Picking the right Medicare Advantage health insurance plan can be difficult, especially when each plan offers a unique mix of benefits. Make the decision easier by learning about the top plans in Oregon for 2021.

Oregon residents who have Original Medicare (Medicare Part A and Part B) and are considering a Medicare Advantage plan have a number of options. In fact, there are 128 Medicare Advantage plans available in Oregon in 2021. 

It can take a lot of consideration before you’re ready to enroll in a plan. Read on to see which plans are the top options in the state and learn more about whether MA plans offer the right health plan coverage for your needs and budget.

Take the guesswork out of comparing MA plans in your service area. Give the Insurify Medicare comparison tool a try for a side-by-side comparison of your options.

 

What Are the Best Medicare Advantage Plans in Oregon?

Before talking with an insurance agent, it can help to have a baseline for comparing your MA plan options. Below, you’ll find the top Oregon Medicare Advantage plans for 2021 to make that a bit easier. 

The plans below were chosen using a number of factors, including their Medicare star rating and plan costs, such as the monthly premium, co-payments and coinsurance, drug plan deductibles, and out-of-pocket costs. Note that only plans offering a Medicare Part D prescription drug plan were considered for the list.

If you’re considering enrollment for one of the plans below and would like to know more, be sure to check with the insurance provider for more details. This can include a formulary detailing which medications are covered in the prescription drug plan and whether they are in a lower tier or a higher tier. You’ll also find other requirements for the plan after enrollment, such as if you need to seek care from within a provider network or point of service requirements.

#1 Kaiser Permanente Senior Advantage Enhanced H9003-001 (HMO)

    • Rating: 5/5
    • Premium: $127
    • Deductible: $0
    • Out-of-pocket maximum: $3,000
    • Counties: Benton, Clackamas, Columbia, Linn, Marion, Multnomah, Polk, Washington, and Yamhill

This plan offers low co-pays for Tier 1 drugs, at $5–$10. Doctor visits are also quite affordable, with a $5 primary care co-pay and a $25 specialist co-pay. Hearing and vision exams are $25, and a hearing fitting and evaluation has a $0 co-pay. Unfortunately, there are no additional benefits for hearing, dental, or vision with this plan.

#2 Kaiser Permanente Senior Advantage Standard H9003-006 (HMO

    • Rating: 5/5
    • Premium: $44
    • Deductible: $0
    • Out-of-pocket maximum: $4,900
    • Counties: Benton, Clackamas, Columbia, Linn, Marion, Multnomah, Polk, Washington, and Yamhill

This plan’s costs are similar to the previous Kaiser Permanente plan. Tier 1 drug costs range between $5 and $10. Doctor visits require co-pays of $5 for primary care and $35 for specialist care. Like the first plan, the only hearing and vision benefits are exams with a $35 co-pay and hearing fitting and evaluation services with a $0 co-pay.

#3 Kaiser Permanente Senior Advantage Standard Lane H9003-007 (HMO

    • Rating: 5/5
    • Premium: $49
    • Deductible: $125
    • Out-of-pocket maximum: $3,000
    • Counties: Lane

Tier 1 drug co-pays with this plan can range from $4 to $57. Doctor visits are even more affordable than with the previous Kaiser Permanente plans, with co-pays of $0 for primary care and $25 for specialist care. Like the previous plans, vision and hearing benefits are scarce; exams for both carry a $25 co-pay, and hearing fitting and evaluation benefits have a $0 co-pay.

#4 Kaiser Permanente Senior Advantage Value H9003-009 (HMO

    • Rating: 5/5
    • Premium: $0
    • Deductible: $0
    • Out-of-pocket maximum: $5,600
    • Counties: Benton, Clackamas, Columbia, Linn, Marion, Multnomah, Polk, Washington, and Yamhill

This plan’s Tier 1 drug costs are $5–$15. Doctor visit co-pays are $5 for primary care and $45 for specialist care. This plan offers the same vision and hearing benefits as the other Kaiser Permanente plans, with $45 co-pays for exams and a $0 co-pay for hearing fitting and evaluation services.

#5 Kaiser Permanente Senior Advantage Value Lane H9003-008 (HMO)

    • Rating: 5/5
    • Premium: $0
    • Deductible: $175
    • Out-of-pocket maximum: $4,100
    • Counties: Lane

As the final Kaiser Permanente plan on the list, this option has high Tier 1 drug costs of $4–$57. While primary care visits have a low co-pay of $5, specialist visit co-pays are $40. This plan offers the same hearing and vision benefits as the previous Kaiser Permanente plans, with $40 exam co-pays and a $0 co-pay for hearing fitting and evaluation visits.

#6 Humana Gold Plus H1036-153 (HMO

    • Rating: 4.5/5
    • Premium: $0
    • Deductible: $150
    • Out-of-pocket maximum: $5,700
    • Counties: Washington, Columbia, Clackamas, and Multnomah

This plan’s Tier 1 drug costs are $2–$30. For doctor visits, you can expect to pay relatively low co-pays of $0 for primary care and $35 for specialist care. This plan offers a wider range of hearing, vision, and dental benefits as well. All covered dental and vision benefits have a $0 co-pay, and a hearing exam requires a $34 co-pay. This plan also includes hearing aid coverage, with a co-pay of $499–$799.

