Who qualifies for Medicare?
Medicare is generally available to:
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U.S. citizens and lawful permanent residents
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Who are age 65 or older
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As well as to some younger individuals with qualifying disabilities or End-Stage Renal Disease.
If you do not qualify for Medicare, you may be eligible for health coverage through the Marketplace. Learn more about Marketplace Health Insurance in Oregon.
We have access to a wide range of insurance options in Oregon.
*We do not offer every plan available in Oregon. For 2026 we represent 9 organizations which offer 40 Medicare Advantage plans and dozens of Medicare Supplements in Lane County. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options..
Click here to request an Insurance Quote today.
• Medicare Basics for Oregonians
Once Oregonians understand the basics, it's much easier to select the right plan for you.
The Four Parts of Medicare
Part A
Coverage
Inpatient Hospital
Skilled Nursing*
Home Health
Hospice Care
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Requirements
Must be 65 years old or have a qualifying disability​
Administered By
The US Government
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Cost
$0**
*for a limited time and under specific circumstances
**Most people pay $0. Others will pay more depending on how long they've paid Medicare taxes.
Part B
Coverage
Doctor Visits
Outpatient Rehab
Urgent Care
Durable Med. Equipment
Outpatient Hospital
Lab Tests & X-Rays
Preventative Services
Ambulance Services
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Requirements
Must be 65 years old or have a qualifying disability
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Administered By
The US Government
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Cost
$202.90 (2026)*
*People with higher incomes can be required to pay more. People with low incomes may have this paid by the state.
Part C
Coverage
An "all in one" coverage that bundles everything from Parts A and B and sometimes Part D
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Requirements
Must be enrolled in Part A and B to enroll
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Administered By
Private Companies
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Cost
Vary by plan*
*Private companies offer plans at different costs and some low-income individuals can receive help with these costs in some situations.
Part D
Coverage
Helps cover the cost of prescription drugs
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Requirements
Must have Part A or B to enroll
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Administered By
Private Companies
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Cost
Vary by plan*
*Private companies offer plans at different costs and some low-income individuals can receive help with these costs in some situations.
Understanding IRMAA
What higher-income Oregonians should know about Medicare surcharges
IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that some Medicare beneficiaries pay in addition to the standard Medicare Part B and Part D premiums. Whether you pay IRMAA in a given year is based on the Modified Adjusted Gross Income (MAGI) from your tax return two years prior.
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For example, for 2026, Medicare looks at your 2024 MAGI. MAGI is generally your Adjusted Gross Income (AGI) from your federal return plus any tax-exempt interest income (such as interest from municipal bonds).
Important things to know about IRMAA
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IRMAA is a 'cliff' surcharge. Going one dollar over a threshold places you in the next higher bracket for the full year.
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Surcharges apply to both Original Medicare and Medicare Advantage enrollees.
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The Part B surcharge is typically deducted from your Social Security check. The Part D surcharge is billed separately by Medicare, not by your Part D plan.
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If you have experienced a life-changing event (such as retirement, marriage, divorce, death of a spouse, or loss of pension income), you may appeal using Social Security Form SSA-44.
2026 IRMAA Brackets (based on 2024 MAGI)
Source: Centers for Medicare and Medicaid Services (CMS) 2026 Medicare Parts A and B Premiums and Deductibles announcement. The top bracket ($500,000 single / $750,000 joint) is currently frozen and is not annually inflation-adjusted until 2028.
Types of income that can push you into IRMAA
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Wages and salaries
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Taxable portion of Social Security benefits
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Distributions from Traditional IRAs, 401(k)s, and other tax-deferred accounts, including Roth conversions
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Interest (taxable and tax-exempt) and dividends
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Capital gains, including those from the sale of a home or business
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Pension, annuity, rental, and royalty income
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Business income
Common Medicare Pathways Oregonians Use
While there are many potential Medicare pathways we will only break down the most common. An example of another pathway would be Oregon Veterans who receive prescription benefits through the VA and don't require a prescription coverage. If you have a less common situation please let us know.
