By Lynne Terry/Oregon Capital Chronicle
State officials are offering free help enrolling in insurance to 1 million Oregons who qualify for Medicare or buy health insurance on the federal marketplace.
Open enrollment for Medicare, available to those at least 65 years old or receiving Social Security disability benefits, started Oct. 15 and runs through Dec. 7, while open enrollment for buying individual plans starts Nov. 1 and runs through Jan. 15. Only a fraction of Oregonians buy their own insurance — about 145,500 — while more than 930,000 people are on Medicare.
During open Medicare enrollment, people can enroll for the first time or change their plan, including a prescription drug plan — Medicare Part D — or switch between Medicare Advantage and original Medicare. Health insurance is complicated and there are a lot of options. The Department of Human Services has five staff members and works with nearly 160 volunteers around the state to help people sort through them and avoid scams.
Through this year, most Medicare prescription plans have a “donut hole” or coverage gap for prescription drugs, but the Inflation Reduction Act, signed in 2022, closed the gap for Medicare policies starting in 2025. Also next year, Medicare plans will cap out-of-pocket expenses for prescriptions at $2,000. The DHS specialists also can explain coverage for weight loss drugs, expanded family caregiver coverage and increased access to mental health services.
For individual plans, the state has revamped its Window Shopping tool this year to make it easier to explore insurance options and curb costs, according to an Oregon Health Authority news release. The tool compares plans, previews out-of-pocket costs and checks whether plans cover certain providers, facilities and prescription drugs. And it’s not just limited to individual plans but can help people with the Oregon Health Plan or Medicaid, the new OHP Bridge Plan for lower income people who earn a bit more than what’s allowed under Medicaid, Medicare and the federal marketplace for an individual plan.
The health authority has 1,700 free specialists to help people with their Medicaid and marketplace applications in English and other languages.
The marketplace offers federal tax subsidies, and more than 80% of enrollees benefit, according to Amy Coven, a health authority spokesperson. The federal government offers an average tax credit of about $525 a month, bringing monthly premiums down to an average of about $165.
Get Help
- For general Medicare help, go to shiba.oregon.govor call 800-722-4134.
- For local help, go to shiba.oregon.gov/get-help/Pages/help-near-you.aspx.
- For marketplace help, go to OregonHealthCare.gov.
- Call 800-699-9075 with application questions.
- Call 800-273-0557 for coverage questions.
This story first appeared in the Oregon Capital Chronicle.
