Thousands of Oregon seniors will lose health insurance after some Medicare Advantage insurers cut services in response to rising costs.
Moda Health and Summit Health end Medicare Advantage Oregon's Regence Blue Cross Blue Shield, Aetna and Pacific Sauce also plan to remove some Advantage plans from their menus next year.
In total, more than 12,000 Oregon seniors will need to find new insurance options for 2025. Data from Centers for Medicare and Medicaid Services.
In Oregon, Curry, Harney, Lake, Umatilla, and Union counties will no longer offer Medicare Advantage at all. That means residents of La Grande, Umatilla, Lakeview, Barnes, Brookings, Hermiston and Pendleton will have their own Medicare option.
Many counties in Oregon will have fewer options in 2025 than they do this year. For example, people living in Coos County will only have one Medicare Advantage plan option next year, down from seven in 2024.
Lisa Rettenmeyer, Founder of Tigard Medicare Insurance Brokerage health source northwestsays it's important for Medicare Advantage enrollees to check with their carrier about any changes to their plan.
“We have seen an increase in changes to Medicare Advantage plans this year, with more plans being withdrawn from the market than usual,” he said. “This is truly a year of big changes, and patients desperately need to read all the information from their carriers.”
Regence Blue Cross Blue Shield of Oregon will stop offering Medicare Advantage Health Maintenance Organization (HMO) plans in all counties except Lane County. Aetna draws some Medicare Advantage plans from the Portland metropolitan area and southern Oregon. PacificSource also plans to eliminate Medicare Advantage PPOs and offer one fewer plan in the Portland metro area.
Retenmeyer said if a patient's insurance company terminates all Medicare Advantage plans on the marketplace, they will receive a termination notice from their insurance company. These patients will have extra time to shop during the special enrollment period, which runs from Dec. 8 to the end of February. However, if you want coverage starting January 1st, you must register by the end of December.
Insurers cannot automatically transfer patients enrolled in HMO plans to preferred provider organization (PPO) plans, said Jeannie Fuglsten Biniek, associate director of the Medicare Policy Program at the Kaiser Family Foundation. He said he couldn't do it and vice versa.
If a patient takes no action after their Medicare Advantage plan ends, they will automatically be enrolled in Medicare Parts A and B, Biniek said. They do not receive Medicare Part D drug coverage and must enroll separately.
Patients who are removed from a Medicare Advantage plan have the option of moving to another Advantage plan or enrolling in traditional Medicare.
Regence Blue Cross Blue Shield of Oregon said it will eliminate HMO plans in most Oregon counties because more customers are signing up for PPO plans.
“The nature of the industry is changing, and many payers are evaluating their Medicare Advantage businesses in light of these changes and recent plan performance. We are no exception,” Regens said in a statement. mentioned in. “We regret the impact that required benefit reductions and plan cuts will have on our members and are doing our best to minimize disruption.”
Moda Health and Summit Health did not respond to requests for comment about the discontinued services.
“While the Medicare Advantage market has historically been economically attractive to insurers, their participation is not mandatory,” Biniek said. “Because it's not guaranteed, insurance companies make decisions every year about where to offer plans, what plans to offer, and what benefits they offer.”
Biniek said her team at the Kaiser Family Foundation found that the average beneficiary eligible for Medicare Advantage benefits this year has slightly fewer plan options this year than in previous years. said.
“It's chaos. This is the most disruptive set of changes I've seen in the last 10 years,” said CEO Diane Faligowski. oregon health planan insurance agency that receives funding from the state to help residents sort out their health insurance plans.
But traditional Medicare can be prohibitively expensive for beneficiaries who switch from Medicare Advantage, Faligowski said. With traditional Medicare, enrollees pay monthly premiums. And after you reach your deductible, you're expected to pay 20% of the cost of each doctor's visit or medical procedure.
Faligovsky said monthly premiums for hospitalization coverage under traditional Medicare are expected to be about $1,600, while monthly premiums for primary care and specialist visits are expected to be about $185 in 2025. said.
To limit out-of-pocket costs, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or Medicare Supplemental Insurance. Medicare supplement insurance, also known as Medigap, is additional insurance from private insurance companies that covers out-of-pocket costs that traditional Medicare doesn't cover.
Faligovsky said Medicaid may provide additional coverage if enrollees are low-income.
Beneficiaries who initially enroll in traditional Medicare are guaranteed eligibility for Medigap insurance without medical history-based pricing, while Medigap insurers will They can deny coverage or set prices based on medical underwriting.
Only four states – Connecticut, Maine, Massachusetts and New York – prohibit insurers from denying Medigap insurance if a patient has a pre-existing condition. According to KFF.
However, patients excluded from Medicare Advantage plans will be allowed to sign up for Medigap insurance without the insurance company evaluating the patient's medical history to cover costs under traditional Medicare. said Elma Friend, founder of Medicare Advantage. Willamette Valley Advisorsa health insurance broker in Milwaukee.
He said in Oregon, people who want Medigap insurance without medical underwriting will pay premiums based on their tobacco use, gender identity and age. The older the patient, the higher the monthly Medigap premium, Friend said.
Friend said it's not just Medicare Advantage patients who are experiencing changes. He said patients with stand-alone Part D prescription plans may also be fighting for new plans.
Omaha Insurance Mutual Company announced The company will no longer offer stand-alone prescription drug plans starting in 2024 due to changes in the Inflation Control Act.
Approximately 1,540 Oregonians have Part D insurance solely through Mutual of Omaha, according to the latest data from the Centers for Medicare and Medicaid Services.
Friend said insurers offering drug coverage may be reacting to the government's new $2,000 out-of-pocket cap that Medicare beneficiaries can spend on Part D prescription drugs, an amount that The amount has been reduced from this year's $8,000.
The change will impact drug coverage as a stand-alone prescription drug plan and as part of a Medicare Advantage plan, Friend said.
“It's a bit of a hit. Who's going to cover the $6,000 per person they're currently paying?” she said. “That's adding to the financial burden on insurers, which they will look to offset.”
If your plan changes or you are removed from your Medicare plan, you can receive assistance from the Senior Health Insurance Benefits Assistance Program by calling 800-722-4134. SHIBA connects people to local offices and schedules appointments.
Portland Parks and Recreation is also offering two free classes to help Portland-area seniors take advantage of Medicare, scheduled for October 22nd and December 10th. . portlandparks.gov/parks/register.
Oregon Health Plan's Fagliowski said her team provides Medicare counseling in languages other than English, including Spanish, Vietnamese, Russian, Mandarin, Cantonese and Tagalog. Ta. For assistance in other languages, please call 503-928-6918 or visit healthplansinoregon.com/enrollment-events.
Meanwhile, Jewish Family and Children Services, in conjunction with Congregation Neve Shalom, will host a class on navigating Medicare on Nov. 7. You can register: jfcs-portland.org/medicare-answers/.
— Kristine de Leon covers consumer health, retail, small business, and data companies. Please contact kdeleon@oregonian.com.
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