Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
With Medicare Advantage, seniors in Oregon have the opportunity to get a private health insurance plan that includes the same benefits as Original Medicare. While regulations require Medicare Advantage policies, known as Part C, to cover what’s in Parts A and B, they can also include additional benefits that seniors in Oregon need to maintain a healthy life. Common coverage options include vision, dental, hearing aids, medical transportation and wellness programs designed for groups with chronic conditions. Prescription drug coverage is part of most Medicare Advantage insurance plans.
Out of almost 900,000 Medicare members in the Beaver State, more than 460,000 are on Medicare Advantage and other plans instead of Original Medicare in 2022. This means Oregon has one of the highest Medicare Advantage enrollment rates in the country. In the state’s most populous counties, such as Clackamas, Multnomah and Washington, the proportion of Medicare Advantage enrollees is higher than 60%. In more rural areas, it’s common to see Part C enrollment at less than 10%. The national average rate for Medicare Advantage participation is 42%, and this has been steadily growing for the past 20 years.
This guide is designed to give seniors in Oregon the information they need to decide if they want to switch from Original Medicare to Part C. It can also help them pick the right type of plan. It includes comparisons in costs, benefits, service areas and satisfaction.
The Top 10 Medicare Advantage Plans in Oregon
More than a dozen insurance companies offer Medicare Advantage plans in the Beaver State. The table below lists the 10 most popular providers according to their total enrollment numbers across the state. Since most insurance companies offer more than one type of Part C coverage, the cost information is listed in a range. The table also includes a Medicare rating, which is based on satisfaction surveys that the federal government conducts every year. These ratings are updated every fall before the open enrollment period for Medicare Advantage begins. The information in this table is current as of April 2022. For the most up-to-date cost and rating data, seniors should visit Medicare.gov.
Regence BlueCross BlueShield of Oregon
Providence Medicare Advantage Plans
Wellcare by Health Net
ATRIO Health Plans
Moda Health Plan, Inc.
How Medicare Advantage Plans Work in Oregon
Due to the high number of Medicare Advantage beneficiaries in Oregon, insurance companies offer a variety of plans. In order to get the best possible care with the lowest costs, it’s important for seniors to know how Part C works in this state. Each plan has different premiums, deductibles, copays and other out-of-pocket expenses. Companies that offer Medicare Advantage plans in Oregon have to renew their contracts with the federal government every year, so coverage options and costs may change. The plans available to seniors vary from county to county.
What Medicare Advantage Plans Cover in Oregon
The Centers for Medicare & Medicaid Services only certifies a Medicare Advantage insurance plan if it covers the same benefits as Parts A and B, excluding hospice care. This includes inpatient hospital care, preventative medicine and durable medical equipment. These private health insurance policies may also offer coverage for routine annual physicals, dental care and vision. Many types of Medicare Advantage plans in Oregon are available with and without prescription drug coverage.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Oregon
Seniors in Oregon must already have Medicare Parts A and B to be eligible for a Medicare Advantage policy. Original Medicare requires the beneficiary to be at least 65 years old, or younger with certain disabilities or end-stage renal disease. They must also live in the service area where the coverage is provided. While this is usually determined by county, some policies just cover certain zip codes because certain insurance companies only provide managed care in specific cities. Seniors who meet all of these qualifications can only enroll during certain times of the year. These enrollment periods are listed in the table below.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Oregon
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Senior Health Insurance Benefits Assistance (SHIBA)
Oregon’s Senior Health Insurance Benefits Assistance (SHIBA) program provides free, one-on-one Medicare counseling services to seniors interested in enrolling and those who have questions, issues or concerns about their plan. Trained volunteers answer questions and can assist with enrollment applications, helping a senior understand a plan’s benefits and compare all types of Medicare and prescription drug plans. Volunteers can also help seniors file claims or appeals with their Medicare plan.
The Oregon Senior Medicare Patrol (SMP) program aims to empower seniors enrolled in Medicare to recognize and report fraudulent activity related to their health care. Highly trained volunteers educate seniors to help them understand their Medicare documents and bills so they can more easily spot errors or scams. The Oregon SMP partners with other state organizations such as SHIBA and the Association for Oregon Centers for Independent Living (AOCIL).
Oregon’s Services for Seniors and People with Disabilities office is part of the state’s Department of Human Services (DHS). The office provides information on state medical programs including Medicare and the Prescription Drugs Assistance Program that gives interested Oregon residents of any age and income a discount card for prescription drugs. Through the office’s website, seniors can apply for benefits and access information on services such as in-home support, reporting abuse, caregiver support and disability benefits.
The YWCA of Greater Portland is a nonprofit women’s organization that offers programs and services to improve the lives of women and their families. The YWCA’s Senior Services program provides resources, information and referrals to low-income seniors ages 60 and older who wish to remain in their homes. Services include insurance and benefits counseling, care management and legal assistance. Seniors can also stay active through the YWCA’s fitness programs and shop for clothes and home goods at its affordable thrift store.
Oregon’s numerous Aging and Disability Resource Connection (ADRC) offices are located throughout the state, each serving designated counties. Oregon seniors and people with disabilities can contact their local ADRC to be connected to resources and support programs that fit their needs. Options counselors can help individuals plan for their futures by discussing their short- and long-term goals and assessing their needs related to insurance, health care, in-home care and caregiver support.
Throughout Oregon, 17 Area Agencies on Aging serve seniors and their loved ones through advocacy and support programs geared to help seniors receive the long-term care they need while remaining in the community. These agencies are members of O4AD, the Oregon Association of Area Agencies on Aging and Disabilities. This associate promotes the long-term care needs of seniors across the state and supports member programs including home-delivered meals and ADRC services.
Seniors and caregivers can find the contact information for their local Area Agency on Aging on the O4AD website here.