Turning 65 is a milestone that brings many changes — including the opportunity to enroll in Medicare. For Oregon Coast retirees in Bend, Prineville, Redmond, and Sisters, navigating Medicare's alphabet soup of Parts A, B, C, and D — plus Medigap supplements — can feel overwhelming. This guide breaks it down in plain English.
Understanding Original Medicare (Parts A and B)
Original Medicare consists of two parts. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don't pay a premium for Part A if they've worked and paid Medicare taxes for at least 10 years. Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Part B has a monthly premium (adjusted based on income) and an annual deductible.
The key limitation of Original Medicare is that it doesn't cover everything — and what it does cover often comes with significant cost-sharing. Medicare Part A has a deductible per benefit period (not per year), and Part B covers only 80% of approved costs after the deductible, leaving you responsible for the remaining 20% with no out-of-pocket maximum.
The 20% Gap Can Be Significant
With a serious illness or extended hospital stay, the 20% you owe under Part B can add up to tens of thousands of dollars. Medicare Supplement (Medigap) insurance is designed to fill these gaps and protect you from catastrophic out-of-pocket costs.
What Is Medicare Supplement (Medigap) Insurance?
Medicare Supplement insurance — commonly called Medigap — is private insurance that helps pay some of the healthcare costs that Original Medicare doesn't cover, including copayments, coinsurance, and deductibles. Medigap policies are standardized by the federal government, meaning Plan G from one insurer offers the same benefits as Plan G from another — the only difference is the premium.
The most popular Medigap plans for new enrollees in Oregon are:
Plan G
The most comprehensive plan available to new Medicare enrollees (since Plan F was discontinued for new enrollees in 2020). Plan G covers everything except the Part B deductible. After you pay the annual Part B deductible, Plan G covers 100% of your Medicare-approved costs.
Plan N
Similar to Plan G but with small copayments for some office visits and emergency room visits. Plan N typically has a lower premium than Plan G, making it a good choice for relatively healthy retirees who don't expect frequent doctor visits.
High-Deductible Plan G
Offers the same coverage as Plan G but with a high annual deductible before benefits kick in. This plan has very low premiums and works well for retirees who want protection against catastrophic costs but can handle routine expenses out of pocket.
When to Enroll: The Open Enrollment Window
The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period — the six-month window that begins the month you turn 65 and are enrolled in Medicare Part B. During this period, insurers cannot deny you coverage or charge higher premiums based on your health history. After this window closes, you may be subject to medical underwriting, which can result in higher premiums or denial of coverage if you have pre-existing conditions.
Oregon has some additional consumer protections beyond federal requirements. Oregon law provides a birthday rule that allows Medigap policyholders to switch to a plan with equal or lesser benefits without medical underwriting during the 60-day period following their birthday each year. This is a valuable protection that allows Oregon retirees to shop for better rates as they age.
Medicare Advantage vs. Medigap: Which Is Right for You?
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers. It typically includes Part A, Part B, and often Part D (prescription drug coverage) in a single plan, often with additional benefits like dental and vision. Medicare Advantage plans often have lower premiums than Medigap but come with network restrictions, referral requirements, and prior authorization requirements that can limit your flexibility.
For Oregon Coast retirees who travel frequently, spend time at a second home, or want the freedom to see any Medicare-accepting provider nationwide, Original Medicare plus a Medigap plan typically offers more flexibility. For retirees who stay close to home and prefer lower premiums, Medicare Advantage may be a better fit. Our life and health insurance specialists can help you compare options based on your specific situation.
