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You pay $0 for all these benefits:
Monthly premium
Annual deductible
Doctor visits
Prescription drugs
Supplemental drugs
$0
CareOregon Advantage CareCard
Routine eye exam (every 12 months)
$0
Additional dental care
Hearing benefits
$0
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Prior Authorization
CareOregon Advantage Plus requires you or your prescriber to get prior authorization for certain drugs. This means that you will need to get approval from CareOregon Advantage before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
2025 CareOregon Advantage Prior Authorization Criteria (PDF)
Step Therapy
In some cases, we require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.
You can find out if your drug has any additional requirements or limits by checking our Drug List/Formulary.
You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat
your health condition. See the Drug List/Formulary for information about how to request an exception.
CareOregon Advantage Plus has no premium for medical coverage for Part A and B services. You must continue to pay your Medicare Part B premium unless it's paid for through your Medicaid coverage. Most medical services have no copayment as long as you have Medicaid coverage through CareOregon.
For Part D services, CareOregon Advantage Plus has a premium of $0 per month for prescription drugs (any premium is covered through Low-Income Subsidy).
If you qualify for Extra Help with your Medicare prescription drug plan costs, your premium will be lower. When you join CareOregon Advantage, Medicare will tell us how much Extra Help you are getting. Then, we will let you know the amount you will pay. If you aren't getting any Extra Help, you can see if you qualify by calling:
An online application for Extra Help is also available.
As a member of CareOregon Advantage, most medical services and office visits do not have copays. If you receive a bill, do not pay it. Please call Customer Service, who can work with you and your provider to resolve the balance.
CareOregon Advantage has a network of providers that our members can choose from. See our Provider Directory or online provider search tool to find a specific provider, or to see if your current provider is in our network.
If you do not choose a network provider as your primary care provider (PCP) when you sign up, we will assign one to you. You can change your PCP by calling Customer Service at 503-416-4279, toll-free at 888-712-3258 or TTY 711. Our hours are 8 a.m. to 8 p.m. seven days a week, October 1 to March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 to September 30.
Generally, you must use providers who are in our network to receive benefits. However, CareOregon Advantage Plus has a Point-of-Service (POS) option that allows you to get care from out of network PCPs and specialists under certain conditions. There are annual limits to this benefit. For more information, see “POS benefit” Chapter 4, section 2.1 of the Evidence of Coverage.
You can find the Evidence of Coverage on the My plan documents web page.
Special enrollment periods are times when you may be eligible to enroll in Medicare even though it’s outside of Medicare open enrollment. Open enrollment, also called the annual enrollment period (AEP), runs from October 15 to December 7 every year.
Certain circumstances, though, make you eligible to enroll in Medicare Part A, B or both at other times. For example:
Yes, the Medicare rules offer Medicare Advantage plan enrollees a limited chance to back out of their choice. This three-month opportunity is called the Medicare Advantage Open Enrollment Period. From January 1 to March 31, you may drop or disenroll from your Medicare Advantage plan and switch to Original Medicare Parts A and B. If you disenroll, the change takes effect the first day of the month after your plan gets your disenrollment notice.
To switch to Original Medicare, contact your current plan, or call 800-MEDICARE (800-633-4227).
If you disenroll from Medicare Advantage, you’re allowed to enroll in a Part D prescription drug plan. This is important because Original Medicare doesn’t include prescription drug coverage. Your new Part D drug benefits will start on the first day of the month after the plan gets your enrollment form.
The allowed actions during the disenrollment period are very narrow. You may not switch from one Medicare Advantage plan to another Medicare Advantage plan, you may not switch from one Part D plan to another, and you may not switch from Original Medicare to a Medicare Advantage plan.
The CareOregon Advantage CareCard is an added benefit to our Plus plan that gives you up to $1,378 per year ($344.50 per quarter) to spend on health items, healthy foods and household utilities. This is money that would otherwise come out of your own pocket. There are also opportunities to earn more money by getting your checkups and/or treating specific qualifying conditions*.
There is no cost to get this card and it can be used to shop at stores like Albertsons, Walgreens, Walmart, Fred Meyer, Farmbox Rx and more, or to pay your utility bills.
*Please note: some screenings or activities are only available to members who meet program conditions or when recommended by a provider.
Page last updated: October 15, 2024
Pending CMS approval H5859_COAWEB_M_2025
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