Medicare in Oregon: Plans and Coverage (2026)

Medicare in Oregon runs on federal rules, with two state advantages worth knowing: no asset test for its Medicare Savings Programs, and a Medigap birthday rule you can use every year.1,2

Oregon applies no asset or resource test to its Medicare Savings Programs, so cost help is based on income alone, and its Medigap birthday rule gives you a yearly chance to switch supplement companies, guaranteed regardless of your health.

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 through December 31. Medicare costs change every year, so once a new year starts, check that CMS fact sheet or medicare.gov for the updated figures.3 To talk through your own coverage with a person, call Medicare at 1-800-633-4227 (1-800-MEDICARE), which reaches a representative 24 hours a day, 7 days a week except some federal holidays (TTY 1-877-486-2048), or Oregon SHIBA at 1-800-722-4134.9,8

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.10

The hospital deductible applies per benefit period, not per calendar year.3 A benefit period begins the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a skilled nursing facility. 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.11 Original Medicare doesn't cover routine dental, vision, or hearing care, apart from narrow medically necessary exceptions. Many Medicare Advantage plans add them, but not all, so check the specific plan.12,13

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $283
• After the deductible: 20% of the Medicare-approved amount for most services

Delaying Part B without qualifying for a Special Enrollment Period or a Medicare Savings Program carries a permanent late penalty: 10% added to your premium for every 12 months you could have had it but didn't, for as long as you keep Part B.14 Creditable drug coverage is a Part D term and does not excuse a late Part B enrollment.14

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 and some clinical-trial costs, which Original Medicare continues to cover. Most plans bundle Part D drug coverage along with extras like dental, vision, and hearing.13

The plans you can join depend on where in Oregon you live, because you must live in a plan's service area to enroll.15

How These Plans Work

• You still pay your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage plan premium at about $14 a month in 2026, and many plans charge $0 extra. CMS notes that some plans may have a $0 premium and may help pay all or part of your Part B premium, so check that on the plan's benefit summary.3,13
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in the plan's network or outside it.13
• Plans may require prior authorization (plan approval) before covering certain services; Original Medicare generally does not.13
• 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 yearly out-of-pocket limit unless you have supplemental coverage such as Medigap, Medicaid, or employer, retiree, or union coverage.13

Use the Medicare Plan Finder at medicare.gov to compare the plans offered where you live side by side.16 Enter your doctors and prescriptions to see which plans cover them and your estimated costs.

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:4

1. Deductible: you pay full price up to your plan's deductible (up to $615 in 2026).17
2. Initial coverage: in the standard benefit, you pay 25% coinsurance until your out-of-pocket spending reaches the yearly cap.17
3. Catastrophic: once your out-of-pocket drug spending hits $2,100, you pay $0 for covered drugs the rest of the year.4

The $2,100 cap is the headline number for 2026 (up from $2,000 in 2025). The average standalone Part D premium runs roughly $34.50 a month, though actual premiums vary by plan.3 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.4 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. A Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.13

Oregon follows the standard federal Medigap framework, offering plans A-D, F, G, and K-N.5 The benefits inside each letter are standardized, so Plan A is the same from one company to the next and they compete on price and service.2 Plans C and F can't be sold to people new to Medicare, meaning they turned 65 and got Part A on or after January 1, 2020. If disability or End-Stage Renal Disease (ESRD) gave you Part A before 2020, or you were eligible then but never enrolled, you may still be able to buy one.5,6 Plan G is their option in place of Plan F: it covers the same benefits as Plan F except the annual Part B deductible ($283 in 2026), including the Part A deductible, Part A and Part B coinsurance, skilled nursing coinsurance, and Part B excess charges.7,3

Your best chance to buy Medigap on guaranteed terms is the federal Open Enrollment Period, the one-time six-month window that starts the first month you are both age 65 or older and enrolled in Part B. During that window, an insurer can't refuse to sell you any plan it offers, can't use medical underwriting to deny you for pre-existing health problems, and can't charge you more because of your health. One limit: an insurer can delay covering a pre-existing condition for up to 6 months, unless you had 6 months of continuous prior creditable coverage.7 Outside that window, Oregon insurers can review your health history, charge more, or decline to cover you.

