How does each option work?
Original Medicare with Medigap: Medicare pays first for hospital and medical care, and your Medigap policy pays some or all of what's left, such as deductibles and the 20% Part B coinsurance. You add a standalone Part D plan for drugs. In Oregon, the Division of Financial Regulation regulates Medigap. See Medigap in Oregon.
Medicare Advantage: a private plan approved by Medicare replaces Original Medicare for your Part A and Part B care. Most plans include Part D, use a provider network, and charge copays or coinsurance as you use care, up to a yearly limit. See Medicare Advantage in Oregon.
You need Part A and Part B either way, and you keep paying your Part B premium either way.
How do the costs compare?
| Cost | Original Medicare + Medigap + Part D | Medicare Advantage |
|---|---|---|
| Monthly premium | Part B, plus the Medigap premium, plus the Part D premium. | Part B, plus the plan's premium if it has one. |
| Bills when you get care | Depends on the plan letter. Plan G leaves you the Part B deductible; Plans K, L and N leave more cost sharing. | Copays or coinsurance for most services, set by the plan. |
| Yearly limit on medical costs | None in Original Medicare alone. Plan K's limit is $8,360 and Plan L's $4,180 in 2027; with Plan G, little is left to pay. | Required. Up to $9,850 in network in 2027 (a PPO's combined limit can be up to $14,800). |
| Drug costs | Through a Part D plan, with a yearly cap of $2,400 in 2027. | Usually included, with the same $2,400 cap in 2027. |
| How premiums change | Medigap premiums usually rise over time. Oregon allows companies to price by attained age, and some use other methods; ask how a policy is priced. | Premiums and benefits can change every January 1. Your Annual Notice of Change shows what's new. |
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Networks, travel and rural access
| Question | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| Which doctors and hospitals? | Any provider in the U.S. who accepts Medicare. | The plan's network. HMOs generally cover out-of-network care only for emergencies and urgent care; PPOs cover it at a higher cost. |
| Referrals and prior approval | No referrals. Medicare rules decide what's covered. | Many plans need referrals or prior authorization for some services. |
| Travel in the U.S. | Works the same in every state. | Emergencies and urgent care are covered anywhere; routine care away from home usually isn't in an HMO. |
| Winters in Arizona or California | Usually the simpler fit. | Leaving the service area for more than 6 months in a row ends your enrollment unless the plan has a visitor program. |
| Travel outside the U.S. | Plans C, D, F, G, M and N pay 80% of emergency care for the first 60 days of a trip, after a $250 deductible, up to a $50,000 lifetime limit. | Generally not covered beyond emergencies; check the plan's Evidence of Coverage. |
| Rural and eastern Oregon | Works with any hospital that accepts Medicare, including Oregon's 25 critical access hospitals and hospitals across the line in Washington, Idaho or California. | Depends on the county. For 2027, Multnomah County has 32 plans open to everyone, Deschutes County 3, Baker County 5, and five counties none. |
Counties with no Medicare Advantage plan open to everyone in 2027: Grant, Harney, Lake, Umatilla and Union (only employer group plans). Curry County has only a special needs plan, and Coos County has one plan. In these counties, Original Medicare with Medigap and Part D is the main option unless you qualify for a special needs plan. If your plan is ending, see Oregon plans ending in 2027, and look up your county on our counties page.
Switching later: health questions and Oregon's birthday rule
This is where Oregon's rules matter most, because they work differently depending on which way you move.
| Change | Health questions? | Oregon rule |
|---|---|---|
| Buy Medigap in your first 6 months with Part B, at any age | No; every policy the company sells, priced no higher than for people 65 | Medigap open enrollment, OAR 836-052-0138 |
| Switch Medigap policies to the same or lesser benefits, any company | No, from 30 days before to 30 days after your birthday each year | Birthday rule, OAR 836-052-0143 (current version effective January 1, 2023) |
| Switch Medigap policies to more benefits | Yes, the company can review your health | Not covered by the birthday rule |
| Leave Medicare Advantage for Medigap | Usually yes | Birthday rule doesn't apply. No health questions only with a guaranteed-issue right (OAR 836-052-0142) |
| Leave Medicare Advantage in your first 12 months (trial right) | No | Guaranteed issue, OAR 836-052-0142 |
| Your Medicare Advantage plan ends or leaves your county | No, for Plans A, B, D, G, K, L, M or N (C or F if eligible for Medicare before 2020) | Guaranteed issue; apply up to 63 days after coverage ends |
| Switch Medicare Advantage plans | No | Federal enrollment periods: October 15 to December 7, and January 1 to March 31 |
In short: in Oregon it's easier to start with Medigap and shop for a different Medigap policy later than to start with Medicare Advantage and move to Medigap later. Oregon also protects people under 65: during their first 6 months with Part B, companies must offer every policy they sell, at no more than the premium for people 65 (OAR 836-052-0138). Every new Medigap policy comes with a 30-day free look: you can return it within 30 days of delivery for a refund of the premium (OAR 836-052-0160).
