We have the independence to offer you a wide range of insurance options.
*We do not offer every plan available in Oregon. Currently we represent 8 organizations which offer 33 Medicare Advantage plans and 35 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.
The Medicare basics in Oregon
Once Oregonians understand the basics, it's much easier to select the right plan for you.
The Parts of Medicare
Part A
Coverage
Inpatient Hospital
Skilled Nursing*
Home Health
Hospice Care
Requirements
Must be 65 years old or have a qualifying disability
Administered By
The US Government
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
Requirements
Must be 65 years old or have a qualifying disability
Administered By
The US Government
Cost
$185.00 (2025)*
*People with higher incomes can be required to pay more.
Part C
Coverage
An "all in one" coverage that bundles everything from Parts A and B and sometimes Part D
Requirements
Must be enrolled in Part A and B to enroll
Administered By
Private Companies
Cost
Vary by plan*
*Private companies offer plans at different costs and some low-income individuals can receive help with these costs in some situtations.
Part D
Coverage
Helps cover the cost of prescription drugs
Requirements
Must have Part A or B to enroll
Administered By
Private Companies
Cost
Vary by plan*
*Private companies offer plans at different costs and some low-income individuals can receive help with these costs in some situtations.
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 $185.00 (2025) per month for part B plus about $20-50 more depending on the particular PDP plan they select.*
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 $185.00 (2025) 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.*
Pros
Peace of mind knowing most medical expenses will be covered
Cons
Relatively high monthly premium costs and complexity
*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 $185.00 (2025) for "zero premium plans" but others could select plans that cost $10-100 more.*
Pros
All-inclusiveness, relative low cost, and additional plan benefits
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.
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.
2025 Changes
Elimination of the Donut Hole-
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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- After reaching the out-of-pocket spending limit, you enter catastrophic coverage, but starting in 2025, your costs will be significantly reduced. There will be a $2,000 cap on out-of-pocket costs for the year. Once you hit this cap, you won't have to pay anything for covered drugs for the rest of the year.
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.
How T. Mann Financial can help you with Medicare
Why struggle? Medicare costs the same whether we assist you or you do it yourself.
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.
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
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
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.
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.
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
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
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.
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.
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
2025 Oregon Medicare Assistance Chart
Information is provided by the Oregon Senior Health Insurance Benefits Assistance Program (SHIBA)
*Please note that Medicaid long-term care eligibility has different income cap (2025- $2,829), asset limits (2025- $2,000), and recapture provisions.
