Oregon Guide to Medicare Insurance Plans

2020

Oregon Guide to Medicare Insurance Plans

If a company is not listed, it may not be authorized

to sell insurance in Oregon, it is new, it is

suppressed, or information was unavailable by

Oct. 31, 2019, for this consumer guide.

Terms are defined in the glossary on Pages 83-87. Information supplied in this guide is in the public domain and may be copied and distributed

without permission. This guide is produced by the Department of Consumer and Business Services. This project

was supported, in part by grant number 90SAPG0022-03-00 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent

official ACL policy.

SHIBA is a statewide network of certified counselors volunteering in their community to help all Oregonians make educated Medicare decisions.

To get help

Call SHIBA: 800-722-4134 (toll-free). You will be asked to use the phone keypad to enter your ZIP code. Depending on where you live, your call may be routed to a local agency in your area or will be returned by one of the state SHIBA staff members.

If you need to talk to state SHIBA staff, do not enter your ZIP code or select * and you will be directed to the Salem office.

Learn more about SHIBA at shiba..

New to Medicare? Check out medicarestartsat65..

Be sure to get your Medicare information from a reliable source (rather than family or friends) and document the contact to protect yourself with date, time, number you called from (calls are recorded), representative with whom you spoke, and what was said. ? Social Security, 800-772-1213 for Medicare Parts A & B questions ? 1-800-MEDICARE (800-633-4227) for Part D questions

To give help

Become a SHIBA certified counselor. Call SHIBA at 800-722-4134 (toll-free). Counselors must complete an application, go through our training program, and work with a SHIBA coordinator in their community.

To apply online, go to healthcare.shiba/volunteers/Pages/volunteer.aspx.

Medicare agent locator tool

While the SHIBA program offers Medicare counseling services through a statewide volunteer network, help is also available at no cost through licensed health insurance agents. Agents can assist with recommendations and purchase of Medicare insurance plans. If you want to work with a local agent in your community, the Oregon Health Insurance Marketplace has a Medicare agent locator tool available on its website, healthcare.Pages/find-help.aspx. The agents that can be found on the tool have gone through a state certification process and have a local office available. Be sure to select "Medicare Agent" when you search.

New to Medicare?

Medicare starts at 65, no matter where you are or what you're doing. Find out how Medicare will affect you. Go to medicarestartsat65..

Basics Drug Coverage Medigap Medicare Advantage Resources Glossary

Table of contents

The Basics................................... 6-21

Your Medicare options......................................... 7 Part A ? Original Medicare hospital insurance..... 8 Part B ? Original Medicare medical insurance..... 9 The ABCs ? and D ? of Medicare...................... 10 Enrollment periods............................................. 12 Part B Medicare preventive services................. 14 Preventive visits................................................. 15 Original Medicare ? ABN and DMEPOS............ 16 Veterans' benefits and Medicare........................ 17 Retiree plans and Medicare............................... 18 Medicare and the Marketplace........................... 20

Part D prescription drug coverage........................... 22-29

Medicare Part D................................................. 22 Do I need prescription drug coverage?.............. 22 What if I have prescription coverage?................ 22 The late penalty.................................................. 22 Where do I get help choosing a prescription drug plan?.......................................................... 22 Can I switch plans?............................................ 23 Things to look for in a drug plan......................... 23 What are the out-of-pocket costs for Part D?..... 24 Can I have more than one prescription drug plan at a time?........................................... 24 Extra Help and the Medicare Savings Program.. 25 More ways to pay for prescription drugs............ 26 Part D standard benefit coverage terms............ 26 Part D standard benefit, what you pay for drugs............................................................. 27 2020 stand-alone prescription drug plans.......... 28

About Medigap plans...............30-46

What is Medigap?.............................................. 30 What do Medicare Supplement SELECT plans offer?........................................................ 30 What is an Medicare Supplement Innovative plan?................................................. 30 Policy costs differ............................................... 31

When can I buy a Medigap policy?.................... 31 Medigap for enrollees younger than age 65....... 32 Will I have to wait to use my Medigap?.............. 32 Medigap waiting periods.................................... 32

Medigap coverage outside the United States..33 Guaranteed Issue............................................... 34

What Medigap plans cover...............................35

Medicare Supplement (Medigap) policy information ............................................36 Medigap policies by plan type............................ 38 Medigap vs. Medicare Advantage Comparison chart.............................................. 46

About Medicare Advantage plans........................47-76

Medicare Advantage.......................................... 47 Who can join a Medicare Advantage plan?........ 47 Medicare Advantage election periods and enrollment actions.............................................. 47 Special Enrollment Periods (SEP)...................... 48 Help comparing plans........................................ 48 How do I select a plan?...................................... 49 Prescription drug coverage................................ 49 About Medicare Advantage dental coverage..... 50

Medicare Advantage Open Enrollment Period...................................48 Medicare Special Needs Plans (SNPs).............. 51 Medicare Advantage plan contact information... 53 Medicare Advantage plans by county................ 54 Medicare Advantage plans................................. 55

Appeals.......................................... 77

Resources and publications......... 79

Phone numbers.................................................. 80 Acronyms........................................................... 81 Index.................................................................. 82

Glossary......................................... 83

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