Introduction to Medicare Advantage in Oregon (Part C)

Medicare “replacement” (or Medicare Part C) are both alternative names for what most people know as Medicare Advantage. If you have Medicare, and you are worried about expensive coverage gaps, Medicare Advantage is a comprehensive supplement insurance policy which could help protect you from the gaps in Medicare Parts A and B. However, there are some drawbacks which you should learn about before you make a final decision.

Federal Regulations for Medicare Advantage

When you sign up for a Medicare Advantage policy, you are signing up for a private health insurance provider to take over responsibility for paying out claims on your Medicare benefits. For this reason, the government closely regulates such plans to make sure you are getting at least the coverage you deserve, if not better. By law, your Medicare Advantage plan must include the same benefits as Medicare Parts A and B. Fortunately, most plans include much more than that (which will be discussed in detail below).

Medicare Advantage Enrollment In Oregon

Medicare Advantage plans are actually quite common in Oregon. Around 43% of seniors in the state have replaced their Medicare with an Advantage plan. Below, you can take a look at which types of Advantage plans are the most popular among Oregon seniors:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Below, we have a chart which displays estimated rates for Medicare Advantage plans near you. Keep in mind, though, that these are just estimates. Your individual quote and rate will vary greatly, based on attributes such as gender, health status, and even your zip code.

Most Popular Medicare Advantage Plans in Oregon

The biggest difference between Medicare Advantage plans is the network provider option. You have several different providers to choose from, but the choice you make will have a significant impact on your overall premium. Larger provider networks are, of course, more expensive but also more convenient. Smaller networks will save you money, but could end up costing you in stress or inferior medical care.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Depending on the Advantage policy you choose, your provider network could come with different restrictions on where, when, and how you can get your medical care. Limited Networks, such as HMOs, won’t let you see anyone outside of your network – unless you want to pay out-of-pocket, that is. Other networks will allow you to venture out for non-network care, but they will charge you more. Regardless of your network, nobody is legally allowed to deny you medical care in the event of a medical emergency.

Doctor/Providers List

Drug, Vision and Dental Coverage

One good thing about Medicare Advantage (which many Oregon seniors are familiar with) is its simplicity. Instead of juggling many different types of coverage on separate plans, you can combine all of the health coverage you need onto a single plan. This includes your Medicare benefits, Medicare gap coverage, vision, dental, and even prescription drug coverage with a MAPD plan. Feel free to add as much coverage as you want, or keep your policy simple. Just remember that the more you add, the more expensive it will be each month.

Enrollment Options & Best Time To Enroll

Enrolling within your Initial Enrollment Period (or, in most cases, during a Special Enrollment Period) should result in your request for coverage getting approved without a physical exam or a health survey. Should you enroll outside of those special periods, you may have a more difficult time getting approved. People with serious health conditions (ESRD among them) will have an even greater challenge getting approved. But your state department of insurance is there to help, as well as your local insurance agent. You can also visit our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

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