Medicare open enrollment: what you need to know

Medicare open enrollment, which runs from Oct. 15 to Dec. 7, is a crucial time for people in Oregon to review and adjust their Medicare health coverage for the following calendar year.

During the open enrollment period, Medicare recipients can:

• Switch between Original Medicare (Parts A and B) and Medicare Advantage plans (Part C).
• Join, switch or drop a Medicare drug plan (Part D).
• Change from one Medicare Advantage plan to another.

This year, Medicare open enrollment is even more important as many people face changes in their Oregon Health Plan (OHP/Medicaid) due to the end of the federal public health emergency. After losing OHP, people on Medicare should consider their plan choices, such as a Medicare Advantage plan, Medigap plan, or Part D prescription drug coverage. (The Medicare open enrollment window does not enable you to enroll in or make changes to your Medigap plan, but if you have Medicare and lost OHP you have a 63-day window to enroll.)

This blog will also tell you about OHP and Medicaid programs that can help with Medicare costs, which you can apply for at any time.

A Medicare Advantage plan (also known as “Part C”) is a type of Medicare plan offered by private companies. These bundled plans include Part A, Part B and usually Part D (prescription drug coverage). Initial open enrollment for MA plans runs from Jan. 1 to March 31, but you can also switch to or from an MA plan during Medicare open enrollment (Oct. 15 – Dec. 7).

When considering an MA plan, be sure to closely compare costs and benefits, as they can change from year to year, from plan to plan.

Some features of Medicare Advantage plans:

• MA plans must cover all Medicare-covered services, and may offer more benefits such as routine physicals, vision, dental or hearing.
• You will still pay the Part B premium, plus a monthly premium to the MA plan. However, some plans have a $0 premium.
• The copays and other out-of-pocket costs that differ from Original Medicare, and may cost more in some cases.
• MA plans have more limited provider networks than Original Medicare.
• MA plans limit how much you have to pay for out-of-pocket medical bills in a year. Once you reach the limit, you will not have to pay anything for covered services.

For an overview of MA Plans by county, check out the Oregon Guide to Medicare Insurance Plans (2025), starting on page 47.

Medigap, also known as Medicare Supplement Insurance, is another option to help fill the “gaps” in Original Medicare coverage.

You generally cannot sign up for Medigap during Medicare open enrollment. But if you lost OHP and have Medicare, you have a 63-day window after losing OHP when you can sign up for a Medigap plan.

Medigap plans help pay for:

• Medicare Part A and Part B out-of-pocket costs, such as copays and deductibles.
• Skilled nursing facility care costs (after deductibles are met).

The costs for Medigap plans vary widely depending on the plan, your age, where you live, etc. These plans limit how much you have to pay for out-of-pocket medical bills in a year. Once you reach the limit, you will not have to pay anything for covered services for the rest of the year.

OHP/Medicaid has programs that can help people who also have Medicare and limited income. Having one of these programs may affect your Medigap plan choices. To learn more, please see the OHP/Medicare section section below.

Part D plans typically cover brand-name and generic prescription drugs, commercially available vaccines not covered by Part B (such as the RSV vaccine), and some drugs administered in a doctor’s office or hospital outpatient setting.

Part D features for 2025 include:

• Monthly premiums ranging from $0 to $110.
• An annual deductible of $590 for covered drugs. Copays vary by plan and medication.
• Maximum out-of-pocket limit of $2,000. Once you reach the maximum, you will not have to pay anything for covered drugs.

If you need help paying for a Part D plan, you may qualify for a Medicare Part D Low Income Subsidy (LIS, or Extra Help), which could save an individual several thousand dollars per year. See page 32 of the Oregon Guide to Medicare Insurance Plans (2025).

Oregon Health Plan (OHP) is Oregon’s version of Medicaid — free health coverage for people who meet income and other requirements. You can have both OHP/Medicaid and Medicare at the same time. However, the rules to get OHP change when you qualify for Medicare.

If you lost OHP, please review your notice to make sure the information used to decide you no longer qualify was correct. You can always reapply if something has changed. You can also request a hearing. Losing OHP also gives you a special enrollment period to sign up for or change your Medicare coverage.

Beyond OHP, there are other Medicaid programs that can help people who also have Medicare. You can apply for these programs any time of year:

Medicare Savings Programs (MSP)

If you have Medicare but don’t qualify for full OHP benefits, you may still qualify for a Medicare Savings Program, which can help pay your Medicare costs. There are two types of programs depending on how much you earn:

• Qualified Medicare Beneficiary (QMB) provides secondary Medicaid coverage that pays your Medicare premiums and out-of-pocket costs. QMB benefits will typically cover the same costs that Medigap would. If you qualify for QMB, a Medigap plan is unnecessary, but you can still consider a Medicare Advantage plan.
• Part B Premiums only: For most Medicare members, the Part B premium is automatically taken out of their Social Security check. If you qualify, this type of MSP can pay that for you. This type of MSP does not provide additional benefits beyond paying the premium, so it does not replace a Medigap or Medicare Advantage plan.

Additionally, having an MSP automatically qualifies you for the Medicare Part D Low Income Subsidy (LIS, or Extra Help), which helps pay for prescription drugs. This could save you several thousand dollars per year.

Many people don’t realize they qualify for Medicare Savings Programs. For example, in 2024, a single individual with monthly income below $1,715, or below $2,320 for a couple, could qualify for help paying their part B premiums.

Long-term care benefits

If you need in-home care such as bathing, dressing or using the bathroom, or need care in a facility such as a nursing home, Medicaid can provide significant help with these long-term services and supports (LTSS). LTSS can help people stay in their homes and maintain their independence much longer.

If you need help with these daily tasks, be sure to answer “yes,” that you need this help, when applying. You will then have an interview with a worker to assess your needs. The need for LTSS can help you qualify for full OHP benefits on top of your Medicare benefits, even if your income or assets are above the usual OHP limits. However, there are many additional requirements to qualify for LTSS. Don’t hesitate to discuss your daily living needs during the application process.

Dual Eligible Special Needs Plans (D-SNPs)

D-SNPs are a type of Medicare Advantage plan designed for people with both Medicare and OHP and who have more complex needs. These plans can offer additional benefits beyond what Original Medicare provides, often at little to no cost to you, such as dental, vision, hearing, as well as transportation to medical appointments. All D-SNPs offer prescription drug coverage (Medicare Part D).

D-SNPs are specifically designed to work well with your local coordinated care organization (CCO) that administers your OHP benefits. CCOs offers D-SNP plans through an affiliated health insurance company.

Your local Oregon Department of Human Services (ODHS) office can help you find out if you qualify for a D-SNP. They can also tell you which CCO you have. If you can get a D-SNP, the next step is to contact your CCO to learn more and enroll.

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Remember, Medicare open enrollment is your chance to make sure you have the best coverage for the coming year. Take the time to review your options, seek help if needed, and make informed decisions about your health coverage.

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• Oregon Guide to Medicare Insurance Plans (2025)
• Medicare and the Oregon Health Plan (OHP)
• 10 Medicare myths: Understand the truth behind some of the many myths surrounding Medicare.
• Aging and Disability Resource Connection of Oregon (ADRC) specializes in helping people who are aging or with disabilities to find resources in Oregon, such as medical care, food supports, housing, transportation and more. Call 855-673-2372.
• Medicare.gov is the official U.S. government site for Medicare and provides comprehensive information and tools to help you compare plans. Call 800-MEDICARE (800-633-4227).
• Oregon Health Insurance Marketplace: If you’re not eligible for free Medicare part A based on work history, you may be able to get coverage through the Marketplace. Call 855-268-3767.