Oregon PERS and Medicare: How Retiree Coverage Works

November 1, 2026

Retiree comparing Medicare and PHIP coverage mailings

If you retire from a public job in Oregon, Medicare does not replace your PERS health coverage. The two fit together. The PERS Health Insurance Program (PHIP) requires you to hold Medicare Part A and Part B, and then offers a Medicare plan on top of them. The main risk is timing: miss a window and you can lose the chance to join PHIP at all.

This guide covers who qualifies, what you must do around age 65, what the RHIA subsidy pays, and how a PERS retiree in Bend can compare PHIP with the open market.

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TL;DR

PHIP requires every Medicare-eligible member and dependent to hold both Medicare Part A and Part B.
You generally have 90 days from your initial Medicare eligibility to join PHIP, and missing it usually means losing the chance.
Eligible Tier One and Tier Two retirees may receive an RHIA subsidy of up to $60 a month toward a Medicare companion plan.
Public retirees can compare PHIP with plans on the open market. Run the numbers for your own situation before you choose.
If you hold or want an individual Medigap policy, Oregon’s birthday rule gives you a yearly window to switch.

How Medicare and PERS retiree coverage work together
When Medicare eligibility starts
The 90-day PHIP window and why it matters
What Medicare costs you in 2026
RHIA: help with your Medicare plan premium
Comparing PHIP with the open market
Oregon’s Medigap birthday rule
What a Bend retiree should check first
Perspective: why we start with education
Get a local second opinion
FAQ
Sources

How Medicare and PERS retiree coverage work together

PHIP is a group health program for PERS retirees, their spouses and dependents. It offers both Medicare and non-Medicare plans, plus dental coverage. To take part, you must keep a permanent residence, not just a mailing address, inside a plan’s service area and within the United States.

Before 65, PHIP’s non-Medicare plans can be your coverage. When you become Medicare-eligible, the arrangement changes. Medicare becomes your primary coverage, and the PHIP Medicare plan fills in around it. That is why Part A and Part B are not optional for PHIP members. The PERS Medicare enrollment guide states that you must keep both parts to stay eligible for a PHIP Medicare health plan.

PHIP’s Medicare options fall into two types:

Medicare Supplement. It pairs with Original Medicare and is sold through one PHIP carrier.
Medicare Advantage. These are all-in-one plans (Part C) offered through several PHIP carriers.

The carriers and plan lineup change by plan year, so check the current list on the PERS PHIP page.

When Medicare eligibility starts

Medicare eligibility for most retirees begins the first day of the month you turn 65. If you receive Social Security disability benefits, it begins on the first day of the 25th month after those benefits started.

The state’s SHIBA program advises that if you are not covered by qualifying active-work group coverage, you should contact Social Security up to three months before turning 65 to sign up. SHIBA also tells you to check whether any prescription drug coverage you hold is creditable, because that decides whether a Part D late penalty can apply.

Medicare eligibility and enrollment timing

If you want a plain walk-through of the age-65 sequence, our step-by-step guide to turning 65 covers the order of events.

The 90-day PHIP window and why it matters

Eligible PERS retirees can enroll in PHIP within 90 days of their initial Medicare eligibility date, as long as they are enrolled in both Part A and Part B. There is also a 90-day opportunity tied to retirement.

The consequence is the part people overlook. If you do not enroll during these designated opportunities, you generally lose the chance to enroll in PHIP. The same guide warns that skipping Part B when you first become eligible can bring a federal late enrollment penalty and may make you ineligible for PHIP.

A simple checklist for the months before you turn 65:

Confirm your Medicare eligibility date, not just your birthday.
Sign up for Part A and Part B on time.
Ask PERS which PHIP enrollment opportunity applies to you and when it closes.
Decide between PHIP and outside options before that window closes.
Write down the deadline and keep the confirmation letters.

Spouses and dependents

Your spouse can follow a different path. PERS notes that a spouse may enroll in PHIP at their own initial Medicare eligibility while you stay on your retiree plan, though their eligibility depends on your own status. If your spouse is still working or has employer coverage, timing rules for their Medicare differ. Our article on avoiding spouse Medicare gaps in Oregon explains the special enrollment period.

What Medicare costs you in 2026

Part B is the premium everyone must pay on top of whatever PERS plan they choose. For most people on Medicaid in 2026, Oregon lists the monthly Part B premium at $202.90. Your own bill depends on your income and on whether a state program covers it.

Oregon’s Medicare Savings Programs can help. The state has no asset limit, and the QMB individual income limit is $1,330 a month from March 2026 through February 2027. Limits are updated each year, so confirm the current figure with the state before you rely on it.

RHIA: help with your Medicare plan premium

The Retirement Health Insurance Account (RHIA) was created by the Oregon Legislature to help pay Medicare companion plan premiums. According to PERS, a Tier One or Tier Two retiree can receive an RHIA contribution if they:

are enrolled in a PERS-sponsored Medicare health plan,
carry Medicare Parts A and B,
have at least eight years of qualifying service, and
receive a PERS retirement benefit.

The contribution is a monthly subsidy of up to $60 applied to the companion plan premium. The subsidy is modest next to a total premium, so it should be one line in your comparison and not the deciding factor.

