- In 2019, there were 78 Medicare Advantage Plans available in Oregon.
- 43% of the total Medicare population in Oregon is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $7,816 per beneficiary in Oregon, which is 23% lower than the national average.
- Available Medicare Advantage Plans range from two to 42 across Oregon’s 36 counties.
If you’re eligible for Medicare, you can remain with Original Medicare or select a Medicare Advantage Plan. In Oregon, the availability of MA plans varies depending on the provider and location. You can only select a Medicare Advantage Plan that’s available in your county, even if the choice of providers and plans is limited.
Medicare Advantage Plans in Oregon
Types of Medicare Advantage Plans
The Oregon Medicare Advantage program includes four basic types of plans. Each plan type has pros and cons, and the premiums and covered benefits differ. You can select from one of the four, depending on availability in your county, to choose the plan that best suits your health care needs and finances.
Health Maintenance Organizations (HMO)
A Medicare Advantage HMO is like a regular HMO. These plans are among the least expensive Medicare Advantage Plans, but also the most restrictive. You can only use in-network health care providers, you need to select a primary care physician, and you must obtain a referral to see a specialist. Many, but not all, of these plans offer prescription drug coverage. Also, you may need to pay the premiums for Original Medicare Part B and Part A, if applicable.
Preferred Provider Organizations (PPO)
Medicare Advantage PPO plans have a network of health care providers. You can use providers from outside the network if desired, although it can be more expensive if you do. You won’t need to choose a primary care physician or obtain a referral to see a specialist. Many Medicare Advantage PPOs include prescription drug coverage and extra benefits, such as vision care, dental and hearing coverage, and access to fitness programs.
Private Fee-for-Service Plans (PFFS)
Medicare Advantage PFFS plans offer you the flexibility of not having to choose a primary care doctor or get referrals to see specialists. However, the insurance company sets limits on how much it will pay providers and what you will pay. In some cases, PFFS plans work with a network of providers who only see members of that plan. You can, however, use any provider who will accept your plan’s terms. Some won’t, so always check first. Many PFFS plans provide prescription drug coverage.
Special Needs Plans (SNP)
SNPs are targeted at specific groups: seniors in nursing homes, people eligible for both Medicare and Medicaid, and individuals suffering from certain conditions, such as AIDS, End-Stage Renal Disease (ESRD), or cancer. All SNPs must include prescription drug coverage. If you want to sign up for a Special Needs Plan, look for one that provides coverage for your specific needs. With an SPN plan, you need to use the plan’s in-network health care providers, name a primary care physician and obtain referrals to see specialists.
Enrollment and eligibility for Medicare Advantage Plans in Oregon
You must be at least 65 years of age or disabled to enroll in a Medicare Advantage Plan offered in your Oregon county. Additionally, you must be a U.S. citizen or a permanent resident who’s lived in the United States for the past five years. You also need to be enrolled in Original Medicare Parts A and B but not enrolled in a Medicare Supplemental Insurance plan.
You can sign up or switch from Original Medicare to a Medicare Advantage Plan during specific periods:
- Initial Enrollment Period. This seven-month period includes the three months before you turn 65, your birth month, and the three months after you turn 65.
- Open Enrollment This annual period runs from October 15th to December 7th, when you can switch from Original Medicare to a Medicare Advantage Plan or return to Original Medicare. You can also change your Medicare Advantage Plan, provided the new one is available in your county.
- Medicare Advantage enrollment. During this annual period from January 1st to March 31st, you can switch Medicare Advantage Plans or return to Original Medicare. If you don’t have a Medicare Advantage Plan, however, you can’t switch from Original Medicare to an MA plan. If you haven’t already signed up for Medicare Part B, you can do so during this period. You can then select a Medicare Advantage Plan between April 1st and June 30th, and your coverage will start on July 1st.
If you move to another county in Oregon, lose your eligibility or coverage, or meet certain other conditions, you may qualify for a special enrollment period to sign up for a Medicare Advantage Plan.
If you are still on your employer’s health care insurance or if your spouse is still working and you’re covered by their insurance, you don’t need to sign up for Medicare when you turn 65. You’ll have eight months after this insurance ends to sign up for Original Medicare or a Medicare Advantage Plan.
Prescription drug coverage
Many HMO and PPO Medicare Advantage Plans offer prescription drug coverage which is often included in the premiums. Some plans may charge a separate premium. If your HMO or PPO plan doesn’t include this coverage, you can’t sign up for a separate Medicare Part D plan. If you do, you’ll be expelled from your Medicare Advantage Plan and revert back to Original Medicare. Most PFFS plans include prescription coverage, but if yours doesn’t, you can sign up for a separate Medicare Part D plan. All SNPs must include prescription drug coverage.
Medicare Advantage Resources in Oregon
Deciding between Original Medicare and Medicare Advantage or choosing a particular MA plan can be a daunting task. Fortunately, several organizations in Oregon provide free counseling and guidance about your options. The resources listed below can provide unbiased assistance with your Medicare decisions.
Oregon has 16 Area Agencies on Aging that administer senior-oriented programs or support other aging-related community resources in specific regions. Each AAA also acts as the local Aging and Disability Resource Connection that can help seniors access free Medicare and Medicare Advantage counseling in their area.
Contact Information: Website | 855-673-2372
Senior Medicare Patrol
SMP volunteers provide information and education to Oregon seniors, their families, and their caregivers on how to avoid fraud and abuse in Medicare, Medicare Advantage, Medicare Supplemental Insurance, and Medicaid. The SMP program works with the Senior Health Insurance Benefits Assistance (SHIBA) program, the Office of the Long-Term Care Ombudsman (LTCO), and the Association for Oregon Centers for Independent Living (AOCIL) to raise awareness among seniors and others around these issues.
Contact Information: Website | 503-945-5600
Oregon Senior Health Insurance Benefits Assistance (SHIBA)
The SHIBA program provides senior Oregonians with access to trained and experienced counselors who provide information about all aspects of Medicare. These SHIBA-certified Medicare counselors help you shop, compare, and make decisions about whether to enroll in Original Medicare or Medicare Advantage or how to purchase a Medicare Part D or Medicare Supplement Insurance plan. SHIBA Medicare counselors can be found across the state of Oregon. This service is free of charge.
Contact Information: Website | 800-722-4134
Learn More from Our Sources
- Medicare |Who can join a Medicare Advantage Plan | Last accessed June 2021
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Part D | Last accessed June 2021
- Medicare | Health Maintenance Organizations (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organizations (PPO) | Last accessed June 2021
- Medicare | Private Fee-for-Service Plans (PFFS) | Last accessed June 2021
- Medicare | Special Needs Plans (SNP) | Last accessed June 2021
- Medicare | Special Circumstances (Special Enrollment Periods) | Last accessed June 2021