from the premium required by Medicare Part B.
The most popular supplemental plan offers coverage for Medicare prescription drugs, and this type is called Medicare Part D. Other plans can cover additional health services which are not covered under Original Medicare. This type of plan may even cover the out-of-pocket expenses of Medicare Part A and Part B.
Instead of obtaining Original Medicare and supplemental plans separately, beneficiaries can instead purchase a comprehensive Medicare Advantage Plan that combines all the benefits of Part A, Part B, and the supplemental plans such as Part D.
As these plans may offer different extra benefits and coverage aside from the core Original Medicare coverage, they will have different costs. It will also depend on which of the Medicare-approved carriers the beneficiaries buy these plans from, which are also known as Medicare Part C.
Oregon does have a significant poverty rate of 16.6%, and residents of the state with lower income may receive assistance from Medicare Savings Programs (MSP) to help cover the Medicare expenses. The MSPs in Oregon do not have a resource limit like in other states.
The program for Qualified Medicare Beneficiary Basic (QMB-BAS) offers the most generous assistance package, as it covers virtually all the Medicare expenses. It pays for the premiums for Part A and Part B, along with the costs of deductibles, copays, and coinsurance. It does have the most stringent income limits, as individuals cannot earn more than $1,032 a month. The combined monthly income for married couples should be less than $1,392.
The next program is for the Special Medicare Beneficiary or QMB-SMB, which is known as the SLMB (Specified Low-Income Medicare Beneficiaries) program in other states. It pays for the premium of Part B only. To qualify, an individual’s income has to be less than $1,234 while the limit for married couples is $1,666.
The QMB-SMF program for Supplemental Medicare Full also pays for just the Part B premium. This has an enrollment cap, and late enrollees may not be admitted. Oregon residents who also receive full OHP Plus Medicaid cannot receive the SMF benefits. To qualify, an individual has an income limit of $1,386 while married couples have an income limit of $1,872.
All the beneficiaries of any of the Oregon MSPs are automatically eligible for the Extra Help Low-Income Subsidy for Medicare Part D. They will then pay none or just a little of the premium for Medicare Part D, and their prescription copays will be reduced as well.
Every state is required by law to set up a State Health Insurance Program (SHIP) to provide assistance and counselling for Medicare beneficiaries in their state. In Oregon, this is called the Senior Health Insurance Benefits Assistance program, or SHIBA. Beneficiaries can call the SHIBA toll-free number at 1-800-722-4134, and they can also be directed to the nearest counselling sites in Oregon.