Other Oregon factors to weigh
- OHP: if you also have OHP, Medigap usually isn't needed, and a dual eligible special needs plan may coordinate both. See OHP vs. Medicare.
- PEBB, OEBB and PERS retirees: check the PERS Health Insurance Program's Medicare plans before buying on your own. See PEBB, OEBB and PERS vs. individual Medicare plans.
- Tribal clinics: you can keep using IHS and tribal clinics with either option. See IHS and tribal clinics vs. Medicare.
- Veterans: VA care and TRICARE For Life work alongside Medicare. See veterans and Medicare in Oregon.
How to decide
- List your doctors, hospitals and drugs. Include specialists you see in Portland, Eugene, Bend, Medford or out of state.
- Check what's sold in your county. Look up your county's Medicare Advantage count on our counties page, and check each plan's network for your providers.
- Compare a typical year and a bad year. Add premiums plus expected copays, then compare with the plan's out-of-pocket limit or your Medigap plan's coverage.
- Think about travel and winters away. If you spend months outside Oregon, weigh how each option handles care there.
- Mind your timing. Your Medigap open enrollment period is the one time any company must sell you any policy. If you're leaving a plan that's ending, keep the notice and apply within 63 days.
To compare Medigap policies and Medicare Advantage plans from the companies they work with, you can request a call from a licensed insurance agent, at no cost to you, or see plans for your ZIP code. See also does Oregon have a Medigap birthday rule?
Sources
- Or. Admin. Code § 836-052-0143, annual opportunity to select another Medicare supplement policy (birthday rule) (via Cornell LII)
- Or. Admin. Code § 836-052-0138, Medigap open enrollment (via Cornell LII)
- Or. Admin. Code § 836-052-0142, guaranteed issue for eligible persons (via Cornell LII)
- Or. Admin. Code § 836-052-0160 (30-day free look) (via Cornell LII)
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- Medicare.gov — Travel outside the U.S.
- eCFR — 42 CFR 422.74 (6-month absence from service area)
- CMS — Medicare Advantage and Part D Landscape files, contract year 2027 (plan counts)
- CMS — CY 2027 Rate Announcement (Part D out-of-pocket threshold)
- CMS — Out-of-pocket limits for Medigap Plans K and L for 2027
- Oregon Office of Rural Health (OHSU) — Oregon's critical access hospitals
Frequently asked questions
Is Medigap or Medicare Advantage better in Oregon?
Neither is better for everyone. Medigap with Original Medicare suits people who want to see any provider in the U.S. who accepts Medicare, travel or spend winters elsewhere, or want predictable bills. Medicare Advantage suits people comfortable with a network who want drug coverage in the same plan. Where you live matters: Grant, Harney, Lake, Umatilla and Union counties have no Medicare Advantage plan open to everyone for 2027.
If I choose Medicare Advantage, can I switch to Medigap later in Oregon?
You can always go back to Original Medicare during open enrollment, but a Medigap company can ask health questions and turn you down unless you have a guaranteed-issue right, such as your plan ending or leaving your county, or the trial right in your first 12 months of Medicare Advantage. Oregon's birthday rule only applies to people who already have a Medigap policy.
How does Oregon's Medigap birthday rule work?
If you have a Medigap policy, you can switch to one with the same or lesser benefits, from the same or a different company, without health questions, from 30 days before to 30 days after your birthday each year (OAR 836-052-0143). The new company can't price the policy based on your health. Policies issued before 1990 aren't included.
Do I need a separate drug plan with Medigap?
Yes. Medigap policies don't cover prescription drugs, so most people with Medigap also join a standalone Part D plan. CMS lists 8 standalone Part D plans in Oregon for 2027. Most Medicare Advantage plans include drug coverage.
Does Medigap or Medicare Advantage cover me when I travel?
Original Medicare with Medigap works with any provider in the U.S. who accepts Medicare, and Plans C, D, F, G, M and N pay 80% of emergency care abroad after a deductible, up to a lifetime limit. Medicare Advantage covers emergencies and urgent care anywhere in the U.S., but routine care away from home is often limited, especially in an HMO.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
