In 2025, around 25% of Medicare Advantage plans in Oregon will be discontinued due to the impact of the Inflation Reduction Act (IRA). This change aims to make healthcare services more affordable for seniors struggling with financial challenges.
However, the reduced payments to insurance companies have led some major providers, like Moda Health, Summit Health, Regence BlueCross BlueShield, Aetna, and Pacific Source, to exit the Medicare Advantage market in certain areas of Oregon.
This shift will especially affect seniors in rural counties, where alternatives are limited or nonexistent.
Without Medicare Advantage, some seniors may have to rely on Original Medicare, which doesn’t include extra benefits like dental and vision coverage that many Medicare Advantage plans provide.
Here’s a look at what Oregon seniors need to know about these changes and how to prepare.
Key Changes for 2025
1. Impact of the Inflation Reduction Act
The IRA’s goal of reducing healthcare costs has led to lower payments to insurance providers. While this helps make services more affordable for seniors, it also makes it financially difficult for insurers to continue offering certain plans.
2. Insurance Providers Leaving Oregon
Major companies, including Moda Health, Summit Health, and Regence BlueCross BlueShield, will exit the Medicare Advantage market in Oregon. These companies are reducing or completely ending their Medicare Advantage plans, especially affecting residents in the Portland metro area.
3. Limited Plan Options in Rural Areas
In rural counties like Curry, Harney, Lake, Umatilla, and Union, there are no other private Medicare Advantage plans available. Seniors in these areas will have to rely on Original Medicare, which does not cover additional services like dental and vision care.
4. Changes for Coos and Lane County Residents
Coos County residents will have one remaining Medicare Advantage option, though coverage may be limited. In Lane County, Regence will continue to offer HMO plans, making it the only county with this option.
5. Guidance for Medicare Enrollees
Medicare recipients have been informed about these changes. Health policy experts advise seniors to review any updates received during the regular Medicare enrollment period. A special enrollment period from December 8 to February is also available to make adjustments.
What Can Seniors Do?
Seniors affected by these changes have options to protect their healthcare coverage:
- Check Notices from Providers: Pay attention to any letters or notifications about coverage changes.
- Explore Other Medicare Options: If your Medicare Advantage plan is ending, consider enrolling in Original Medicare Parts A and B. You may also add a Part D plan for prescription drug coverage.
- Consult a Trusted Insurance Agent: An experienced agent can help seniors navigate the changes and find suitable coverage.
- Stay Informed: The changes in Medicare Advantage plans are expected to affect benefits and choices each year, so regular updates are essential.
In 2025, significant changes to Medicare Advantage in Oregon will affect thousands of seniors, particularly in rural areas.
The Inflation Reduction Act aims to reduce costs, but this has led to some insurers ending coverage due to financial strain.
Oregon seniors should review their Medicare options carefully and stay updated on new developments to make informed decisions about their healthcare.
Why are some Medicare Advantage plans ending in Oregon?
Due to the Inflation Reduction Act, insurers receive lower payments, making it hard for them to sustain Medicare Advantage plans in Oregon.
Which providers are leaving the Medicare Advantage market in Oregon?
Major companies like Moda Health, Summit Health, and Regence BlueCross BlueShield will discontinue their Medicare Advantage plans in Oregon.
What happens if I lose my Medicare Advantage plan?
If your plan ends, you will be automatically enrolled in Medicare Parts A and B, but you’ll need to add Part D coverage yourself if needed.
Are there other Medicare Advantage options in rural Oregon counties?
In some rural counties, there are no remaining private Medicare Advantage options, so seniors may have to rely on Original Medicare.
Can I change my Medicare plan outside of the regular enrollment period?
Yes, a special enrollment period runs from December 8 to February, allowing seniors to make changes if their coverage is affected.
