According to estimates, 25% of Oregon’s Medicare Advantage plans will be canceled in 2025, putting seniors at risk of losing their coverage the following year.
All of this is a result of modifications made by the Inflation Reduction Act (IRA) to lower the cost of various services for people who are having financial difficulties in retirement.
The decreased reimbursement rates for insurance providers, which they say make providing the services economically unfeasible, particularly in some important regions of the nation, are one of the most significant shifts we have witnessed since the IRA was put into place.
Several major providers in the state have made the decision to stop providing services, including Regence BlueCross BlueShield of Oregon, Aetna, and PacificSource, which will be reducing the number of plans and services they offer for seniors on Medicare, particularly in the Portland metro area, and Moda Health and Summit Health, which will be terminating all Medicare Advantage plans.
Even though it might not seem like much, 12,000 people in Oregon will be left without a plan, and some of them won’t be able to find another firm that is willing to work with them. There are plenty of alternative carriers who could fill the gap.
Seniors will be forced to rely on the original public version of Medicare and will be deprived of some of the dental and vision care that these plans offered because there are no alternative private Medicare Advantage plans available in counties including Curry, Harney, Lake, Umatilla, and Union Counties.
Residents of Coos County are fortunate since there will be a single private plan offered, however it might not have as comprehensive coverage as earlier ones. HMO (Health Maintenance Organization) plans, which are the only county in the state to offer them, will remain an option for Lane County residents under Regence.
“The industry is changing, and many payers are evaluating their Medicare Advantage business in light of these changes and recent plan performance,” Regence, the insurance firm, said in a statement announcing their exit from the market.
We are not any different. We’re working hard to minimize any interruptions, but we regret the impact that essential benefit changes and plan adjustments will have on our members.
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The state’s Medicare Advantage notification
Seniors should make sure they are informed of the changes and take the appropriate steps to stay insured, according to Louise Norris, a health policy analyst with healthinsurance.org. Last month, enrollees were notified by their insurer of any changes to their 2025 plan, including terminations of coverage.
Medicare beneficiaries should make sure they comprehend any communications they have gotten from their plan this fall because there are a lot of changes this year.
Though some situations might be covered under the special enrollment period, which runs from December 8 through February, notifications should have been sent in time to make the modifications during Medicare’s regular enrollment period.
In any event, anyone who make any changes and lose their Medicare Advantage plan will be automatically enrolled in Medicare Parts A and B. If they want to add prescription drug coverage (Part D), they will need to do so on their own.