Types of Medicare Supplements
Source: medicare.gov (accessed 09/29/2024)
Why Oregonians Might Choose a Medicare Path
Original Medicare + PDP Plan
Cost
Most people will pay $202.90 (2026) per month for part B plus about $20-50 more depending on the particular PDP plan they select.*
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Pros
Flexibility to go wherever Medicare is accepted
Cons
Coverage gap means catastrophic loss could occur
*People with higher incomes can be required to pay more and others will pay more depending on how long they've paid medicare taxes. Some people with low-income might qualify for assistance and be required to pay less or even nothing for this coverage.
Original Medicare + PDP and Med Sup
Cost
Most people will pay $202.90 (2026) per month for part B plus about $20-50 more depending on the particular PDP plan they select plus $100-$300 more depending on the particular Med. Sup they select and their age.*
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Pros
Broader coverage for most Medicare-approved medical expenses.
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Cons
Relatively high monthly premium costs and complexity
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*People with higher incomes can be required to pay more and others will pay more depending on how long they've paid medicare taxes. Some people with low-income might qualify for assistance and be required to pay less or even nothing for this coverage.
Medicare Advantage Plan (MAPD)
Cost
Many people will pay $202.90 (2026) for "zero premium plans" but others could select plans that cost $10-100 more.*
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Pros
All-inclusiveness, relative low cost, and additional plan benefits
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Cons
Must receive care within networks such as HMOs and PPOs
*People with higher incomes can be required to pay more and others will pay more depending on how long they've paid medicare taxes. Some people with low-income might qualify for assistance and be required to pay less or even nothing for this coverage.
Additional Considerations
as some plans may require:
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In-network PCP- Some plans may require you to have an in-network PCP.
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Referral requirements- Some plans may require a referral to see specialists.
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Step Therapy- Some plans may require you to try a different drug as a first step.
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Prior Authorizations- Some plans may require prior authorizations for some drugs and procedures.
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Formulary & Quantity Limits- Some plans may limit the specific drugs and the amount of the drugs they will cover.
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Reimbursements- Some plans may require you to pay upfront and then request reimbursement for covered care.
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In-network only coverage- Some plans may limit coverage to in-network providers only.
Transition Supply Process
A transition supply is a temporary one-time supply of a medication that a Medicare plan offers when you switch plans or if your current plan no longer covers a drug you're using. This allows you to get a 30-day supply of your prescription to avoid gaps in treatment while you work with your doctor to find an alternative drug or to request coverage.
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Exception Process
If the medication you need isn't covered by your Medicare plan or if there are special restrictions (like prior authorization), you can request an exception. This process involves:
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Requesting an Exception: Either you or your doctor can ask the plan to make an exception to cover the drug.
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Submitting Supporting Information: Your doctor will need to provide medical reasons for why you need that specific drug instead of alternatives.
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Plan Review: The Medicare plan reviews the request and, if approved, will cover the medication as an exception.
The goal of both the transition supply and exception processes is to make sure you have access to needed medications without interruptions, while still following Medicare's coverage rules.
Recent Medicare Program Changes
​Elimination of the Donut Hole
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The Deductible Stage- You pay the full cost of your covered prescription drugs until you meet your plan's annual deductible. In 2026, Medicare Part D plans can set a deductible of up to $615, though many plans choose a lower amount or have no deductible at all. Once you meet the deductible, you move into the Initial Coverage Stage.
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Initial Coverage Stage- You and the plan share the cost of your prescription drugs with either copayments or coinsurance, just like before. This continues until you reach a certain threshold of total drug spending.
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Catastrophic Coverage Stage- Since 2025, Medicare Part D enrollees have had an annual out-of-pocket cap on covered prescription drugs. The cap was $2,000 in 2025 and is $2,100 in 2026. Once you reach the cap, your covered Part D drugs will cost you $0 for the remainder of the plan year. Premiums do not count toward the cap. The cap applies to stand-alone Part D plans and to prescription coverage included in Medicare Advantage plans.
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The new Medicare Prescription Payment Plan (M3P)
Designed to make it easier to manage your prescription drug costs. With M3P, starting in 2025, Medicare Part D members can spread out their out-of-pocket costs over the year instead of paying large amounts at once.
