Seniors in Oregon are at risk of losing their Medicare Advantage coverage next year as an estimated 25% of plans are being discontinued in the state in 2025. This is all because of changes the Inflation Reduction Act (IRA) has introduced in order to make some of the services more affordable for those struggling with their finances during retirement.

One of the biggest changes we have seen since the implementation of the IRA is the lower reimbursement rates for insurance providers, which they claim make offering the services not viable from an economic standpoint, especially in some key areas of the country.

Some of the most important providers to decide to discontinue their service in the state are Moda Health and Summit Health, which will be ending all Medicare Advantage plans, as well as Regence BlueCross BlueShield of Oregon, Aetna and PacificSource, which will be several reducing the amount of plans and services they offer for seniors on Medicare, especially around the Portland metro area.

While it may not seem like a big deal, there are many other providers that could bridge the gap, 12,000 residents in Oregon will be left without a plan, and some of them will not be able to fins another amenable company. In counties like Curry, Harney, Lake, Umatilla and Union Counties there are no other private Medicare Advantage plans available, which will leave seniors reliant on the original public version of Medicare and without some of the dental and vision care that these plans provided.

Coos County residents are in luck, as there will be one private plan available, but its coverage may not be as complete as previous ones have been. Lane County residents will also have one option available to them, Under Regence, HMO (Health Maintenance Organization) plans will still be available to them, the only county to have them in the state.

The insurance company Regence gave a statement announcing their withdrawal form the market and explaining “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 no different. We regret the impact necessary benefit cuts and plan reductions will have on our members and we’re doing our best to minimize disruptions.”

Medicare Advantage notice for the state

Louise Norris, a health policy analyst for healthinsurance.org, urged seniors to make sure that they are aware of the changes and that they take the measures necessary to remain covered “Enrollees received notifications from their insurer last month about any plan changes for 2025, including coverage terminations. There are a lot of changes this year, so Medicare beneficiaries need to make sure they understand any communications they’ve received from their plan this fall.”

Notifications should have been made in time to make the changes during the normal enrollment period for Medicare, but some cases may be covered under the special enrollment period, which runs from December 8 through February. In any case, those who do make any changes and are losing their Medicare Advantage plan will be automatically enrolled in Medicare Part A and B and will need to independently add prescription drug coverage (Part D) should they wish to do so.

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Chris Fong, a Medicare expert and the CEO of Smile Insurance advises that getting used to Medicare Advantage coverage may have some drawbacks seniors may not have considered “This is the unfortunate reality with Medicare Advantage plans. They have the potential to have changes and to not be renewed each year. A lot of insurance companies are feeling the financial pressure of lower Medicare reimbursements and the Inflation Reduction Act. The fear for most people is that they may not know where to turn to for help finding out if their plan is renewing or terminating or navigating the changes for 2025. My advice is to find a trustworthy and knowledgeable agent for those who are worried about navigating the coverage on their own.”

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