In general, Medigap works the same way in Oregon as it does in most other states, except for one special regulation: the Medigap Birthday rule. This buyer’s guide will help you learn about this and other Medigap rules for residents of the Beaver state.
How does Medigap work in Oregon?
Just like in most states, Medigap is a standardized type of private insurance that is designed to supplement Original Medicare (Medicare Part A and Part B). The main purpose of Medigap is to help cover out-of-pocket costs such as deductibles, co-payments, and coinsurance.
In Oregon, as in other states, Medigap policies are standardized and identified by letters (Plan A, Plan B, Plan C, etc.) Scroll below to see full chart.
The benefits of each Medigap plan are the same, regardless of the insurance company offering the plan. This means that a Medigap Plan G offered by one insurance company in Oregon will have the same benefits as a Medigap Plan G offered by another company in the state.
Who is eligible to buy Oregon Medigap Coverage?
Individuals who meet the following criteria may buy an Oregon Medigap policy:
- 65 years of age or older: All Medigap plans available in the area are open to enrollment.
- Under 65 due to a disability: Although Medigap plans must be made available, not all plans may be offered and the cost of coverage may be higher. Further information regarding Medigap coverage for individuals under 65 years of age can be obtained here in our Medigap for Under 65 article.
When is the ideal time to buy an Oregon Medigap Plan?
It is strongly recommended that individuals enroll in an Oregon Medigap plan as soon as they enroll in Medicare Part B. The best rate for coverage is guaranteed for individuals who apply within a 3-month period prior to becoming eligible for Medicare and within 6 months after. This is known as the Initial or open enrollment period and is not an annual event.
It is important to note that failure for Oregon residents to enroll in a Medigap plan during the Initial Open Enrollment period may result in increased premiums, denial of coverage for pre-existing conditions, or denial of coverage altogether.
Please be advised that if you are continuing to work and have credible coverage through your employer, you may choose to delay your enrollment in a Medigap plan.
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Oregon Buyers Perk: Medigap Birthday Rule
Most states require many on Medicare to apply and answer health questions to switch Medigap plans beyond their initial enrollment. Oregon, however, uses the Medicare “birthday rule” for Medigap insurance which is only available in a few states. The Oregon Medigap birthday rule begins on your date of birth and ends 30 days following. During this time, OR residents have the guaranteed right to switch to another Medigap policy without having to answer any health questions or being charged more due to pre-existing conditions. Those that are eligible can switch to an equal or lesser plan with the same insurance provider or a competitor during the birthday rule period.
This means that if you buy a new Medigap policy within 30 days of your birthday, insurance companies cannot deny you coverage or charge you more for any health problems you have. After this 30-day period, insurance companies may still sell you a Medigap policy, but they can use medical underwriting to decide whether to accept you and what rate to charge you. The Ultimate Guide to the Medigap Birthday Rule: Every State Edition.
Do Oregon Medigap plans pay for Prescription Drugs?
It’s worth noting that those buying Medigap policies in Oregon and other states do not receive prescription drug costs. Prescription Drugs are covered by a separate policy called Medicare Part D.
You can purchase prescription drug plans from private insurance companies and compare prices for the best price and plan that meets your needs.
Chart Oregon Medigap plans
| Benefits | A | B | D | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| Medicare Part A Deductible ($1,632) | 100% | 100% | 100% | 50% | 75% | 50% | 100% | |
| Part B Deductible ($240) | ||||||||
| Medicare Part A Hospital Coinsurance and 365 additional hospital days | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B Coinsurance | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| First 3 Pints of Blood for a Transfusion | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part A Hospice Coinsurance or Copay | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility Coinsurance | 100% | 100% | 50% | 75% | 100% | 100% | ||
| Medicare Part B Excess Charges | 100% | |||||||
| Foreign Emergency Healthcare | 80% | 80% | 80% | 80% | ||||
| Max Out-of-Pocket | $7,060 | $3,530 |
*Medigap Plan G High deductible ($2,800) is also available. Note: Plan F and Plan C are not featured on this chart as they are no longer available to those new to Medicare.
Oregon Medicare Excess Charges
Part B Excess charges occur when doctors exceed Medicare’s approved amount. If they reject Medicare assignment, they can legally charge up to 15% more. Fortunately, Medigap plan G covers 100% of excess charges, relieving you from paying these extra fees. For more details, check out our article “How to Avoid Medicare Excess Charges.“
Oregon Medigap Discounts
Oregon Medigap plan providers may offer discounts to save on your monthly premium cost. The following options are available:
Next steps with Oregon Medigap
If you’re turning 65 and enrolling in Medicare Part B in Oregon, it’s a good idea to shop around for the best Medigap policy that fits your needs and budget. Contact our team here at Senior65.com to review your options and enroll in a plan. There is no hidden charge to work with Senior65.com and no one can offer the same Medigap plan for less than us.