Medicare Changes Are Coming: What Portland-Area Older Adults Should Know
As Medicare’s fall Annual Enrollment Period approaches, many Portland-area older adults and their families are concerned about changing plan availability, provider networks, prescription coverage, and access to primary care.
Those concerns are understandable. Medicare Advantage insurers are reassessing where they offer plans and may reduce certain supplemental benefits. Because changes vary by plan and county, do not assume that the coverage that worked for you in 2026 will remain unchanged in 2027.
Review Your Annual Notice of Change
If you are enrolled in a Medicare Advantage or Part D prescription drug plan, your insurance company will send you an Annual Notice of Change in September. Review it carefully for changes taking effect January 1, including:
Premiums, deductibles, copayments, and out-of-pocket limits
Prior-authorization requirements
Dental, vision, hearing, transportation, fitness, and other supplemental benefits
If you do not receive this notice, contact your plan directly.
Medicare’s Annual Enrollment Period runs from October 15 through December 7. During this time, beneficiaries may change Medicare Advantage or Part D plans, move from Original Medicare to Medicare Advantage, or return to Original Medicare. Changes generally take effect January 1.
Compare Plans on Medicare.gov
The official place to begin comparing coverage is Medicare.gov. Select “Find health and drug plans,” enter your ZIP code and county if requested, and choose the coverage you want to explore:
Medicare Advantage plans, also called Part C
Stand-alone Part D prescription drug plans
Medicare Supplement policies, commonly called Medigap
Some Medicare Advantage plans do not include prescription drug coverage. These are often referred to as MA plans, while Medicare Advantage plans that include prescription drugs are called MAPD plans.
An MA plan without drug coverage may be appropriate for someone who already has creditable prescription coverage through the Department of Veterans Affairs, TRICARE, or another qualifying source. Anyone without separate creditable drug coverage should be careful not to enroll in a plan that leaves them without prescription coverage.
Medicare.gov allows you to enter your prescriptions, preferred pharmacies, and information about other coverage, including Medicaid. A low-premium plan may ultimately cost more if it does not cover an important medication, has high copayments, or excludes a preferred physician or hospital.
Before enrolling, confirm medication coverage with the insurance company and verify provider participation with both the plan and the provider’s billing office.
Finding an In-Network Primary Care Physician
A doctor who “accepts Medicare” does not necessarily participate in every Medicare Advantage network, and may not be accepting new patients.
If you have Original Medicare, use Medicare’s Care Compare tool to search for participating physicians.
If you have Medicare Advantage, use your plan’s provider directory or call the member-services number on your insurance card. Then call the physician’s billing office and ask:
Are you contracted with my specific Medicare Advantage plan?
Is the physician accepting new patients with this plan?
At which clinic location is the physician in-network?
Will the physician remain in-network next year?
Record the date, the name of the person you spoke with, and the information provided.
Where to Get Help
Oregon’s Senior Health Insurance Benefits Assistance program, known as SHIBA, provides free, unbiased Medicare counseling. Call 800-722-4134 or visit Oregon SHIBA. You may also call 1-800-MEDICARE (1-800-633-4227) or consult a licensed Medicare insurance agent. The Portland Elder Care Council currently has three medicare plan specialists available to support you.
The coming changes may feel overwhelming, but there is time to prepare. Make a current list of your doctors and medications, review your Annual Notice of Change, and compare your options carefully. Most importantly, do not cancel existing coverage until you understand when your replacement coverage will begin.
This article is intended for general educational purposes and is not individualized insurance or legal advice.
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