Seniors in Oregon could face significant disruptions in their healthcare coverage next year, as an estimated 25% of Medicare Advantage plans in the state are set to be discontinued in 2025.
This shift results from changes brought about by the Inflation Reduction Act (IRA), which aims to make certain services more affordable for retirees facing financial challenges. While the legislation’s goals may be beneficial, its impact on reimbursement rates for insurance providers has led to a reduction in available plan options.
Impact on Providers
One of the most significant consequences of the IRA’s implementation is the reduction in reimbursement rates for insurance companies. These lower rates have made it economically challenging for some insurers to continue offering Medicare Advantage plans, particularly in specific regions. As a result, several major providers, including Moda Health and Summit Health, will end all their Medicare Advantage plans in Oregon. Other companies, such as Regence BlueCross BlueShield of Oregon, Aetna, and PacificSource, will significantly reduce the number of plans they offer, primarily affecting seniors in the Portland metro area.
The loss of these providers will leave approximately 12,000 Oregon residents without a Medicare Advantage plan. While other providers may be available to fill the gap, some seniors may find it difficult to secure a comparable plan that meets their needs, especially in rural areas.
Limited Options
Seniors living in rural counties like Curry, Harney, Lake, Umatilla, and Union will face particularly challenging circumstances. In these areas, no other private Medicare Advantage plans will be available, leaving seniors dependent on the original public Medicare program. Unfortunately, this could mean losing access to additional benefits like dental and vision care, which were often included in Medicare Advantage plans.
Coos County residents will still have a single private plan available, but the coverage may not be as comprehensive as previous options. Similarly, Lane County seniors will have just one option for coverage under Regence’s HMO plan, making it the only county in the state to continue offering HMO plans.
Provider Statements
Regence, one of the affected insurers, explained its decision to withdraw from the Medicare Advantage market in Oregon, citing changes in the industry and recent plan performance as reasons for its exit. In a statement, the company acknowledged the impact that benefit reductions and plan discontinuations would have on members, noting that it was working to minimize disruptions.
The shifting landscape reflects a broader trend in the insurance industry, where many payers are reevaluating their Medicare Advantage offerings in light of lower reimbursement rates and regulatory changes introduced by the IRA.
Notices and Enrollment
Medicare beneficiaries in Oregon have been notified of the upcoming changes to their plans. According to Louise Norris, a health policy analyst for healthinsurance.org, insurers sent notifications to enrollees in September, detailing any coverage terminations or plan alterations for 2025. She emphasized the importance of seniors understanding these changes and taking appropriate measures to maintain coverage.
The annual enrollment period allows beneficiaries to review their options and make changes to their plans, running from October 15 to December 7. For those whose plans are discontinued, automatic enrollment in Medicare Part A and Part B will occur. However, seniors will need to enroll separately in a Part D prescription drug plan if they want to retain drug coverage.
Challenges Ahead
As the changes take effect, navigating Medicare Advantage coverage could be more challenging for some seniors. Chris Fong, CEO of Smile Insurance, highlighted the reality that Medicare Advantage plans can change or be discontinued annually. He advised seniors to seek assistance from knowledgeable agents who can help them understand their options for the coming year. Lower Medicare reimbursements and changes introduced by the IRA have added financial pressure on insurers, complicating the process for those trying to find suitable coverage.
With these changes, it’s crucial for seniors to stay informed, look into all available options, and take action during the enrollment period to ensure they maintain the coverage they need.
FAQs
Why are Medicare Advantage plans being discontinued in Oregon?
The plans are being discontinued due to lower reimbursement rates introduced by the Inflation Reduction Act, making it financially challenging for some insurers to continue offering coverage.
Which counties in Oregon will have no private Medicare Advantage plans?
Curry, Harney, Lake, Umatilla, and Union counties will have no private Medicare Advantage plans available in 2025.
Will seniors automatically lose their Medicare coverage?
No, seniors losing Medicare Advantage coverage will be automatically enrolled in Original Medicare (Part A and B), but they will need to enroll in a separate Part D plan for prescription coverage.
What options do Lane County residents have for 2025?
Lane County residents will have one option available: a Regence HMO plan, the only HMO plan still offered in the state.
How can seniors prepare for these changes?
Seniors should review any notifications received from their insurance providers, look into new plan options during the enrollment period, and consider consulting a knowledgeable agent.
