Medicare Advantage

Medicare Advantage

Medicare Advantage plans are Medicare-approved plans from a private company that offers an alternative to Original Medicare for health and drug coverage. These plans bundle together Part A (hospital insurance), Part B (medical insurance), and usually Part D (prescription drug coverage). To learn more about Medicare Advantage plans and the other options you have for Medicare, go to the Oregon Guide to Medicare Insurance Plans or Medicare.gov.

2026 Medicare Advantage plans  Plan types  Special Needs Plans  Carrier contact information

Explanation of plan types

HMO (Health Maintenance Organization): A Medicare Advantage plan where you must get care from the plan’s network of providers. You may need referrals from your primary care doctor to see specialists.

HMO-POS: An option in some HMO plans that lets you use doctors outside the plan for an extra cost. You may need a prior approval for certain medical services.

PPO (Preferred Provider Organization): A Medicare Advantage plan where you pay less if you use doctors, hospitals, and providers in the network. However, you can use out-of-network providers at an additional cost.

SNP (Special Needs Plan): These plans can be either an HMO or PPO plan, and have specific eligibility requirements. You can find more information on the Medicare.gov website.

• C-SNP (Chronic Condition Special Needs Plans): You must have at least one qualifying chronic condition and your provider will need to verify your condition(s). Qualifying chronic conditions vary by plan.
• D-SNP (Dual Eligible Special Needs Plans): You must be eligible for both Medicare (Part A and Part B) and Medicaid.
• I-SNP (Institutional Special Needs Plans): You must live (or expect to live) in a facility, like a nursing home or skilled nursing facility, for at least 90 days in a row. You can also live in the community but need the level of care a facility offers.