If you're looking for an all-in-one plan, you may be interested in Medicare Advantage (MA). Also known as Medicare Part C, over half of eligible Medicare beneficiaries are now enrolled in an Advantage plan. This page explains Medicare Advantage plans in Oregon and describes how the program works.
What is Medicare Advantage?
Every Oregon Medicare Advantage plan must cover the same services you get with Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance.
Original Medicare does not provide for prescription drug coverage. For that, you need Medicare Part D.
Around 90 percent of Medicare Advantage plans offer additional benefits, such as prescription drugs and routine vision and dental care.
Even if you join an Advantage plan, you must still pay the Medicare Part B premium.
Oregon Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Parts A, B, and D benefits into a single policy. Although most MA plans include prescription drug coverage, around 10 percent do not. If you join one of these, you'll need a standalone Medicare Part D plan as well.
Who is eligible for Medicare Advantage in Oregon?
If you have Medicare Parts A and B, you are eligible for Medicare Advantage in Oregon.
You become eligible for Medicare once you turn 65. People who collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months may also qualify, even if they aren't yet 65.
When can you sign up for a Medicare Advantage plan in Oregon?
The Medicare Advantage sign-up periods are:
- Initial Enrollment Period (IEP): Lasts for 7 full months, beginning 3 months before your Medicare eligibility month. For example, if your birthday or 25th month of disability is in September, your IEP lasts from June 1 through December 31.
- General Enrollment Period: From January 1 through March 31, anyone who did not sign up for Medicare Part A and/or Part B can do so. Then, from April 1 through June 30, you may join an Advantage plan.
- Medicare Annual Enrollment Period (AEP): From October 15 through December 7, current Medicare beneficiaries can join a Part C plan.
- Medicare Advantage Open Enrollment Period (OEP): If you already have Medicare Advantage, you may participate in OEP from January 1 through March 31. Your options are switching to a new MA plan or returning to Original Medicare. You can also join a standalone Part D plan if making that change leads to you losing your prescription drug coverage.
- Special Enrollment Periods (SEP): A variety of special circumstances may qualify you for an SEP. The full list is on Medicare.gov.
Types of Medicare Advantage plans in Oregon
There are four main types of Medicare Advantage plans in Oregon.
- Health maintenance organizations: HMO plan members must use the provider network for all covered services. Additional requirements include choosing a primary care doctor and getting a referral before seeing a specialist.
- Preferred provider organizations: PPO plans also use a provider network, but plan members can go out-of-network for a higher copay. You don't need a primary doctor or specialist referrals with a PPO plan.
- Private fee-for-service: PFFS plans set price limits for covered services. You don't have to choose a primary doctor, but some PFFS plans have a provider network. Your copay is higher for out-of-network services.
- Special needs plans: SNPs limit membership to people who have certain chronic illnesses, qualify for both Medicare or Medicaid, or who live in a nursing home or require at-home care.
How to choose a Medicare Advantage plan in Oregon
When comparing Medicare Advantage plans in Oregon, look at the following metrics:
- Coverage (including the drug formulary if it's an MA-PD plan)
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Oregon. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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