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Medigap in Oregon: Plans, Costs and the Birthday Rule

Older woman reviewing Medigap premium notices

Medigap, also called Medicare Supplement, is private insurance that pays some of what Original Medicare leaves behind: deductibles, coinsurance and copays. In Oregon you have two moments when an insurer must accept you regardless of health: your six-month Open Enrollment Period, and every year around your birthday under the Oregon Birthday Rule. If you live in Bend or Central Oregon and suspect you are overpaying, the second one matters most.

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TL;DR

  • Medigap only works alongside Original Medicare (Parts A and B). It does not pair with a Medicare Advantage plan.
  • Your Medigap Open Enrollment Period lasts six months and starts the first month you have Part B and are 65 or older. After it closes, insurers can usually ask health questions.
  • Oregon’s Birthday Rule lets you move to a policy with the same or lesser benefits, with no health questions, in the window from 30 days before to 30 days after your birthday.
  • Do not cancel your current policy until the new one is issued.
  • Help is free: you can talk to a state SHIBA counselor, or to a local agent like us who explains the options without pressure.

Table of Contents

What Medigap does, and what it does not

Original Medicare covers a lot, but it leaves you with real costs. In 2026 the standard Part B premium is $202.90 a month, with a $283 annual deductible, and Part B generally leaves you paying 20 percent of covered outpatient services. There is no annual out-of-pocket cap in Original Medicare itself. Medigap is what fills that hole.

Three things to keep straight:

  1. Medigap is not Medicare Advantage. Advantage plans (Part C) replace Original Medicare. Medigap sits on top of it. You cannot use both at once.
  2. Medigap is not the Oregon Health Plan. OHP is Oregon’s Medicaid program. For people who have both, Medicare is the primary coverage and OHP can help with premiums, deductibles and coinsurance. If you qualify for OHP, talk to a counselor before buying a Medigap policy you may not need.
  3. Medigap is not a drug, dental or vision plan. Prescription coverage comes from a separate Part D plan, and routine dental and vision are usually bought separately. We help with those too, and for the dental side of aging well, this guide on dental care as you age is worth a look.

Medigap policies are standardized by letter. Plan G, for example, has the same core benefits whichever company sells it. That is good news: you are comparing price and service, not hunting for hidden differences in coverage. The Part A and Part B rules behind each letter are laid out on our Medicare Supplement plans page.

Your six-month window to enroll

Under federal law, your Medigap Open Enrollment Period lasts six months and starts the first month you have Part B and are 65 or older. During it you can buy any Medigap policy sold in Oregon, and the insurer cannot turn you down or charge more because of your health history.

This window happens once. Outside it, insurers can typically use medical underwriting to deny coverage or raise the price. That is why timing matters if you are turning 65 soon:

  • Sign up for Part B when you intend your coverage to begin, because the clock starts with Part B.
  • Pick your Medigap plan inside the six months, not at the end of them.
  • If you have ongoing conditions, the window is when your history cannot be used against you. We cover that in more depth in our post on Medigap and preexisting conditions, and on choosing a plan while open enrollment lasts.

If you are still planning your move to Medicare, our step-by-step guide to turning 65 walks through the order of events.

The Oregon Birthday Rule, explained

Most states let you change Medigap plans only if you pass health questions. Oregon is different. The Birthday Rule lets you switch to a policy with the same or lesser benefits, regardless of your health. The window opens 30 days before your birthday and closes 30 days after it. That is about a 60-day stretch every year.

In plain terms, this means you are not stuck with a policy just because rates crept up. Medigap premiums can rise over the years, and the same coverage is often available for less from another company. The Birthday Rule is how you act on that.

We have written more on the mechanics in using the Oregon Birthday Rule in Central Oregon and how to switch plans during the window.

The Oregon Birthday Rule, explained — overview diagram

Same or lesser benefits: what that means

The rule protects switches to an equal or smaller benefit set. Moving from Plan G to another company’s Plan G is straightforward. Moving from Plan G down to Plan N also qualifies. Moving up to richer coverage, say from Plan N to Plan G, is a different story, because the insurer may be allowed to ask health questions for the extra benefits. Check this before you apply, not after.

Rules that trip people up

A worked example for a Bend household

Say your birthday is November 10. Your window runs roughly October 11 through December 10. Here is how a careful switch goes:

  1. Before the window opens, pull your current policy’s letter, monthly premium and your plan’s last rate notice.
  2. At the start of the window, get quotes for the same letter from the companies selling in Oregon. Because the benefits are standardized, you are comparing premium, rate history and service.
  3. Apply early in the window, so there is time to fix a problem before it closes on December 10.
  4. Wait for the new policy to be issued and for its effective date to be confirmed in writing.
  5. Only then cancel the old one, with the dates lined up so you have no gap and no overlap.