Comparing PHIP with the open market

PHIP is designed for PERS retirees, and PERS itself tells members to compare all available options before enrolling, since other plans may offer better benefits or lower premiums for those not yet on Medicare. Medicare-age retirees should make the same comparison.

One local news column on choosing a plan as a public retiree compared monthly premiums directly. It put a PERS plan at about $275 against $131 for a plan on the open market in one example. We cannot vouch for those figures today, since rates change every year, but the lesson holds: price the plans side by side.

The comparison should include:

What to compare	Why it matters
Monthly premium after any RHIA subsidy	The real cost to you
Doctors and hospitals in Central Oregon	Network rules differ by plan type
Prescription drug coverage	Formularies and costs vary by plan
Out-of-pocket maximum	Your worst-case year
Travel and out-of-area coverage	Snowbirds and family visits
Your ability to re-enter later	PHIP windows can close for good

That last row is the one that separates a PERS decision from an ordinary Medicare decision. An open-market plan can usually be changed in a later enrollment period. A PHIP opportunity that lapses generally does not return. Weigh that before you leave PHIP or skip it.

Open enrollment each fall

PHIP runs its own annual open enrollment in the autumn, and the PERS Board approves the next year’s plan rates in the summer. Rates and carriers can change between years, so read the notice PERS sends you and the official PHIP page for the current schedule. Separately, Medicare’s own annual period runs from October 15 to December 7. Our Medicare open enrollment guide for Central Oregon explains how the two calendars line up.

Oregon’s Medigap birthday rule

Some retirees hold an individual Medigap policy instead of, or after, a group option. If that is you, Oregon has a rule worth knowing. The Division of Financial Regulation describes it as a yearly window that runs from 30 days before to 30 days after your birthday. In that 60-day window you can switch, without health underwriting, to a policy of the same plan type or one with lesser benefits.

The limits matter:

You must move to the same or lesser benefits.
The rule does not apply to self-funded employer group Medigap plans.
Do not cancel your current policy until the new one is issued.
The rule applies to policies issued after January 1, 1990.

If you feel your supplement premium has crept up, this window is the cheapest time to shop. We lay out the mechanics in our guides to the Oregon birthday rule and how to switch Medigap plans, and you can review the Medigap plan lineup before you decide.

What a Bend retiree should check first

Central Oregon has its own pattern: many retirees keep seeing specialists in Bend, travel in winter, or split time between homes. A few local checks save trouble:

Provider access. Ask each plan whether your primary care doctor, hospital and key specialists are in network.
Service area. PHIP needs a permanent residence inside the plan’s service area. If you plan to move, confirm the new address qualifies.
Working past 65. If you or a spouse still work, group coverage may change when Part B must start. See our piece on the 20-employee rule.
Drug coverage. Confirm whether your current drug coverage counts as creditable.
Paperwork. Keep copies of every Medicare and PERS notice.

If you want a second set of eyes on common slip-ups, read our list of mistakes to avoid when enrolling at 65.

Perspective: why we start with education

We meet many Bend-area retirees who assume that a group retiree plan makes Medicare simple. In our experience, it makes the deadlines more important, because one missed window can close a door for good.

Our approach is education first. We explain Parts A, B, C and D in plain words, show you where each deadline falls, and let you decide at your own pace. We are a local agency, not a call center, and a consultation costs you nothing.

For a PERS retiree, we think the best first step is a side-by-side comparison of what you have, what the open market offers and what each choice means for later flexibility. That is the kind of clear picture we work to give every client.

Jesse Zimmerman

Get a local second opinion

We help Central Oregon residents sort through Medicare enrollment, Medigap and annual plan checks. Our Medicare enrollment assistance walks you through Parts A and B and your options, and our annual plan reviews help you check your coverage each year. Consultations are free, in person or remote. You can start from our home page.

FAQ

Do I have to enroll in Medicare if I am a PERS retiree?

If you want a PHIP Medicare plan, yes. PHIP requires Medicare Part A and Part B for all Medicare-eligible members and dependents. Skipping Part B can also bring a federal late penalty.

How long do I have to join PHIP when I turn 65?

Generally 90 days from your initial Medicare eligibility date, as long as you hold Parts A and B. Confirm your exact deadline with PERS, since it depends on your retirement and eligibility dates.

What is RHIA and who gets it?

RHIA is a monthly subsidy of up to $60 toward a Medicare companion plan premium. Eligible Tier One and Tier Two retirees with at least eight years of qualifying service, Parts A and B, and a PERS-sponsored Medicare plan can receive it, per the PERS companion plan page.

Can my spouse join PHIP at a different time than I do?

Yes, in some cases. A spouse may enroll in PHIP at their own initial Medicare eligibility while you stay on your retiree plan, but their eligibility depends on your status. Ask PERS to confirm the dates for your household.

Can I use the Oregon birthday rule with a PERS plan?

The birthday rule applies to individual Medigap policies issued after January 1, 1990, and not to self-funded employer group plans. If you hold an individual policy, it can help you switch without health questions. Ask your PERS contact how it applies to any group coverage you have.