#7 Providence Medicare Bridge 1 + RX H9047-059 (HMO-POS

    • Rating: 4.5/5
    • Premium: $35
    • Deductible: $100
    • Out-of-pocket maximum: $4,900
    • Counties: Multnomah, Clackamas, Washington, and Yamhill

For this plan, Tier 1 drugs require a $0–$48 co-pay. In-network doctor visits carry the same co-pays as the earlier Humana plan, with $0 for primary care and $35 for specialist care. While the plan offers a number of vision benefits with $0 in-network co-pays, it offers no comprehensive dental benefits, though many preventive dental benefits are covered under office visits. The plan’s hearing benefits include an in-network exam with a $35 co-pay and hearing aids with an in-network co-pay of $399–$699.

#8 Providence Medicare Bridge 2 + RX H9047-060 (HMO-POS

    • Rating: 4.5/5
    • Premium: $40
    • Deductible: $100
    • Out-of-pocket maximum: $4,900
    • Counties: Marion, Lane, Columbia, and Polk

Tier 1 drugs in this plan require a co-pay of $0–$48. For in-network doctor visits, expect to pay the same $0 primary care and $35 specialist care co-pays as with the previous Providence Medicare Bridge plan. Many in-network vision co-pays are $0, and many preventive dental benefits are covered with the office visit. For the hearing exam, expect to pay a $35 in-network co-pay and a $399–$699 in-network co-pay for hearing aids. 

Are you ready to increase your Medicare coverage with a Medicare Advantage plan? Start comparing your options today with the Insurify Medicare comparison tool.

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How Much Does Medicare Advantage Cost in Oregon?

If you’re looking for a Medicare Advantage plan in Oregon, you might have to pay a higher monthly premium than the national average. Keep in mind that plans are also provided by private insurance companies that set plan costs and determine benefits, so costs from one plan to another can vary greatly.

If your MA plan also comes with a prescription drug plan, you can check to see if you qualify for the Extra Help program to help pay drug plan costs. You can learn more about qualifying and applying for Extra Help on the Social Security Administration website, SSA.gov

Note that while some plans pay your Medicare Part B premium, if the MA plan doesn’t pay the premium, you’re responsible for paying it in addition to the MA plan premium.

What Is Medicare Advantage?

Medicare Advantage lets you bundle Original Medicare coverage with other coverage you may need, such as vision, dental, hearing, and drug plan coverage. Other benefits that Medicare beneficiaries may find in these plans include: 

    • Nursing home or skilled nursing facility care
    • Outpatient services
    • Fitness programs
    • Transportation to doctor visits
    • Over-the-counter drugs

Eligibility requirements for a plan typically include enrolling in Original Medicare coverage and picking a plan in your service area. However, beginning January 1, 2021, those with end-stage renal disease (ESRD) can enroll in an MA plan without first enrolling in Original Medicare.

What Types of Medicare Advantage Plans Are Available in Oregon?

Within the state of Oregon, residents seeking an MA plan have access to the four most common plan types: the preferred provider organization plan (PPO), health maintenance organization plan (HMO), special needs plan (SNP), and private fee-for-service plan (PFFS).

With PPO plans, you will usually pay less for in-network provider or hospital care, and you’ll also likely get prescription drug coverage through the plan. You also likely won’t have to choose a primary care doctor, and you won’t need a referral to see an in-network specialist.

HMO plans usually require that you seek in-network care and also typically provide drug coverage. They also usually require that you select a primary care doctor and have a referral to see a specialist.

SNPs are a bit different from both of the options above. First, they only offer membership to those with certain diseases or characteristics. They typically require that you seek care from in-network providers. These plans are required to offer drug coverage, and they require that you have either a primary care doctor or care coordinator along with referrals for specialist visits.

PFFS plans will allow you to see either any provider or, if the plan has a network, any in-network or out-of-network provider who agrees to treat plan members (with in-network care being cheaper). It’s optional for these plans to offer drug coverage, and they usually don’t require you to select a primary care doctor or have a referral for specialist care.

 

 

FAQ: Oregon Medicare Advantage

When is the open enrollment period for Medicare Advantage?

You can add, drop, or change your MA plan during the Medicare Open Enrollment Period each year, which is from October 15 to December 7. However, there is also a special Medicare Advantage Open Enrollment Period yearly from January 1 to March 31, when you can change your plan or return to Original Medicare.

I receive Medicaid services? Can I still enroll in Medicare Advantage?

If you qualify for Medicare enrollment and also receive Medicaid services, you may be eligible for dual enrollment in Medicare and Medicaid. Visit the Centers for Medicare & Medicaid Services at CMS.gov for more information on dual enrollment.  

Should I enroll in a Medicare Advantage plan or a Medicare Supplement Insurance (Medigap) plan?

Medigap coverage is meant to help you fill the gaps in your Medicare coverage, so choose this option if you want your bases covered. If you’re looking for additional coverage outside of what’s typically covered with Medicare, such as transportation or fitness benefits, then Medicare Advantage might be the better option. Visit Medicare.gov to learn more about the differences between the two plan options. You’ll also find contact details on the site to reach out to a Medicare specialist for more information (with support for TTY users).

Conclusion: Compare Plans Now to Save Time and Money Later

Finding the right MA plan to meet your healthcare needs can be difficult, especially when there are so many options available. Comparing plans now can help you pick the best option for your health and budget before speaking to an insurance agent

As a disclaimer, keep in mind that not all plans are offered in every county in Oregon. Comparing plans virtually can help you narrow down your options to only the ones in your service area.

Ready to start comparing plans online quickly and easily? Get started with just your ZIP code using the Insurify Medicare comparison tool.

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Updated April 14, 2021

Jasmine Fleming is a freelance digital content marketer and strategist. She loves crafting helpful content that readers can use to make important decisions. You can learn more about Jasmine at her website, www.jasminefleming.com.