Medicare options in Oregon
Everyone knows that life is precious. But as you grow older, you slowly become susceptible to certain inevitable medical conditions and illnesses that require expensive treatments and medication, while some can even lead to hospitalization. In today’s day and age, affordable healthcare is out of reach for far too many people.
Most people meticulously plan their expenses so they can save a little bit of money on the side for a comfortable retirement. But even after diligent financial planning and saving their entire lives, a single medical emergency is enough to lead people to bankruptcy. On the other hand, people with disabilities are more likely to go through medical debt and financial troubles due to extensive hospital stays and medical equipment.
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This is why the government finally initiated the Medicare health insurance plan to provide people easy access to affordable healthcare. Medicare is a federal health insurance program for US citizens that are 65 years old or older. Youth with disabilities can also join this program at any time if they meet the eligibility criteria. This broad health insurance coverage covers a wide range of medical treatments and pays for prescription drugs for legal US citizens nationwide.
Medicare Part A: covers hospitalization costs
Medicare Part B: provides coverage for all outpatient doctor appointments, tests, exams, treatments, and certain medical equipment.
Medicare Part C: Also known as Medicare Advantage – will be explained in detail below.
Medicare Part D: Offers coverage for prescription drugs.
Finding the right healthcare plan that provides ample coverage for all of your specific needs and requirements is crucial to preventing any out-of-pocket expenses when you’re facing a medical emergency. This is why at Integrity Now Insurance Brokers, we make sure we’re going above and beyond for our clients to help them streamline the most comprehensive health insurance plans at competitive rates. Our team of AHIP-certified insurance agents has years of experience and can help you access the best healthcare facilities that will keep you stress-free and debt-free. Call us now to get in touch with our expert team of Medicare insurance brokers and find health insurance plans that are most suitable for you and your financial situation.
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What You Need to Know About Medicare Insurance Plans in Oregon
Medicare coverage is automatically activated once any US citizen reaches the age of 65. In addition to that, any person becomes eligible for Medicare if they have been receiving disability benefits from the Railroad Retirement Board or social security for at least 24 months, as well as those who are on regular dialysis or have had renal failure.
Original Medicare
Original Medicare or traditional Medicare includes two comprehensive coverage plans: Part A and Part B.
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Part A plans provide coverage for hospital services like lab tests, hospital inpatient treatments, hospice care, skilled nursing facilities, and other at-home healthcare options.
Part B plans cover any outpatient care, doctor appointments, in-home care, mental health, partial hospitalization, and as well as medical equipment.
If you purchase the Original Medicare health insurance, the government will cover 80% of your overall medical expenses. For 20% of the leftover coinsurance, Medicare beneficiaries can invest in a supplemental Medigap policy which is funded by private insurance companies. You will also be charged a monthly premium for Medicare Part B unless your income does not allow it.
Supplemental Healthcare – What is Medigap?
Since the Original Medicare health insurance only offers 80% coverage for all of your medical expenses, many people in Oregon like to purchase a secondary healthcare policy called Medigap.
Medigap, also known as Medicare Supplement, is a private insurance policy that covers all the gaps in the Original Medicare plan. These secondary healthcare policies are labeled from A through N.
Medigap is funded by private insurance companies that must adhere to federal regulations since each state’s insurance commissioner governs these policies.
To qualify for Medigap:
- The individual must be 65 years old or older
- Have been diagnosed with amyotrophic lateral sclerosis (ALS)
- Have been receiving disability benefits from the Railroad Retirement Board or Social Security
- Have been diagnosed with end-stage renal disease(ESRD)
Medigap insurers set their premiums in three ways.
Issue-age Rating
This approach for calculating premiums depends on the enrollee’s age at the time they apply. Enrolment premiums are cheaper for younger individuals, and the overall costs are never affected due to the person’s age.
Attained-age Rating
Many insurance companies like to use the attained-age method for calculating premiums unless they are mandated to do otherwise. These premiums are less costly for younger subscribers
Community Rating
In this method, the premiums are unaffected by the enrollee’s age. Eight states in the US have mandated this approach, but many insurance companies tend to avoid it.
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Medicare Part C – Medicare Advantage
The Medicare Advantage plan or Part C is another reliable healthcare plan that is funded by numerous private insurance companies that work under contract with Medicare. Many major companies in the US enable US citizens to have access to various premiums at competitive rates, and these services vary between different service providers.
Medicare Advantage plans also include several additional healthcare benefits like coverage for prescription drugs (Part D), vision, dental, hearing, gym memberships, and other health and wellness support programs.
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Oregon’s Medicare Advantage program offers four different types of plans:
Health and Maintenance Organization (HMO)
The HMO is a collective of medical healthcare providers who offer coverage for a variety of medical treatments by in-network physicians and hospitals that work on their terms and conditions.
HMOs require their subscribers to only receive their healthcare benefits from in-network providers.
- A primary care physician (PCP) and a specialty referral are required
- Most of their policies provide coverage for prescription medication
- Higher premiums and charges are applicable if you opt for an out-of-network provider
Preferred Provider Organization
The PPO also includes a network of recommended providers that their subscribers can choose from without the burden of paying any extra premiums.
- PCP and specialty referral are not required
- Drug coverage is included in most policies
- No extra premiums or charges apply when opting for an in-network healthcare provider.
Private Fee-For-Service (PFFS)
This healthcare program is offered by State-licensed organizations that work under contract with Medicare and Medicaid Services.
