If you’re a current or prospective Medicare recipient, you should be aware of recent federal legislation and subsequent rule changes by the Centers for Medicare & Medicaid Services to the Medicare Part D prescription drug coverage program.
While these changes are intended to minimize prescription drug costs, insurance companies are left to pay the difference, which led many carriers to adjust their offerings or exit the Medicare market altogether. In some cases, these changes may affect your healthcare access and premium costs going forward.
“Change is inevitable, disruption isn’t. However, the Medicare Advantage marketplace is certainly being disrupted by these changes, making this the ideal time to speak with a SELCO Medicare Specialist,” said Nick Bloxham, Vice President of SELCO Insurance Services. “Our specialists cover the entire state and can help you make sense of the evolving Medicare landscape and choose the right coverage.”
Let’s take a look at the changes and their impact on Oregonians.
What changed?
The changes focus on the Medicare Part D prescription drug coverage program, which is being adjusted with the following enhancements:
- Part D Coverage Gap. Also known as the “donut hole,” the Part D Coverage Gap was eliminated in 2025, resulting in the cap for annual out-of-pocket expenses being lowered to $2,000, after which costs for covered prescriptions become $0. Before the change, the Part D out-of-pocket limit was $7,500, with enrollees still responsible for 5% of drug costs after reaching that threshold.
- Insulin & vaccine benefits. The co-pay for insulin is now capped at $35 per month with the deductible waived. There was no universal co-pay limit before, and out-of-pocket expenses varied widely. In addition, adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are now free.
- New monthly payment option. The Medicare Prescription Payment Plan gives Part D enrollees the opportunity to pay out-of-pocket prescription costs in monthly installments rather than in one lump sum at the pharmacy.
Impact on Oregon recipients
As insurance carriers absorb rising costs from these changes, some were forced to adjust their offerings or exit the Medicare Advantage marketplace. Oregonians will likely see fewer plan choices, higher premiums, and/or network changes. Here’s a snapshot of how this disruption is being felt in Oregon. Please note that this is not a complete list of changes impacting the state.
- Due to lower reimbursements and administrative burdens, two providers, Moda Health and Summit Health, no longer accept certain Medicare Advantage plans.
- Regence BlueCross BlueShield of Oregon, Aetna, and PacificSource will remove some MA plans in 2026 but will continue offering HMO plans in Lane County.
- Samaritan Health Plans, which serves the Willamette Valley and Oregon’s central coast, will exit the Medicare Advantage market in 2026, affecting nearly 14,000 members and impacting access to Samaritan-affiliated providers.
- Providence Health Plans will exit or reduce Medicare Advantage coverage in Curry, Deschutes, Harney, Lake, Umatilla, and Union counties and consolidate its offerings in more urban areas. Additionally, Providence’s PPO plans are being eliminated in some areas, including the Portland metro. Remaining plans are mostly HMO and HMO-POS, with limited out-of-network coverage.
What you can do
To ensure you maintain the coverage and provider access you need, it’s recommended that you do the following:
- Review your Annual Notice of Change (ANOC)
- Have your providers confirm if they’ll still accept your current plan.
- If they won’t, explore alternative plans during Medicare Open Enrollment, which runs October 15 through December 7. Check out SELCO’s Medicare page to learn more and sign up for a free Open Enrollment seminar.
- Contact SELCO Insurance Services for a personalized review.
These are big changes that may impact your healthcare insurance in the future. But you’re not alone. SELCO’s local and experienced insurance specialists are here to make sure you continue to have quality, uninterrupted coverage.