Oregon also has a Medigap birthday rule. Starting 30 days before your birthday and ending 30 days after, you can compare prices and apply to switch companies, and the change is guaranteed regardless of your health, as long as you keep the same plan type or move to one with lesser benefits. It applies only to Medicare supplement policies issued after January 1, 1990, and new coverage typically begins the first of the month following your application; self-funded employer-sponsored group Medigap plans are not eligible. It sits on top of the federal six-month Open Enrollment Period, not in place of it.2 Medigap is one of the topics Oregon SHIBA covers, and its counseling is free.8

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) as Medicaid programs that cover some or all of your Medicare premiums and cost-sharing based on income.1

Oregon's standout is what it leaves out. ODHS states it plainly: "There are no asset limits for these programs in Oregon."1 The federal resource limits are $9,950 for an individual and $14,910 for a couple in 2026, but Social Security's manual notes that "some states have used this authority to effectively eliminate resources tests."1 Oregon is one of them, for all four of its programs, so no amount of savings or property puts you over a resource limit. Income limits are effective March 2026 through February 2027 and update each March.1

Do not stop at the first three. ODHS publishes four programs, and QDWI's limit, 200% of the federal poverty level, is exactly twice the QMB figure. ODHS scopes it to "disabled workers who lost Social Security disability benefits because they are working and are not eligible for another Medicaid program," and points those who need full coverage to Oregon's separate Employed Persons with Disabilities program instead. So an Oregonian whose income clears the QMB, SLMB, and QI figures has not necessarily run out of routes. The $20 reconciliation explained below applies to QMB, SLMB, and QI only; QDWI's federal figure is built on a different basis, so do not add $20 to it. Every applicant must also hold Medicare Part A.1

Two conditions come with QI, and ODHS states both. Enrollment is capped: "We are only allowed to serve a certain number of people each year for the SMF benefit. Unfortunately, we must shut down enrollment if we reach our limit." And anyone with other Oregon Medicaid is barred: "If you are eligible for any other Medicaid benefit offered by the State of Oregon, you are not eligible for the SMF benefit."1

Why you'll see two different sets of numbers

Don't rule yourself out if your income lands just over one of these limits. ODHS publishes the smaller figure in each pair above, because it lists the poverty-level amount itself: $1,330 a month for a QMB individual, which is 100% of the federal poverty level.1

So both numbers are right; they're just measured at different points. Social Security's own manual publishes the QMB limit as $1,350 for an individual and $1,824 for a couple, listing it under the heading "100% FPL + $20". That is the same limit ODHS describes, with the $20 SSI general income exclusion already added. If your monthly income is $1,340, ODHS's $1,330 figure makes it look like you've missed QMB by $10. You may not have: income up to $20 above the ODHS figure may still qualify. Social Security instructs its own staff on exactly this point, telling them that "even if the individual's income or resources appear somewhat higher than the state limits, encourage them to apply."1

The practical rule: if you're anywhere near these numbers, apply, and let ODHS run the math. Oregon SHIBA counsels on Medicare cost help free of charge if you want to go over your numbers first.8

QMB is the most comprehensive, and federal law bars providers from billing a QMB enrollee for Medicare cost-sharing.1 QI must be applied for again every year. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D; QDWI does not.1

Here's how to apply:

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, helps pay Part D premiums (up to a regional benchmark amount), deductibles, and copays for people with limited income and resources. Since 2024 there is only one full-subsidy tier; the partial tier is gone.18

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher). Those are one- and two-person figures; supporting relatives who live with you can raise your limit, and SSA excludes some earned income and all interest and dividends, so apply rather than rule yourself out18
• Resource limits: $18,090 for an individual, $36,100 for a married couple living together; the lower $16,590 and $33,100 limits apply only if you report that none of your resources will be used for funeral or burial expenses. Your home, car, and personal belongings don't count18
• Full Extra Help enrollees pay no more than $5.10 per generic and $12.65 per brand-name covered drug in 2026, and that is a ceiling: full-benefit dual eligibles at or below 100% of the poverty level pay $1.60 and $4.90, or $0 if they are institutionalized or receiving home and community-based services18
• Enrolling in QMB, SLMB, or QI qualifies you automatically18

Apply through Social Security at ssa.gov or call 1-800-772-1213.18

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.19

Changes made during Annual Open Enrollment take effect January 1 of the following year.19 If you start receiving Social Security benefits at least 4 months before you turn 65, you're enrolled in Parts A and B automatically; otherwise, you sign up through the Social Security Administration.19

Working past 65 with employer coverage? You can delay Part B without penalty and have an 8-month Special Enrollment Period counted from the month that job or employer coverage ends, whichever comes first. COBRA and retiree coverage don't count for this purpose, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).20 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 (ODHS). It's Oregon's version of the federal State Health Insurance Assistance Program. SHIBA counselors are trained volunteers who give free Medicare information and counseling.8

SHIBA's published Medicare topic areas include:

• Medicare Advantage plans
• Medigap plans
• Prescription drug (Part D) plans
• Financial help with Medicare costs

Call the statewide helpline at 1-800-722-4134 or visit shiba.oregon.gov to find local counseling near you.8

Key Oregon Medicare Contacts

Learn More

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.