Medicare Advantage Plans in Oregon
Do you live in Oregon? If you are eligible, you can choose a Medicare Advantage plan, also known as Part C. Medicare Advantage plans often give you more coverage than Original Medicare (Part A and Part B). To enroll in a Medicare Advantage plan, you first must have Part A and Part B.
Part C plans are offered by private insurance companies (approved by Medicare) and cover all of the services that Original Medicare covers – and often more benefits like prescription drugs. Sometimes dental, vision and hearing services are also included. Choosing Medicare Advantage is a way to get these benefits in one convenient plan.
Yearly cost limits
Medicare Advantage plans have a yearly limit on your out-of-pocket costs. After you reach this yearly limit, you won’t have to pay anything for covered services. Yearly limits vary by plan so be sure to ask. It’s important to know that Original Medicare does not have a yearly limit.
What kinds of health care benefits do Medicare Advantage plans offer?
Medicare Advantage plans include coverage for:
- Hospital services (Medicare Part A)
- Medical services (Medicare Part B) – including preventive care
Depending on the plan you choose and where you live, most Medicare Advantage plans may also cover:
- Prescription drugs (Medicare Part D)
- Routine vision, hearing and dental care
- Health, fitness and wellness programs
Medicare Advantage Part C plans you can get in Oregon
- Health Maintenance Organization (HMO) plans: HMOs cover your health care through their network of doctors, specialists and hospitals. They have you choose a primary care doctor from the network, and this doctor coordinates your care and refers you to specialists if needed. If there is a medical emergency, you are covered even outside the network.
- Preferred Provider Organization (PPO) plans: PPOs are different than HMOs. With a PPO plan, you won’t choose a primary care doctor. This means you won’t need a referral to see a specialist. Your share of costs is usually lowest if you see doctors in the network though. You also can visit providers outside of the network – you just may have to pay higher copays and/or coinsurance.
- Private Fee-for-Service (PFFS) plans: Most PFFS plans don’t have networks. Generally you can get covered care from any doctor, specialist or hospital. You will want to check first that they accept the plan’s terms and conditions.
- Special Needs Plans (SNPs): These Medicare Advantage plans are designed specifically for people with chronic conditions or special health needs. The benefits, providers and covered prescription drugs are carefully chosen for these unique needs.
Enrolling in Medicare Advantage
Each plan has different coverage and costs, so choose the plan that’s right for your needs. Some plans have monthly premiums as low as $0. All plans have a yearly limit on your out-of-pocket costs, which may be important to you.
You can enroll in a Medicare Advantage plan during the Initial Enrollment Period and the Open Enrollment Period. Remember you must have Original Medicare, Part A and Part B, in order to enroll in a Medicare Advantage plan.
Initial Enrollment Period: If you’re not automatically enrolled in Original Medicare, you can first enroll during the 7-month Initial Enrollment Period. This begins three months before you turn 65, your birthday month, and three months after you turn 65. You can also enroll in a Medicare Advantage plan during this time period.
Open Enrollment Period: You can also join, change or leave your Medicare Advantage plan during the Open Enrollment Period. This happens every year starting on October 15 and ending on December 7.
Things to remember:
- Availability of plans in specific areas in Oregon depends on the contract between the plans and Medicare.
- Benefits and costs vary by the plan you choose and where you live
- With any Medicare Advantage plan, you must continue to pay your Original Medicare Part B premium
- Review the information and talk with a Medicare expert so you can select the plan that's right for you
How to sign up for a Medicare Advantage plan
- Visit Medicare.gov
- Search the plans you want, choose one and enroll on their website
- Call the plan you're interested in for a paper form to fill out
- Call 1-800-MEDICARE (1-800-633-4227) (TTY: 711)
- If you have both Medicare and Medicaid benefits, contact your state's Medicaid office