Medicare Advantage plans in Oregon are required to provide all the same benefits as Original Medicare Parts A and B . Many plans also offer additional benefits like dental, vision and hearing coverage.
Medicare Advantage plans set their own costs. Most Medicare Advantage plans Oregon offers have low monthly premiums and a cap on out-of-pocket spending.
As soon as you’re enrolled in Original Medicare, you’re eligible to enroll in a Medicare Advantage plan.
Most Medicare Advantage plans in Oregon include Part D prescription drug coverage .
If you’re on Medicare in Oregon, you have the choice to stick with Original Medicare, also known as Parts A and B or enroll in Medicare Advantage (Part C). As of 2024, there are 132 Medicare Advantage plans available in the state; the specific plans you can access depend on your ZIP code.
On this page, we’ll help you understand what you can expect from Medicare Advantage in Oregon. You may discover that these plans offer a variety of benefits to meet your healthcare needs.
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All Medicare Advantage, or Medicare Part C, plans provide the same coverage as Original Medicare, but most also offer prescription drug coverage and can include additional benefits like:
- Vision coverage
- Dental coverage
- Hearing coverage
- Fitness programs or gym memberships
- Over-the-counter pharmacy items
Nearly every Oregonian eligible for Medicare, 98.8% according to the federal government’s Centers for Medicare and Medicaid Services, has access to a Medicare Advantage plan. Each plan provides different coverage options, and a licensed insurance agent can help you find the one that fits your needs.
Original Medicare Part A and Part B have set premiums that apply nationwide, but Medicare Advantage plans don’t have a federally set cost. Each Medicare Advantage plan provider determines their own plan benefits and premiums. The average monthly premium for Medicare Advantage in Oregon was $31.22, and 95.9% of eligible residents had access to plans with $0 premiums.
Both Original Medicare and Medicare Advantage plans have copayments and coinsurance. Copayments are a flat rate you pay each time you access a covered healthcare service, and coinsurance is a percentage of the bill that you may have to pay. For example, Original Medicare has a 20% coinsurance for many healthcare services. This means that Medicare will pay 80% of the bill, and you’ll pay the remaining 20%.
Medicare Advantage plans may set lower copayments for covered services than Original Medicare and have an out-of-pocket maximum. Once you’ve reached this limit, you aren’t responsible for copays and coinsurance for the remainder of the plan year.
Check each Medicare Advantage plan for a list of covered services and information about copays and coinsurance to help you choose a Medicare Advantage plan that’s right for you.
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Not all Medicare Advantage plans are the same. The type of plan you have determines the cost of your plan, as well as how you access care. Here’s an overview of four main types of Medicare Advantage plans available in Oregon.
Health Maintenance Organization Plans
Health Maintenance Organization (HMO) plans are one of the most common Medicare Advantage plans. HMO plans have a robust network of providers that accept your healthcare coverage.
HMO plans ask you to choose a primary care physician when you join the plan. This doctor will be your main point of contact for all your healthcare needs. You will need to get a referral from your primary physician before seeing a specialist or other care provider.
Preferred Provider Organization Plans
Preferred Provider Organization (PPO) plans are also a popular option. These plans provide flexibility since you do not need to select a primary care physician. You can make appointments with other care providers without a referral. And as long as these providers are in-network, your healthcare coverage will apply.
Private Fee-For-Service Plans
Private Fee-for-Service (PFFS) plans may not be available in every coverage area. These plans provide more flexibility but may come at a higher cost. If you have a PFFS plan, you can access in-network and out-of-network care. If the provider accepts your Medicare coverage, your coverage applies.
Special Needs Plans
Special Needs Plans (SNPs) have very specific eligibility criteria. You can enroll in an SNP if you have a specific chronic health condition. For example, if you have end-stage renal disease, dementia, cancer or heart failure, you may qualify for a Special Needs Plan. These plans also include prescription drug coverage, offering coverage for the medications that meet your needs. You may also qualify for a SNP if you’re eligible for both Medicare and Medicaid.
To qualify for Original Medicare, you must be a U.S. citizen or permanent resident. Most Medicare beneficiaries are over 65. However, younger adults with a qualifying health condition can enroll in Medicare before turning 65.
Once you’re enrolled in Original Medicare, the rest is easy! You only need to meet two eligibility criteria to enroll in a Medicare Advantage plan:
- You have your Medicare number, found on your Medicare ID card.
- You live in the coverage area of your new Medicare Advantage plan.
You can enroll in a Medicare Advantage plan or switch between plans during several enrollment periods. Learn more about these enrollment periods so you won’t have to pay any late penalties when enrolling in Medicare.
- Initial Enrollment Period (IEP): Your IEP is the first chance you have to enroll in Medicare. This period is seven months, so you’ll have enough time to enroll in Original Medicare, then switch to a Medicare Advantage plan. Your IEP starts three months before the month you turn 65. It includes your birthday month and then extends three more months after your birthday month.
- Medicare Open Enrollment: Also called the Annual Enrollment Period or AEP, Medicare Open Enrollment runs from October 15 to December 7 each year. It’s open to anyone who has a Medicare plan. During this period you can enroll in a new Medicare Advantage plan in Oregon, or switch between plans.
- Medicare Advantage Open Enrollment Period: From January 1 to March 31 each year, you can switch to a new Medicare Advantage plan or even switch back to Original Medicare. However, if you currently have Original Medicare, you can’t use this period to enroll in a Medicare Advantage plan for the first time.
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Most Medicare Advantage plans include Medicare Part D prescription coverage. Each plan has a list of covered medications, called a formulary. It’s a good idea to check the formulary for your current mediations, and compare the copayment or coinsurance amounts against other plans you’re considering.
A GoHealth licensed insurance agent can help you compare plans and formularies to help you find a plan that offers the right healthcare coverage for your needs.
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