The savings are not guaranteed. Some people compare and find they are already well priced, and staying put is a legitimate result. The point is to check once a year, because the window closes on schedule.

Costs to plan around

A Medigap premium is only one part of the picture. Your monthly total typically includes:

Cost What to know
Part B premium $202.90 a month in 2026 for most people, and higher at higher incomes
Part B deductible $283 in 2026, unless your Medigap letter covers it
Medigap premium Varies by letter, company, your age and how the company prices
Part D premium A separate plan for prescriptions
Dental and vision Usually separate coverage

We do not publish Medigap prices, because they depend on your age, ZIP code and the company. A quote is free from us and takes one conversation.

If money is tight

Before you pay for extra coverage, check whether the state can help. Oregon runs Medicare Savings Programs. As of March 2026, monthly gross income limits for a single person are $1,350 for QMB, $1,616 for SLMB and $1,816 for QI, and there are no asset limits. If you fall under those numbers, the programs can pay your Part B premium and, in some cases, other costs. The 2026 MSP and Extra Help fact sheet explains how each one works.

2026 Oregon Medicare Savings Program income limits

Medigap or Medicare Advantage?

This is the other big decision, and it deserves a straight answer rather than a pitch.

  • Medigap generally means a higher monthly premium and fewer surprises. You keep Original Medicare and pair it with a policy that picks up much of your cost-sharing.
  • Medicare Advantage generally means a lower or zero premium with plan networks and copays, and the details change by plan and year.

The trade-off matters because of timing. In Oregon, the Birthday Rule moves you between Medigap policies. It is not an automatic way back from Advantage into Medigap, so think about which path you want before you leave Original Medicare. If you are weighing Advantage, our overview of Medicare Advantage plans in Bend lays out the types.

Our perspective: education first

We are a local agency in Bend, and we get paid by insurance carriers when someone enrolls through us. We say that out loud because it is the reason we work the way we do: a rushed sale to someone who did not understand the plan is a client who leaves unhappy, and in a town this size, that gets around.

What we see most often is people who bought a Medigap policy years ago and never looked again. They are not careless. Nobody told them Oregon gives them a yearly right to reshop with no health questions. So our first job in a consultation is to explain, not to sell: which letter you have, what it covers, what the Birthday Rule allows in your specific window, and what could go wrong, like a deductible reset or an employer plan you could not get back.

Sometimes the right answer is to keep what you have. We will say so. Consultations are free, in person or remote, and you are never obliged to enroll with us. We also encourage people to use Oregon’s free SHIBA counseling program, which offers unbiased, non-sales help but does not recommend specific plans. Use both if you like. That is what informed decisions look like.

— Jesse Zimmerman

Get a local review of your Medigap policy

If you are turning 65, or your birthday window is coming up, we can walk you through your options and the dates that apply to you. Start with our Medicare enrollment assistance, or ask about an annual Medicare plan review if you already have coverage and want to know whether it still fits. The consultation costs nothing.

Common mistakes with Medigap in Oregon

  • Missing the six-month window and discovering later that health questions apply.
  • Letting the Birthday Rule window pass because the dates were never on a calendar.
  • Canceling before the new policy is issued.
  • Switching up in benefits and assuming it is covered by the rule.
  • Comparing on price alone and ignoring how the company has raised rates in the past.
  • Buying Medigap when OHP or a Medicare Savings Program already covers the same costs.

Our list of common mistakes when enrolling at 65 goes further on the early-stage errors.

FAQ

Is the Oregon Health Plan the same as Medicare?

No. The Oregon Health Plan is Oregon’s Medicaid program, and Medicare is a federal program for people 65 and older and some younger people with disabilities. Some people have both, and in that case Medicare is primary and OHP can help with costs Medicare leaves. The state’s page on Medicare and OHP explains how benefits change when you go on Medicare.

Can I switch Medigap plans in Oregon if I have health problems?

Yes, within limits. During your Birthday Rule window you can move to a policy with the same or lesser benefits without health questions. Outside that window, or when moving to richer benefits, the insurer may be able to underwrite you.

When does my Birthday Rule window start and end?

It opens 30 days before your birthday and closes 30 days after. Apply early in that stretch, and keep your current policy until the new one is issued.

Does Medigap cover prescriptions, dental or vision?

No. Those come from separate plans. We can help you look at Part D, dental coverage and vision coverage alongside your Medigap decision.

Sources

Disclaimer: This article is for general educational purposes only and does not constitute personalized advice. Medicare rules and plan details change frequently.

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