It’s possible for Oregon seniors to lose their Medicare Advantage coverage next year, since about 25% of plans will end in the state in 2025. All of this is because of changes made by the Inflation Reduction Act (IRA) to make some services more cheap for retirees who are having a hard time with money.
One of the biggest changes since the IRA went into effect is that insurance companies are getting paid less for their services. They say that this makes it economically impossible for them to provide those services, especially in certain key parts of the country.
The most important companies in the state to stop doing business are Moda Health, Summit Health, Regence BlueCross BlueShield of Oregon, Aetna, and PacificSource. These companies will be ending all Medicare Advantage plans, and they will also be reducing the number of plans and services they offer to seniors on Medicare, especially in the Portland metro area.
It might not seem like a big deal, but there are many other providers that could fill the gap. Without one, 12,000 Oregon residents will not have a plan, and some of them will not be able to find another company that will work with them.
There are no other private Medicare Advantage plans in counties like Curry, Harney, Lake, Umatilla, and Union. This means that seniors will have to rely on the original public version of Medicare and will not be able to get some of the dental and eye care that these plans offered.
People who live in Coos County will have one private plan to choose from, but it might not cover as much as other plans have. Lane County residents will also have one choice: under Regence, they will still be able to get HMO plans. This makes Lane County the only county in the state that offers these plans.
Regence, an insurance company, said in a statement that they were leaving the market because “the nature of the industry is changing, and many payers are evaluating their Medicare Advantage business in light of these changes and recent plan performance.” We’re the same.
We’re sorry that our members will have to deal with the effects of having to cut benefits and plans, but we’re doing our best to keep things as normal as possible.
Medicare Advantage notice for the state
A health policy analyst for healthinsurance.org named Louise Norris told seniors that they need to be aware of the changes and do what they need to do to stay protected. “Last month, enrollees got notices from their insurance company about any changes to their plan for 2025, such as coverage ending.” This year there are a lot of changes, so people on Medicare should make sure they understand any messages they got from their plan this fall.
People should have been told about the changes in time to make them during the regular Medicare enrollment period. However, the special enrollment period, which runs from December 8 to February, may cover some cases.
If you make any changes and lose your Medicare Advantage plan, you will automatically be registered in Medicare Parts A and B. If you want to add prescription drug coverage (Part D), you will need to do this on your own.
Chris Fong, CEO of Smile Insurance and an expert on Medicare, says that seniors may not have thought about the downsides of getting used to Medicare Advantage coverage. “Unfortunately, this is how Medicare Advantage plans work.” They might be changed, and they might not be reissued every year.
A lot of insurance companies are having trouble making ends meet because Medicare payments are going down and the Inflation Reduction Act is making prices go up. Most people are afraid that they won’t know where to get help to find out if their plan is going to be renewed or kicked off or to figure out how to deal with the changes for 2025.
If you are worried about how to handle your coverage on your own, I suggest that you find an agent you can trust and who knows a lot about it.
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