Medicare Advantage Plans in Jefferson County, OR:
Your Complete 2025 Guide
Discover 11 Medicare Advantage plans in Jefferson County for 2025. These plans combine your Medicare Part A and Part B benefits into one convenient plan, and may offer additional benefits such as dental, hearing and/or vision and/or fitness. There may not be a plan in your area that has all of these benefits in one plan.
Take a look at the options below, or contact a licensed insurance agent from HealthCompare at 833-748-3201 (TTY 711) Mon-Fri 5am-6pm, Sat 6am-5pm PST for personalized assistance.
Types of Medicare Advantage Plans in Jefferson County, OR
With 11 Medicare Advantage plans available in Jefferson County, it’s easier than ever to find one that meets your healthcare needs. However, there are no 5-star plans available this year. Your 2025 options include:
- Health Maintenance Organization (HMO) Plans: These plans (5 available) require in-network care and generally have lower costs. The average monthly premium for these plans is $110.60.
- HMO Point-of-Service (HMO-POS) Plans: These plans (6 available) blend HMO and PPO features, allowing some out-of-network care. The average monthly premium for these plans is $40.67.
- Special Needs Plans (SNP): These are highly specialized Medicare Advantage plans for individuals with special healthcare needs. We organize these plans here: Medicare Special Needs Plans in Jefferson County, OR.
Health Maintenance Organization (HMO) Medicare Advantage Plans
Health Maintenance Organization (HMO) plans offer lower costs in exchange for using in-network providers. These plans are a great choice for those who are comfortable with a more restricted network and want to keep their healthcare expenses predictable and affordable.
Medicare Advantage HMO Plan Options
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| Providence Medicare Extra + Rx | $161 | $4,000 | $0 | |
| Providence Medicare Focus Medical | $140 | $3,800 | N/A | |
| Providence Medicare Timber + Rx | $0 | $6,000 | $250 | |
| PacificSource Medicare Essentials Rx 27 | $43 | $6,200 | $399 | |
| PacificSource Medicare Essentials Rx 6 | $209 | $4,950 | $0 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- In-Network Care: HMO plans generally require you to use in-network providers for all non-emergency care. Be sure to verify that your preferred doctors, specialists, and hospitals are in the plan’s network before enrolling.
- Primary Care Referrals: Many HMO plans require you to get a referral from your primary care doctor before seeing a specialist. Make sure you’re comfortable with this system of care coordination.
- Lower Costs: HMO plans typically offer lower premiums and out-of-pocket costs compared to other plan types, making them an attractive option for those who prioritize cost savings.
- Additional Benefits: Some HMO plans include extra benefits like dental, vision, and/or fitness programs. Consider which additional benefits are most important to you when comparing plans. There may not be a plan in your area that has all of these benefits in one plan.
HMO Point-of-Service (HMO-POS) Medicare Advantage Plans
HMO Point-of-Service (HMO-POS) plans offer a blend of HMO and PPO features. While these plans require in-network care for lower costs, they also allow you to seek care outside of the network at a higher expense. This balance makes HMO-POS plans a flexible option for those who want the best of both worlds.
Medicare Advantage HMO-POS Plan Options
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| Providence Medicare Bridge + Rx | $29 | $6,500 | $0 | |
| Providence Medicare Choice + Rx | $82 | $5,000 | $0 | |
| Providence Medicare Reverence | $25 | $5,000 | N/A | |
| PacificSource Medicare Essentials Choice 2 | $0 | $5,950 | N/A | |
| PacificSource Medicare Essentials Choice Rx 14 | $93 | $5,950 | $199 | |
| PacificSource Medicare Essentials Choice Rx 36 | $15 | $6,200 | $499 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Out-of-Network Costs: While HMO-POS plans allow you to see out-of-network providers, this flexibility comes at a higher cost. Be sure to evaluate how much more you'll need to pay for out-of-network care.