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Termination of the MA Value-Based Insurance Design Model
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​​This program previously allowed MA plans to offer non-health related supplemental benefits such as healthy food and utilities for chronically ill and underserved populations.
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Auto- Reenrollment in the Medicare Prescription Payment Plan (M3P)
Source: Centers for Medicare and Medicaid Services, Final CY 2026 Part D Redesign Program Instructions.
How T. Mann Financial can help you with Medicare
T. Mann Financial helps Oregonians with Medicare through individually licensed and appointed insurance agents. Medicare Advantage, Medicare Supplement, and Part D plans typically pay commissions to the agent based on enrollment. Medicare itself costs the same whether you enroll on your own or work with a licensed agent.
Step 1
T. Mann Financial can help you identify when to enroll in Medicare
IEP
Initial Enrollment Period
7-month period beginning 3 months before your 65th birthday and ending 3 months after.
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During this period you can
Enroll in Part A, Part B, Med Sup, Medicare Advantage, and/or Part D
AEP
Annual Enrollment Period
Oct. 15th-Dec. 7th annually
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During this period you can
Enroll or change Medicare Advantage, Med Sup and/or Part D
GEP
General Enrollment Period
Jan. 1st-March 31st annually
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During this period you can
Enroll in Part A, Part B if you did not enroll when first eligible (late enrollment fee may apply)
SEP
Special Enrollment Period
Situations like employment coverage ending can create a special period that can sometimes last up to 8 months to enroll.
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During this period you can
Enroll in Part A, Part B, Med Sup, Medicare Advantage, and/or Part D
Some things to note when selecting your election period:
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There is a Medicare Advantage Open Enrollment Period (OEP) available to MA enrollees who wish to make a one-time change to their MA plan between Jan 1st and March 31st.
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Enrollment in Part A and Part B can be automatic if you are already receiving social security.
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Some people may be automatically enrolled in Medicare after receiving disability benefits for 2 years.
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​If enrollment in Part A or Part B is not automatic for you, please consider
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Enrolling online at www.ssa.gov
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Calling Social Security at 1-800-772-1213, M-F from 7AM to 7PM.
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Visiting your local Social Security office
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Effects that enrollment may have on other coverage
In some cases the beneficiary is disenrolled from their current health coverage (e.g., another MA plan, Medigap).
Medicare Advantage plans are not "riders" but full plans
Medicare Advantage plans operate on a calendar year basis
Benefits may change on January 1 of the following year.
"Evidence of Coverage" provides all of the costs, benefits, and rules for plans
Step 2
T. Mann Financial can help you assess your unique needs
Information we will gather together
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Lists of:
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Medications, and their dosage and frequency
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Preferred providers such as doctors and clinics
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Preferred pharmacies
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Current health conditions
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Upcoming Procedures
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An idea of how much you currently use medical services
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Your Medicare #
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Your income information if you are interested in assistance programs.
Step 3
T. Mann Financial can help enroll you in the plans that you select
First T. Mann Financial will utilize Medicare.gov to narrow down the plan options available to you and then to run a side-by side comparison of your top choices.
Then we will cover plan specifics like:
Star Ratings (based on things like access to care and customer satisfaction)
Plan Networks such as HMOs and PPOs
Confirm your doctors, pharmacies, and clinics are in-network
Confirm your prescriptions are a part of the plan's formulary
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Once you have made your selection we help you enroll
Enrollment in most cases can be completed online, over the phone, by email, or in person.
*Please note that an SOA (Scope of Appointment) must be signed at the start of any appointment where medicare is discussed and is different than an enrollment application. A SOA does not obligate you to enroll.
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Once Enrolled T. Mann Financial
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Tracks your application
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Can help make sure you get your ID/member numbers
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Can assist you with plan questions throughout the year
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Reviews your plan annually to make sure it is still a good fit
Know your rights!
Filing a Complaint and Canceling Your Enrollment
We are here to make your Medicare experience as smooth as possible. If you have a concern or problem, you have the right to file a complaint and to cancel your enrollment if needed.
