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Medicare Advantage in Oregon

October 6, 2016

Medicare Advantage (Medicare Part C) in Oregon offers Medicare beneficiaries the option to receive their Medicare benefits through a Medicare-approved private health insurance plan, rather than through Original Medicare, Part A and Part B. While Medicare Advantage plans provide at least the same coverage as Original Medicare, Part A and Part B, many plans choose to offer more coverage and/or additional benefits.  Medicare Advantage plans do not offer a single, standardized set of benefits. For beneficiaries in Oregon, Medicare coverage depends upon which Medicare Advantage plan a beneficiary chooses from among the plans available where the individual lives.

How Medicare Advantage works in Oregon

If you’re a Medicare beneficiary in Oregon and require more extensive coverage than what’s provided under Original Medicare, Part A (hospital insurance) and Part B (medical insurance), you may want to consider signing up for a Medicare Advantage plan. Medicare Advantage plans in Oregon, like in the rest of the United States, offer at least the same medical and hospitalization benefits as Original Medicare.  Many offer more coverage and consequently lower out-of-pocket costs for Oregon beneficiaries by reducing coinsurance amounts, copayments and/or deductibles.  Additionally, many Medicare Advantage plans have extra benefits, like vision, hearing, dental, and sometimes prescription drug coverage.

To sign up for a Medicare Advantage plan in Oregon, you must have Original Medicare, Part A and Part B. You may sign up for Original Medicare in Oregon during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. Individuals who receive disability benefits may be automatically enrolled after 24 months of receiving disability benefits. If you have certain medical conditions, you may also be eligible for Medicare before age 65.

If you miss your seven-month Initial Enrollment Period, you may be subject to a late-enrollment penalty, which means you would have to pay higher Medicare premiums. You may sign up for Medicare at a later date, during the General Enrollment Period, which runs from January 1 to March 31 each year, but you could still be subject to a late-enrollment penalty.

If you are enrolled in a Medicare Advantage plan in Oregon and decide to switch from one Medicare Advantage plan in Oregon to another, you can make the change during the Annual Election Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. In addition, if you go through a major life event, you may switch Medicare Advantage plans in Oregon under a Special Election Period. These major life events include, but are not limited to, moving to a new address outside the service area where your current Medicare Advantage plan may not be available, changes in your present plan that affect your health benefits, or losing your employer sponsored group health coverage. In Oregon, as in the rest of the United States, Special Election Periods vary depending on the health plan you select and on the reason you want to switch plans.

If you want to leave your Medicare Advantage plan and switch back to Original Medicare, Part A and Part B, you can do so during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year.

Types of Medicare Advantage plans in Oregon

There are various types of Medicare Advantage plans available in Oregon, so it’s a good idea for you to understand how you access covered health care services and receive benefits under each plan type.

A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that requires you to use doctors, health-care providers, and hospitals included in your plan’s network to receive benefits for covered services. A Medicare Advantage HMO plan usually will not pay for services you receive from a health-care provider who does not participate in the plan’s network unless you needed emergency care or received pre-approval from the plan to receive treatment outside the network. You may have to get a referral from your primary doctor to receive coverage for certain health services. An HMO Point-of-Service plan, on the other hand, is a more flexible option, allowing you to go out of network for some health services and receive benefits, but generally you pay   higher out-of-pocket cost for these covered services than you would pay if you received the services from providers in the plan’s network.

If you prefer a Medicare Advantage plan with more flexibility, you may be able to choose a Preferred Provider Organization (PPO)* plan. In a Medicare Advantage PPO plan, you may choose doctors, health-care providers, and hospitals in or outside of your plan’s network.  Your out-of-pocket costs are typically lower when you receive covered services from providers in the plan’s network.

You may be able to select a Private Fee-for-Service (PFFS) plan, which is a type of Medicare Advantage plan that may include a partial or full network of participating providers. Keep in mind that you should check with the provider to see if he or she accepts the plan before getting treatment.

Another option may be a Medicare Advantage Medical Savings Account (MSA) plan, which combines a high deductible with a savings account that you can use to pay for your health care expenses.

If you have specific health conditions, you may want to consider a Medicare Advantage Special Needs Plan (SNP). There are Medicare SNPs for people with certain chronic diseases, those living in intuitions (like nursing homes), and people who qualify for both Medicare and Medicaid. A Medicare SNP can offer coverage tailored to these situations.

And if you’re seeking both health and prescription drug coverage, you may want to choose a Medicare Advantage Prescription Drug (MAPD) plan, which combines into a single plan health and prescription drug coverage (also available as a stand-alone Medicare Part D Prescription Drug Plan if you have a Medicare Advantage plan without prescription drug coverage or Original Medicare).

Always keep in mind that even if you decide to enroll in a Medicare Advantage plan in Oregon, you have to remain enrolled in Original Medicare, and continue paying your Medicare Part B premium, in order to retain your health insurance coverage.

Comparing Medicare Advantage plans available in Oregon

As a Medicare beneficiary in Oregon, you may find it useful to compare the various Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally vary by location. It’s common for Medicare Advantage plans to have different premiums, with or without different benefits within a single area of Oregon and across the state. You may find that some Medicare Advantage plans in Oregon offer premiums as low as $0. Keep in mind that you must continue to pay your Medicare Part B premium, regardless of which Medicare Advantage plan you choose, in order to retain your Medicare health insurance coverage.

Some Medicare Advantage plans may offer benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug plan. With the various health insurance options available, you can understand why it may be a good idea to compare each Medicare Advantage plan in Oregon that offers benefits and costs suited to your individual health and budget needs.

To start comparing Medicare Advantage plans in Oregon today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates. 

For additional information about Medicare in Oregon, access the following resources:

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.