Insurers cut Medicare Advantage plans, leaving thousands to find new coverage

Thousands of Oregon seniors are set to lose their health plans as some Medicare Advantage carriers cut their offerings in response to rising costs.

Moda Health and Summit Health will end their Medicare Advantage plans in Oregon in 2025. Regence BlueCross BlueShield of Oregon, Aetna and PacificSource are also removing some Advantage plans from the menu next year.

In all, more than 12,000 Oregon seniors will need to find new coverage options for 2025, based on data from the Centers for Medicare & Medicaid Services.

In Oregon, Curry, Harney, Lake, Umatilla and Union counties will no longer have Medicare Advantage offerings at all. That means residents of La Grande, Umatilla, Lakeview, Burns, Brookings, Hermiston and Pendleton will have original Medicare as their only option.

Many Oregon counties will have fewer options in 2025 than this year. Those who live in Coos County, for example, will only have one Medicare Advantage plan option next year, down from seven in 2024.

Lisa Lettenmaier, founder of Tigard Medicare insurance brokerage HealthSource Northwest, said it’s crucial for Medicare Advantage enrollees to check with their carrier about changes to their plans.

“This year, we are seeing more changes to Medicare Advantage plans, as well as more plans leaving markets than we normally do,” she said. “It’s a really big year of changes, and patients desperately need to be reading all the information from their carrier.”

Regence BlueCross BlueShield of Oregon will stop offering Medicare Advantage Health Maintenance Organization, or HMO, plans in all counties except for Lane County. Aetna is pulling some Medicare Advantage plans from the Portland metro area and southern Oregon. And PacificSource will also offer one less plan — eliminating its Medicare Advantage PPO — in the Portland metro area.

Lettenmaier said if a patient’s insurance company ends all their Medicare Advantage plans in a market, then they will receive a notice of termination from their carrier. Those patients will have extra time to shop during the special enrollment period, from Dec. 8 through the end of February. However, they must sign up by the end of December if they want coverage starting Jan. 1.

Jeannie Fuglesten Biniek, associate director for the Program on Medicare Policy at Kaiser Family Foundation, said insurance companies can’t move patients who were on an HMO plan into a preferred provider organization, or PPO, plan automatically, or vice versa.

If patients do nothing after their Medicare Advantage plans have terminated, Biniek said they will automatically be enrolled in Medicare Part A and B. They will not have Medicare Part D drug coverage and will have to sign up for that separately.

Patients dropped from their Medicare Advantage plan have the option to move to another Advantage plan or enroll in traditional Medicare.

Moda Health and Summit Health did not respond to requests for comment on their eliminated offerings.

Regence BlueCross Blue Shield of Oregon said it was eliminating HMO plans in most Oregon counties because more customers are signing up for its PPO plans.

“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,” Regence said in a statement. “We regret the impact necessary benefit cuts and plan reductions will have on our members and we’re doing our best to minimize disruptions.”

“The Medicare Advantage market has historically been financially attractive to insurers, but their participation is not mandatory,” Biniek said. “It’s not guaranteed, and so each year insurers make decisions about where to offer plans, what plans to offer and their benefits.”

Biniek said her team at Kaiser Family Foundation found that the average beneficiary eligible for Medicare Advantage has slightly fewer options for plans this year than previous years.

“It’s chaos. It’s the most disruptive sequence of changes I’ve seen in the last 10 years,” said Diane Faligowski, the CEO of Health Plans in Oregon, an insurance agency that receives funds from the state to help residents sort through health insurance plans.

But traditional Medicare can be very expensive for beneficiaries switching from Medicare Advantage, Faligowski said. In traditional Medicare, enrollees pay a monthly premium. And after reaching a deductible, they are expected to pay 20% of the cost of each doctor visit or medical procedure.

Faligowski said the monthly premium for hospital stay coverage under traditional Medicare is projected to be around $1,600, while the monthly premium for primary care or specialist provider visits is expected to be around $185 for 2025.

To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or Medicare supplemental insurance. Also known as Medigap, Medicare supplemental insurance is an extra policy from a private insurer to help cover out-of-pocket costs traditional Medicare won’t.

If the enrollee is low-income, Medicaid may provide that supplemental coverage, Faligowski said.

While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.

Only four states — Connecticut, Maine, Massachusetts and New York — prohibit insurance companies from denying a Medigap policy if the patient has preexisting conditions, according to KFF.

But patients dropped from their Medicare Advantage plan will be allowed to sign up for a Medigap policy without insurance companies evaluating their medical history to help cover costs under traditional Medicare, said Elma Friend, founder of Willamette Valley Advisors, a health insurance brokerage in Milwaukie.

She said in Oregon, those looking to enroll in a Medigap insurance without medical underwriting will have premiums based on tobacco use, gender identity and age. The older a patient is, the more expensive their monthly Medigap premium will be, Friend said.

Friend said it’s not only patients on Medicare Advantage who are seeing changes. She said patients who are on standalone Part D prescription plans, might also be scrambling for new plans.

Mutual of Omaha Insurance Co. announced it will no longer offer stand-alone prescription drug plans after 2024, citing changes imposed by the Inflation Reduction Act.

Roughly 1,540 Oregonians have standalone Part D coverage through Mutual of Omaha, according to the latest data from the Centers for Medicare & Medicaid Services.

Friend said insurers who offer drug coverage may be reacting to the government’s new $2,000 out-of-pocket maximum Medicare beneficiaries will spend on Part D prescription drugs, which they say is down from $8,000 this year.

That change would impact standalone prescription drug plans and drug coverage as part of a Medicare Advantage plan, Friend said.

“It’s a bit of a hit. Who’s going to make up for that $6,000 they’re now responsible for covering per person?” she said. “That’s putting more financial burden on the insurance companies, and they’re going to try to offset that.”

Oregonians seeing changes to their plans or dropped from their Medicare plans can get help from the Senior Health Insurance Benefits Assistance Program by calling 800-722-4134. SHIBA will connect people to a local office to schedule an appointment.

Portland Parks and Recreation is also offering two free classes to help seniors in the Portland area navigate Medicare, scheduled for Oct. 22 and Dec. 10. People can register at portlandparks.gov/parks/register.

Fagliowski of Health Plans in Oregon said her team offers Medicare counseling in languages other than English, including: Spanish, Vietnamese, Russian, Mandarin, Cantonese and Tagalog. For help in other languages, people can call 503-928-6918, or visit: healthplansinoregon.com/enrollment-events.

Meanwhile, the Jewish Family & Child Service will offer a Navigating Medicare class on Nov. 7, which is co-sponsored by the Congregation Neveh Shalom. People can register at jfcs-portland.org/medicare-answers/.

— Kristine de Leon covers consumer health, retail, small business and data enterprise stories. Reach her at [email protected].

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