- No PCP or specialty referral required
- Prescription drug coverage is included in most policies, but you also have the option to purchase it separately.
- Higher charges and premiums apply when you choose an out-of-network provider.
Special Needs Plan
The SNP health insurance only allows membership to people with specific chronic conditions and characteristics. They offer tailored benefits, drug formularies, and provider choices that are best suited to meet the special needs of these people.
To qualify for this plan, you need to be enrolled in Medicare Part A or Part B or have a chronic condition like an autoimmune disorder, cancer, cardiovascular disease, dementia, diabetes mellitus, HIV/AIDS, or neurological disorders.
- PCP and specialty referral are required
- Plans include drug coverage
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Medicare Part D
Medicare Part D is a voluntary prescription medication benefit plan that is specifically designed to provide Medicare beneficiaries with discounted drugs. Part D plans usually charge a monthly premium, copay or coinsurance, and an annual deductible. These costs vary and depend on the plan you opt for.
Plan D Deductible
A lot of the Plan D policies have an annual deductible. The maximum deductible for Part D enrollees is $480 in 2022.
Initial Coverage Limit
Beneficiaries will be expected to pay 25% of the cost-sharing, and 75% will be covered by the plan.
Coverage Gap
Medicare Part D coverage gap begins right after your drug plan has paid for a certain amount of prescription drugs. In 2022, this limit is $4,430. This amount changes almost every year, and you will have to pay 25% of the plan’s cost for any brand-name drugs listed in your plan’s formulary.
When signing up for a health insurance plan, many people will find the process intimidating and can get overwhelmed with the number of options available. But our Medicare insurance agents are committed to simplifying things as much as they can and can help you choose well-rounded insurance plans that will provide ample coverage at competitive rates.
To learn more about the different Medicare options available in Oregon, make sure to check out our blog and learn about the step-by-step process of signing up for Medicare.
Medigap vs. Medicare Advantage
Medigap and Medicare Advantage are both funded by private insurers, and both of these plans offer their own sets of benefits. It’s best to consult with a Medicare insurance specialist and do extensive research before signing up for one of these plans.
Medigap is the best choice for individuals who are looking for a plan that helps pay for Medicare deductibles, coinsurances, and copayments. Medicare Advantage can be used as a reliable alternative to Original Medicare because along with all of Part A and Part B benefits, Part C plans also include several extra benefits like coverage for dental, vision, hearing, prescription medication, etc.
Unlike Medigap, Medicare Advantage cannot be used in conjunction with the Original Medicare.
Medigap is recommended for individuals who frequently exercise Part A and Part B benefits like to choose their healthcare providers and also want coverage for any out-of-pocket expenses.
Medicare Advantage is best for individuals who need an all-in-one solution for healthcare benefits and medication costs. Medicare Advantage also requires its beneficiaries to follow network restrictions and get a physician’s referral.
Comparing Medicare Plans in Oregon
Here are some factors you should consider before signing up for Medicare.
Provider Network
Several Medicare plans provide their enrollees with a recommended network of providers that work under contract with them. By choosing an out-of-network provider, you will have to pay extra premiums and charges that can become a huge financial burden.
Try to opt for hospitals and physicians that are a part of your health insurance plan.
Amount of Coverage Required
Make a note of all your specific needs and requirements and see if your healthcare plan covers them.
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Medicare Advantage and Medigap plans typically provide coverage for additional benefits like dental, vision, hearing, and other targeted treatments that aren’t included in Part A or Part B plans.
Check Plan Ratings
To compare plan ratings, you can check out the Part C and Part D performance data that is annually released by the Center for Medicare and Medicaid Services.
Deductibles, Copayments, and Coinsurances
These are the maximum payments you will be expected to make if you adhere to the plans in and out-of-network coverage guidelines and do not exceed the premium, deductible, and medication costs.
To compare the pricing on different plans in Oregon, contact our Oregon Medicare agents for help.
Drug Coverage
Prescription drugs are costly, and it’s best to invest in a plan that provides comprehensive coverage, so you never have to face medical debt because of purchasing prescription medication.
Find out if the drugs you’re regularly prescribed are mentioned in your plan’s formulary. If not, you can always consult your doctor to recommend an alternative or generic option that is enlisted in the formulary.
Extra Benefits
Most Medicare Advantage plans provide their beneficiaries with additional benefits that the Original Medicare doesn’t cover.
Try to note down any benefits that are crucial to your situation. You might require vision benefits, hearing benefits, dental services, transportation to doctor appointments, discounted gym memberships, and other services. Medicare Advantage plans often provide tailored benefits to meet the specific needs of chronically ill individuals.
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Why Trust Medicare Hope Insurance Agents at Integrity Now Insurance Agents?
Our team of Medicare insurance agents is a certified team of experienced insurance agents who are well-versed with the complex jargon and the dynamics of the industry. We make sure we’re going the extra mile for all of our clients and helping them land comprehensive health insurance plans that fulfill all of their needs and requirement and are within their budget.
With our assistance, countless of our clients in Oregon have received well-rounded healthcare plans provided by top-tier Medicare insurance providers across the US. We assure you that your health is our priority. With our AHIP-certified agents, you don’t ever have to worry about any lacking in your retirement plans again.
Let’s schedule a call today and get free of charge assistance with our reliable Medicare insurance agents; and we will help you compare quotes and walk with you through the intimidating process of signing up for Medicare.
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