Geography complicates insurance system

It’s that season again. No, I’m not talking about back-to-school season, holiday season or fall leaves.

We’re now into health insurance choice season, which affects a lot of Americans, but referring here specifically to the Medicare side. It’s the time of year when people can change their coverage. 

What’s most important in that area this year is, do you have a choice?

In Oregon — as in many other states — the quality of your health insurance coverage may change from this year to next. As significantly, it may vary depending on where you live. If you live in an urban area, you probably do have some choices. If not, your options are likely fewer.

Rural Oregonians may have a case, in the coming year, for pressing for parity with urban Oregonians in their health care options, and state government might be able to help with that.

While the core idea of Medicare — health insurance coverage for everyone over 65 — is simple, the details become complicated just below the surface. 

Medicare insurance is split into four parts — or five or more, depending on how you count. Parts A and B are core or “original” Medicare, which everyone in the program gets. There’s an optional Part D which covers prescription drugs. None of this is seeing much change.

Part C, which is usually called Medicare Advantage, is different: It is optional, but not everyone has the same purchase opportunities. Most Medicare customers do take Advantage, because original Medicare has major gaps and limitations which the Advantage plans can help fill. Those plans sometimes cost nothing, or very little, to the customers, although prices can be higher in some cases. 

These plans are offered not by the federal government but by private insurers, and while they have to conform to Medicare standards in their offerings, they aren’t required to offer their plans everywhere. The rules around them can vary by state, and also by county. 

These rules also can change from year to year, and some of them are evolving  in a big way next year. 

For example, the Advantage insurance plans offered by Moda Health and Summit Health in Oregon will be dropped at the end of 2025. Also, several specific plans which have been provided by Aetna, PacificSource and Regence BlueCross BlueShield of Oregon will not be continued in 2026. Some other providers, like UnitedHealth, are changing the specific benefits (meaning in effect benefit reductions) on a number of their plans, though the plans generally are staying in place.  

About 12,000 Oregonians on Medicare, according to the Centers for Medicare & Medicaid Services, are this season having to scramble to secure the coverage they need. 

Geography complicates the situation further. 

Because private providers can decide where they want to offer their plans, areas with fewer local medical options may be left out of the picture. As of next year, five Oregon counties — Curry, Harney, Lake, Umatilla and Union — all some distance from larger metro areas, will not have Advantage plans available at all. 

That’s only part of the geographical complexity, because while other Oregon counties offer some Advantage plans, the number of choices varies a lot. 

The website Q1Medicare.com reports that Multnomah County and Washington County residents have their choice of 59 plans, and in Tillamook, Lincoln, Morrow and Baker residents get their pick of just five. Most other counties are in between, with larger counties getting more options and smaller, and more remote, counties fewer. 

Medigap, also an optional program and used by many people (and preferred by some) has standardized benefits. It also is offered by private providers but is only available to some people — primarily, people who have been kicked off Medicare Advantage plans. Many people may not find it a useful substitute.

But for people in rural counties, especially considering their disproportionately older population, the Advantage gap represents a real problem. It’s a problem too for anyone trying to promote economic or population development there. 

Regulators, including the state, could help with this. Medicare Advantage providers are required to adhere to strict Medicaid standards, and those could be expanded to help provide more options to people in smaller counties. 

By the way, this is also an important season in the field of Medicaid and the Affordable Care Act marketplace.

And that’s a whole other level of complexity …

Randy Stapilus wrote this for the Oregon Capital Chronicle. He has covered Northwest politics and issues since 1976 for a long list of newspapers and other publications. A former newspaper reporter and editor, and more recently an author and book publisher, he lives in Carlton.

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