A Guide to Understanding Medicare Supplement Plans in Bend, Oregon

If you're approaching age 65, already enrolled in Medicare, or helping a loved one navigate their health insurance options, you've likely heard the term "Medigap." Feeling a bit confused about what these plans are and how they work? You're not alone!

Original Medicare (Part A for hospital stays and Part B for outpatient care and doctor visits) covers many health care costs, but not all of them. That's where Medicare Supplement Insurance, also called Medigap, comes in. These insurance plans, sold by private insurance companies, help pay for some of the out-of-pocket costs that Original Medicare doesn't cover, like deductibles, copayments, and coinsurance. Don’t navigate Medicare alone. Let Mountaintop Insurance Solutions help you understand Supplement plans in Bend. Contact us today (541) 641-8886 to get a free quote.

Understanding Original Medicare's Gaps

Before we talk about Medigap, let's quickly remember what Original Medicare covers... and what it leaves for you to potentially pay:

Part A Deductible: You pay a deductible for each hospital benefit period.
Part A Coinsurance: You pay daily coinsurance for longer hospital stays.
Part B Deductible: You pay an annual deductible for Part B services.
Part B Coinsurance: After your deductible, you typically pay 20% of the Medicare-approved amount for most outpatient services and doctor visits.
Prescription Drugs: Original Medicare generally doesn't cover most prescription drugs you take at home.

These medical costs can add up quickly, especially if you have ongoing health conditions. That’s why many Medicare recipients look for additional coverage.

What is Medicare Supplement (Medigap)?

Medigap plans are specifically designed to fill those cost-sharing "gaps" in Original Medicare. Here's what you need to know:

Works with Original Medicare: You must be enrolled in Medicare Part A and Part B to buy a Medigap policy. It supplements your Original Medicare coverage; it doesn't replace it.
Standardized Plans: This is key! Medigap plans are standardized by the Centers for Medicare & Medicaid Services (CMS). This means that plans labeled with the same letter (e.g., Plan G, Plan N) offer the exact same basic benefits regardless of which insurance company sells it. A Plan G from Company X has the same core Medicare coverage as a Plan G from Company Y. This makes it easier to compare Medicare plan options.
Freedom of Choice: With Original Medicare plus a Medigap plan, you can generally see any doctor or use any hospital in the U.S. that accepts Medicare. There are typically no network restrictions like you might find with Medicare Advantage plans.
Doesn't Include Prescriptions: Most Medigap plans sold today do not include prescription drug coverage. You'll likely need to enroll in a separate Medicare Part D plan for your Medicare prescription drug needs.
Private Insurance Companies: You buy Medigap policies from private insurance companies offering plans throughout Oregon.

Medigap vs. Medicare Advantage in Oregon

It's crucial to understand the difference:

Medigap: Works with Original Medicare. Helps pay cost-sharing gaps. Doesn't usually include drug coverage. Wide provider choice.
Medicare Advantage (Part C): An alternative way to get your Medicare coverage (Part A, Part B, often Part D). Medicare Advantage plans are offered by private companies. They often have lower monthly premiums and may include extra benefits (like dental/vision), but usually require you to use a network of doctors and hospitals. You cannot have both a Medicare Advantage plan and a Medigap policy at the same time.

Deciding between Medicare Advantage and Medigap is a fundamental choice when considering your Medicare options in Oregon.

Choosing the Right Medigap Plan in Bend

Since the coverage details for each lettered plan are standardized, choosing involves these steps:

Decide Which Plan Letter Fits Your Needs: Look at the different standardized plan options (e.g., Plan A, B, D, G, K, L, M, N – availability can vary, and Plan F/C aren't available for those new to Medicare on or after January 1, 2020). Compare what each plan covers in terms of deductibles, coinsurance, etc.
- Example: Plan G is very popular as it covers most gaps except the annual Part B deductible. Plan N offers lower premiums but requires some copays for doctor/ER visits. Consider your health and lifestyle and tolerance for potential out-of-pocket costs.
Compare Premiums: Once you've chosen a letter (like Plan G), compare the monthly premium for that specific plan letter from different insurance companies offering plans in Oregon. Prices for the exact same coverage can vary significantly between companies.
Consider Company Reputation: Look at the insurance company's financial stability and customer service record.

When to Enroll: The Magic Window

The absolute best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. This is a one-time, 6-month period that starts the first month you are 65 or older and enrolled in Medicare Part B.

Why it matters: During this period, insurance companies cannot deny you coverage or charge you a higher premium based on your health conditions. You have "guaranteed acceptance."
Outside this window: It can be much harder, or impossible, to get a Medigap policy, or you might be charged more due to your health. There are some situations that trigger a Special Enrollment Period, but the open enrollment period is your golden opportunity.

Don't confuse this with other Medicare enrollment periods like the Annual Election Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). While important for Part C and Part D plans, your Medigap Open Enrollment is unique.

Getting Medicare Help in Bend and Central Oregon

Navigating Medicare eligibility and plan options can be easier with help! Oregonians have great Medicare resources:

SHIBA (Senior Health Insurance Benefits Assistance Program): This is Oregon's official State Health Insurance Assistance Program. SHIBA provides free, unbiased Medicare help from trained Medicare counselors. They can explain all types of Medicare plans (Original Medicare, Medicare Advantage or Part C, Medigap, Part D), help you compare plans, screen you for cost-saving programs like Extra Help, and assist with enrollment. They are not affiliated with any insurance company.
Council on Aging of Central Oregon: Located right here, the Council on Aging of Central Oregon often partners with SHIBA and provides local Medicare counselors and resources for seniors and people of all ages needing Medicare help. They can help you make informed decisions.
Medicare.gov: The official Medicare website is a valuable resource for comparing Medicare plans available in Oregon and getting general coverage information.

Making Your Choice

Choosing a Medicare Supplement plan in Bend is about finding the balance between the coverage you want and the premium you're comfortable paying. By understanding how Medigap works with Original Medicare and utilizing local Medicare help resources like SHIBA and the Council on Aging of Central Oregon, you can confidently select a plan that supports your health coverage needs for 2024, 2025, and beyond. Take the time to explore your options and complete your enrollment when the time is right. Get the right Medicare Supplement plan in Bend—call Mountaintop Insurance Solutions e (541) 641-8886 for a free consultation!