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Filing a Complaint
If you’re unhappy with any part of your Medicare plan or the service you've received, you can file a complaint:
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Call Us: Contact our customer service team directly, and we’ll do our best to address your concern quickly.
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Medicare.gov: You can also submit a complaint online at Medicare.gov.
Canceling Your Enrollment
If you decide that your current plan isn’t right for you:
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You have the right to cancel your enrollment at any time during the appropriate enrollment periods.
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Simply call our office, and we’ll help guide you through the cancellation process or provide information about other options that may work better for you.
We want you to feel comfortable and confident in your healthcare choices. Contact us for any assistance or questions you may have.
Oregon specific info on low-income assistance
This information has been provided by Shiba
2026 Oregon Medicare Assistance Chart
Information is provided by the Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)
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*Please note that Medicaid long-term care eligibility has different income cap, asset limits, and recapture provisions.
Figures shown reflect the most recent Oregon Senior Health Insurance Benefits Assistance Program (SHIBA) fact sheet available as of 2026.04.22. Medicare Savings Program eligibility is redetermined each March. For current figures, please visit Oregon SHIBA.
Breaking down Oregon's 2025 Medicare Savings Programs
This 2025 Information is provided by the PacificSource Community Solutions
*Eligibility redetermined every March
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Full Medicaid Dual (QMB Plus or OHP Plus)
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Income Limits
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Individual: Below $967/month
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Married couple: Below $1,450/month
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​Asset Limits Apply: $2,000 (Single), $3,000 (Married Couples).
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Covers
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Part A and/or Part B premiums, deductibles, coinsurance, and copays
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100% LIS (automatically deemed eligible)
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Includes extra Medicaid benefits: transportation, behavioral health, and dental (if eligible)​
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BMD/BMM are the same as OHP+ but without prescription benefits. ​
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Are D-SNP Eligible
Qualified Medicare Beneficiary (QMB)
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Income Limits
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Individual: Below $1,325/month
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Married couple: Below $1,783/month
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Covers
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Part A and/or Part B premiums, deductibles, coinsurance, and copays
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100% LIS (automatically deemed eligible)
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Does NOT include the extra Medicaid benefits (like transportation, behavioral health, dental)
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Eligibility Note: Not eligible for D-SNP, but can enroll in other MA plans
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Due to Federal Law, you can't be balanced billed for Medicare covered services.
Specified Low-Income Medicare Beneficiary (SLMB/SMB)
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Income Limits
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SMB (State-funded): Individual below $1,565/month or $2,115/month for a married couple
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SMF/QI (Federally-funded): Individual below $1,761/month or $2,380/month for a married couple
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Covers
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Part B premium
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100% LIS (automatically deemed eligible)
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Beneficiary still responsible for all cost-sharing under Original Medicare
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Eligibility Note: Not eligible for D-SNP, but can enroll in other MA plans
Qualified Disabled Working Individual (QDWI)
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Covers
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Pays the Part A premium for certain people who have disabilities and are working
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Eligibility Redetermination
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Eligibility is redetermined every March
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Clients are protected from losing Medicaid until March
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Low-Income Subsidy (LIS / Extra Help)
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A federal program through Medicare that helps people with limited income and resources pay for Medicare Part D prescription drug costs.
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Provides help with monthly premiums, annual deductibles, and prescription copayments/coinsurance.
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Can lower out-of-pocket drug costs significantly.
Eligibility (2025)
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Based on income and resources (assets).
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Automatic eligibility if someone is enrolled in:
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Medicaid
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A Medicare Savings Program (QMB, SLMB, or QI)
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Supplemental Security Income (SSI)
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Others can apply separately through Social Security or their state Medicaid office.
Levels of Help
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Full LIS: Pays the entire Part D premium (for benchmark plans), no deductible, very small copays.
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Partial LIS: Reduces the monthly premium and deductible, lowers coinsurance/copay amounts.
Automatic Re-Determination
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Eligibility is reviewed annually.
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If income/resources change, benefits may adjust at the start of the next year.