County Medicare Advantage options dwindle to one

FamilyCare Health will exit northwest Oregon, leaving Clatsop County with only one Medicare Advantage option, Moda Health.

The departure comes after CareOregon pulled its Medicare Advantage plan out of Clatsop County last year, concentrating services in the Portland metro area.

A public notice from FamilyCare said it will no longer offer Advantage Rx, a Medicare Advantage plan, and Community, a special-needs plan supplemented by Medicaid, in Clatsop, Clackamas, Multnomah and Washington counties as of July.

“It is important you take action before July 1, or you will lose your prescription drug coverage and only have original Medicare,” a letter to Medicare Advantage members said.

FamilyCare representatives could not be reached for comment. The insurer’s quarterly statements show 4,135 Medicare Advantage customers in the state. A former FamilyCare spokesman had said its two Medicare Advantage plans cover about 600 people in Clatsop County.

Craig Parker, a regional coordinator with Senior Health Insurance Benefits Assistance, said the people covered by FamilyCare can sign up for Moda Health’s two Medicare Advantage plans or go with original Medicare supplemented by one of many Medigap policies available statewide.

As of January, around 7,900 people in Clatsop County were covered by Medicare, a federal health insurance program for people 65 and older covering hospital care and outpatient treatment, with supplemental policies to cover other services such as prescription drug coverage.

More than 2,800 people were served by health insurance programs such as Medicare Advantage, with coverage provided by private insurers such as Moda Health and FamilyCare that negotiate with health care providers to find the lowest-cost options. The plans can often be more cost-effective than original Medicare coupled with Medigap policies

FamilyCare’s departure from Oregon seems to be a business decision and not regulatory, Parker said. After a spat with the Oregon Health Authority over reimbursement rates last year, FamilyCare in January stopped providing plans for Medicaid recipients under the Oregon Health Plan, affecting approximately 120,000 customers.

Clatsop County had seven Medicare Advantage providers as recently as 2009. The county now joins a wide swath of rural Oregon — including Tillamook, Baker, Gilliam, Harney, Lake, Morrow, Umatilla and Wallowa counties — down to only Moda, Parker said.

A report in August by the Kaiser Family Foundation, a nonprofit focusing on health care issues, found that 147 mostly rural counties across 14 states have no Medicare Advantage plans, including Washington’s Pacific County. Insurers have less leverage to negotiate rates with hospitals and other health care providers in rural markets, the report said, potentially making them less profitable than others.

Ron Beazely, a Cannon Beach resident highlighted by The Daily Astorian in October when he was forced to find a new Medicare Advantage plan in the wake of CareOregon’s departure, said his transition to FamilyCare was seamless.

Beazely is now wondering what he will do next.

“You think the state of Oregon would step in to protect us folks on the coast,” he said.

Customers affected by FamilyCare Health’s departure are advised to contact Northwest Senior & Disability Services at 2002 S.E. Chokeberry Ave. in Warrenton or at 503-861-4200. The office hosts volunteers with the Senior Health Insurance Benefits Assistance program.

(0) comments

Welcome to the discussion.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.