Medicare in Oregon: Plans and Coverage (2026)

Medicare in Oregon follows federal rules, with one standout: Oregon's SLMB covers incomes up to 200% FPL (about $2,660/month), far above the standard 120% threshold in most states.

This guide covers Medicare in Oregon for 2026: what each part costs, how to choose between Original Medicare, Medicare Advantage, Medigap, and Part D, and the programs that can lower the bill.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Oregon (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Oregon
• Help Paying for Medicare in Oregon
• Medicare Enrollment Periods
• Free Medicare Help: Oregon SHIBA
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Oregon SHIBA at 1-800-722-4134.

Original Medicare: Parts A and B

Original Medicare is the federal program administered directly by CMS. The costs are the same in Oregon as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.

The hospital deductible applies per benefit period, not per calendar year. A benefit period begins the day you're admitted and ends 60 days after you're discharged. If you're readmitted after that gap, the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services. It doesn't cover routine dental, vision, or hearing.

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: 20% of the Medicare-approved amount for most services

Delaying Part B without other creditable coverage carries a permanent late penalty: 10% added to your premium for every 12 months you could have had it but didn't.

Medicare Advantage in Oregon (Part C)

Medicare Advantage plans are sold by private insurers approved by CMS. They cover everything Parts A and B do, except hospice, which Original Medicare continues to cover. Most plans bundle Part D drug coverage along with extras like dental, vision, and hearing.

Oregon's plan availability varies considerably by geography. The Portland metro area and the Willamette Valley (Eugene, Salem, Corvallis) tend to have wide selection across both HMO and PPO plan types. Rural areas in Eastern Oregon and along the Southern Oregon coast typically have fewer options, with some counties offering one or two plans. Plan availability, networks, and prices change every year and vary by county, so compare what's actually offered at your ZIP code before enrolling.

How These Plans Work

• You still pay your Part B premium ($202.90) on top of any plan premium. CMS estimates the average MA plan premium at about $14 a month in 2026, and many plans charge $0 extra.
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling.
• Plans typically require prior authorization for certain services; Original Medicare generally does not.
• Every plan caps your annual in-network out-of-pocket spending at no more than $9,250 in 2026 (many plans set it lower). Original Medicare has no such cap.

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions to see which plans cover them and your estimated costs. Oregon SHIBA counselors can walk you through the results for free.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs, available either as a standalone plan alongside Original Medicare or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the donut hole, so Part D now moves through three phases:

1. Deductible: you pay full price up to your plan's deductible (up to $615 in 2026).
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket drug spending hits $2,100, you pay $0 for covered drugs the rest of the year.

The $2,100 cap is the headline number for 2026 (up from $2,000 in 2025). The average standalone Part D premium is about $46.50 a month, though actual premiums vary by plan. Every plan must offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into monthly payments across the year instead of paying in full at the pharmacy. People who qualify for Extra Help often pay much less, sometimes nothing. See Medicare Part D for a deeper look at plan comparison.

Medigap in Oregon

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, not with Medicare Advantage.

Oregon follows the standard federal Medigap framework, offering plans A through N regulated by the Oregon Insurance Division. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the most popular option for newly eligible beneficiaries: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 annual Part B deductible on you.

Your primary opportunity to buy Medigap on guaranteed terms is the federal Open Enrollment Period, the six-month window that begins when you're both 65 and enrolled in Part B. During that window, an insurer must sell you any plan at the standard rate regardless of your health. Outside that window, Oregon insurers can use medical underwriting: they can review your health history, charge more, or decline to cover you.

Oregon does not have a state-specific Medigap birthday rule or guaranteed-issue expansion beyond the federal OEP. If you're considering Medigap, the six-month window at 65 is your best opportunity. A SHIBA counselor can compare carriers and premiums with you at no cost.

For a side-by-side look at Medigap versus Medicare Advantage trade-offs, see our guide to Original Medicare vs. Medicare Advantage. More detail on plan letters and benefits is at How Medigap Works.

Help Paying for Medicare in Oregon

Two programs can meaningfully reduce Medicare costs for Oregonians with limited income.

Oregon Medicare Savings Programs

Oregon administers its Medicare Savings Programs through the Oregon Department of Human Services (ODHS). The programs cover some or all Medicare premiums and cost-sharing based on income and resources.

Oregon's standout is the SLMB program. Where the federal standard sets SLMB eligibility at 120% FPL, Oregon expands it to 200% FPL, roughly $2,660 a month for a single person or $3,607 for a couple. That higher ceiling means substantially more Oregonians qualify for Part B premium help than they would under the federal baseline. Income limits are effective March 2026 through February 2027 and update each March.

QMB is the most comprehensive: it covers your Part A and B premiums and all Medicare cost-sharing (deductibles, coinsurance, copays), and federal law bars providers from billing a QMB enrollee for that cost-sharing. The 2026 resource limit for all three programs is $9,950 for one person and $14,910 for a couple.

Apply through ODHS or with help from a SHIBA counselor. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 there is only one full-subsidy tier; the partial tier is gone.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
• Resource limits: $16,590 for an individual, $33,100 for a married couple
• Full Extra Help enrollees pay no more than $5.10 per generic and $12.65 per brand-name covered drug in 2026
• Enrolling in QMB, SLMB, or QI qualifies you automatically

Apply through Social Security at ssa.gov or call 1-800-772-1213.

Medicare Enrollment Periods

Miss a deadline and you may face a coverage gap or a permanent penalty. The enrollment windows below are federal and apply the same in Oregon as everywhere else.

Changes made during Annual Open Enrollment take effect January 1 of the following year. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically; otherwise, you sign up through the Social Security Administration.

Working past 65 with employer coverage? You can delay Part B without penalty and have an 8-month Special Enrollment Period after that employer coverage ends. COBRA and retiree coverage don't count for this purpose. See Medicare Enrollment Periods for the full breakdown.

Free Medicare Help: Oregon SHIBA

You don't have to figure this out alone. Oregon runs SHIBA (Senior Health Insurance Benefits Assistance) through the Oregon Department of Human Services Aging and Disability Services division. It's Oregon's version of the federal State Health Insurance Assistance Program. SHIBA counselors are trained volunteers who give free, unbiased help and don't sell insurance.

A SHIBA counselor can help you:

• Understand what each part of Medicare covers and what it costs
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Review claims, denials, and appeals

Call the statewide helpline at 1-800-722-4134 or visit shiba.oregon.gov to find local counseling near you.

Learn More

• Oregon Medicare Supplement (Medigap) and the birthday rule
• Medicare: The National Guide
• Original Medicare vs. Medicare Advantage
• How Medigap Works
• Medicare Part D Drug Coverage
• Medicare Enrollment Periods

Find personalized help comparing your Medicare plan options in Oregon at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.