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When you become eligible for Medicare, you have two primary options for coverage. You could get Original Medicare, which includes Medicare Part A for hospital insurance and Part B for medical insurance. Or you could opt for a Medicare Advantage Plan.
Medicare Advantage Plans (also called Medicare Part C) are an all-in-one alternative to Original Medicare that provide the same coverage as Parts A and B. Plans also frequently include other benefits Original Medicare won’t cover, like prescription drug coverage, hearing, dental, and vision.
This article contains everything you need to know about Medicare Advantage Plans in Oregon.
Compare ratings of insurance companies offering Medicare Advantage Plans in Oregon:
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||Fifth out of 10|
|Regence Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of 10|
|Kaiser||5||A||A-||4.5 to 5 stars||First out of 10|
|Providence||5 stars||Not rated||F||4 stars||Not ranked|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 132 Medicare Advantage Plans available in Oregon, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are 132 Medicare Advantage Plans available in Oregon for 2022. The latest data breaking down the type of Medicare Advantage Plans in Oregon is from the 2019 Kaiser Family Foundation report that shows 78 plans, including the following:
Oregon has no MSA, PFFS, or regional PPO plans. Oregon had 9 Medicare Advantage Plans rated 3.5 or higher for 2019 to 2020 by NCQA, including HMOs, PPOs, and POS plans.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Oregon, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Oregon Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Oregon Council on Aging||Phone: 541-640-5423||The Oregon Council on Aging offers programs to connect central Oregon seniors to health care resources.|
|Oregon Office of Health Policy||Phone: 971-273-6844||Oregon Office of Health Policy analyzes and develops policies and coordinates health policy efforts to help the state implement programs.|
|Oregon Division of Financial Regulation||Phone: 888-877-4894||The division provides education and consumer guidance to help Oregon residents access products and services including health care.|
|Legal Aid Services of Oregon||
||Legal help for low-income Oregon residents seeking assistance with civil legal needs.|
email: [email protected]
|Medicare Savings Programs (MSP) help people with limited income and resources pay for some or all of their Medicare premiums.|
|Qualified Medicare Beneficiaries Program||503-945-5600||The state’s Qualified Medicare Beneficiaries Program provides benefits to help pay for the program for those who qualify.|
|Aging and Disability Resource Connection (ADRC) of Oregon||855-673-2372||The ADRC provides information and guidance to help you navigate health care, senior and wellness programs.|
|Oregon Health Plan||Phone:503-947-2340||This is Oregon’s health plan for those who qualify.|
|Resource||Contact||How they help|
|211Oregon||Phone: 211||2-1-1 Oregon can connect you to critical resources (such as shelter availability childcare, or rent payment assistance) simply by dialing a three-digit number.|
|Oregon Wellness Network||Phone: 855-673-2372||The Oregon Wellness Network develops programs for the state’s Area Agencies on Aging (AAA), including home-delivered meals, case management, in-home care, and more.|
|Multnomah County Aging, Disability & Veterans Services||Phone:503-988-3620||This AAA services offers Medicare Assistance along with helping older adults and caregivers access healthcare resources, in-home care, food and nutrition, and more.|
|Lane Council of Oregon Senior & Disability Services||Phone: 541-682-4038||This council is the AAA for the Lane Council region and its services range from Medicare assistance to education and programming geared toward aging adults.|
|Rogue Valley Council of Governments Senior & Disability Services||Phone: 541-644-6674||The council offers a network of services to help seniors and adults with disabilities live with dignity and independence.|
|Klamath and Lake Counties Council on Aging||Phone: 541-205-5400||The council’s services include Medicare Assistance along with helping older adults and caregivers access healthcare resources, in-home care, food and nutrition, and more.|
|Harney County Senior & Community Services Center||Phone: 541-573-6024||The center offers services and programs for older adults, including education and guidance on Medicare and health care.|
|Senior Health Insurance Benefits Assistance (SHIBA)||Phone: 800-722-4134||Oregon SHIBA helps Medicare enrollees navigate the Medicare system and provides free, unbiased and individualized information.|
|Malheur Council on Aging||Phone: 541-889-7651||The council connects aging adults and caregivers with a full suite of resources, including assistance with Medicare.|
|Douglas County Senior Services||Phone: 541-440-3677||This service is one of 17 Area Agencies on Aging in Oregon and connects older adults with education, resources, guidance and programs to help them stay independent and age with care.|
|The Oregon Association of Area Agencies on Aging (OA4)||Phone: 541-464-2456||The OA4 oversees Oregon’s 17 Area Agencies on Aging and is a resource for finding an AAA close to you.|
|Resource||Phone||How they help|
|CMS Medicare Managed Care Appeals & Grievances||1-800-MEDICARE||Offers information and guidance on Medicare and its connected programs.|
|CMS Medicare Managed Care Eligibility and Enrollment||1-800-633-4227||This resource contains information for current and future contracting Medicare Advantage (MA) organizations, other health plans, and other parties interested in the operational and regulatory aspects of Medicare health plan enrollment and disenrollment.|
|CMS Medicare Prescription Drug Eligibility and Enrollment||1-800-424-4301||This page contains enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment.|
|Medicare.gov||1-800-MEDICARE||The main government website for signing up for (or making changes to) Medicare coverage.|