Oregon SHIBA program promotes Medicare plans and addresses premium changes

The House Committee on Behavioral Health and Health Care convened on May 13, 2025, to discuss critical issues surrounding Medicare options and the implications for Oregon residents. The meeting focused on the Oregon Guide to Medicare plans, a resource provided by the Senior Health Insurance Benefits Assistance (SHIBA) program, which aims to assist seniors in navigating their Medicare choices.

The committee highlighted the importance of the guide, noting its comprehensive coverage of Medicare, including Medigap plans. A representative indicated that while a full report was available, a link was provided in the presentation slides to avoid overwhelming attendees with lengthy documents.

A significant portion of the discussion centered on Medicare Advantage plans. Questions arose regarding the stability of premiums for individuals enrolled in these plans. It was clarified that while the premiums for Medicare Advantage can increase over time, the state does not regulate these changes. The committee also addressed concerns about Medigap premiums, explaining that these can rise based on age and health history, with companies able to file for rate increases.

The topic of adverse selection was also examined, particularly regarding the potential for individuals to switch between Medicare Advantage and Medigap plans based on their health needs. The committee discussed the possibility of implementing guardrails to prevent individuals from gaming the system by switching plans only when they anticipate needing more coverage. Current Oregon law limits pre-existing condition exclusions to a six-month period prior to obtaining Medigap coverage.

Committee members emphasized the complexity of choosing between Medicare options. They recommended that individuals consult with SHIBA or a licensed agent to evaluate their choices. The discussion underscored the trade-offs between cost and network access, with Medicare Advantage often being more affordable but with narrower provider networks compared to Medigap plans.

In conclusion, the meeting provided valuable insights into the intricacies of Medicare options available to Oregonians, highlighting the need for informed decision-making among seniors as they navigate their healthcare coverage. The committee plans to continue monitoring these issues and may consider further legislative actions to enhance protections for consumers.