- In-Network vs. Out-of-Network Care: Compare the in-network and out-of-network options available under the plan. If you frequently seek care outside the network, consider whether the additional costs are worth the flexibility.
- Referral Requirements: Like traditional HMO plans, HMO-POS plans often require a referral from your primary care doctor to see specialists. Make sure you’re comfortable with this requirement.
- Additional Benefits: Many HMO-POS plans offer extra benefits such as dental, vision, and/or fitness programs. Consider which additional benefits are important to you when comparing plans. There may not be a plan in your area that has all of these benefits in one plan
How and When to Enroll in a Medicare Advantage Plan
Enrolling in a Medicare Advantage Plan in Jefferson County means understanding your enrollment options. Whether you’re turning 65 or considering a plan change, knowing when and how to enroll ensures that you get the coverage that best fits your healthcare needs.
When to Enroll
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare begins three months before your 65th birthday and ends three months after. This is when you can choose your Medicare Advantage plan. Learn more
- Medicare Advantage Open Enrollment Period (MA OEP): Between January 1 and March 31, people who are currently enrolled in a Medicare Advantage plan can switch to a new one or return to Original Medicare if necessary. Learn more
- Annual Enrollment Period (AEP): From October 15 to December 7, you can review and adjust your Medicare coverage for the next year. Learn more
- Special Enrollment Periods (SEPs): You may qualify for a SEP due to life changes like relocation or losing other coverage, allowing you to make plan changes outside the typical enrollment periods. Learn more
How to Enroll
- Speak with a Licensed Agent: Speak with a licensed health insurance agent from HealthCompare 1-833-748-3201 (TTY 711) (Mon-Fri 5am-6pm, Sat 6am-5pm PST) for personalized guidance.
- Reach Out to the Plan Provider: Visit the plan provider’s website or call their customer service line to enroll directly.
- Go to Medicare.gov: Explore plan options and enroll online at Medicare.gov.
Understanding Medicare Advantage: Frequently Asked Questions
What types of Medicare Advantage plans are available?
Medicare Advantage plans come in different types, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs). Each plan type offers different levels of flexibility in choosing healthcare providers and services.
Do Medicare Advantage plans cover prescription drugs?
Many Medicare Advantage plans, known as Medicare Advantage Prescription Drug (MAPD) plans, include prescription drug coverage. These plans bundle Medicare Parts A, B, and D into one plan. However, not all Medicare Advantage plans include drug coverage, so it's important to check before enrolling.
Are there any additional costs with Medicare Advantage plans?
While Medicare Advantage plans often have lower premiums than Original Medicare, you may still have out-of-pocket costs such as copayments, coinsurance, and deductibles. The costs can vary depending on the specific plan and services you use.
Frequently Asked Questions About Medicare Advantage Enrollment
When can I enroll in a Medicare Advantage plan?
You can enroll in a Medicare Advantage plan during the Initial Enrollment Period (IEP), which starts three months before your 65th birthday and lasts three months after. You can also enroll during the Annual Enrollment Period (AEP) from October 15 to December 7, or during a Special Enrollment Period (SEP) if you qualify due to certain life events.
Can I change my Medicare Advantage plan after enrolling?
Yes, you can change your Medicare Advantage plan during the Annual Enrollment Period (AEP) or the Medicare Advantage Open Enrollment Period (MA OEP) if you are currently enrolled in a Medicare Advantage plan. Special Enrollment Periods (SEPs) may also allow plan changes if you qualify based on specific life events.
What happens if I miss the Annual Enrollment Period?
If you miss joining a plan during the Annual Enrollment Period (AEP), you may have to wait until the next AEP to join a Medicare Advantage plan. In some cases, Special Enrollment Periods (SEPs) may allow you to enroll or make changes outside the standard enrollment windows.
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Culver, Madras, Terrebonne, Warm Springs, and all other areas of Jefferson County, Oregon.
Plans Offered for Enrollment through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.