Updated 10/06/23
On August 14th, 2023, St. Charles Health System announced that it was evaluating whether or not it would continue accepting Medicare Advantage plans. As of October 5th, St. Charles has finalized negotiations with health plans.
When Medicare open enrollment begins October 15th, local seniors will have options should they want to remain in-network for St. Charles Health System. In addition to traditional Medicare and PacificSource, St. Charles will start the year accepting the following Medicare Advantage plans: Providence, Moda and Regence Blue Cross Blue Shield.
St. Charles will no longer be an in-network provider for Medicare Advantage plans from Humana, HealthNet and WellCare starting in 2024. Individuals on these plans should receive a communication from their insurance provider about the changes to their health plan offerings and in-network provider availability.
Visit St. Charles’ Medicare Advantage FAQ page for more information.
What are Medicare Advantage Plans?
Medicare Advantage plans, also known as “Part C,” are offered by private companies approved by Medicare. The plans include Medicare-covered services, and may include benefits not covered by Medicare, such as dental, vision, hearing, and alternative care. According to PacificSource, about 26,000 individuals in Central Oregon are covered by Medicare Advantage plans—around 41% of people eligible for Medicare.
Read more about Medicare and Medicare Advantage on our blog.
What happens if the St. Charles Health System decides to not accept Medicare Advantage?
People who stay on Medicare Advantage plans will have to pay out-of-pocket for coverage through the St. Charles Health System because they will no longer be considered in-network. Others may decide to switch to traditional Medicare during open enrollment period from October 15th through December 7th. St. Charles will continue to accept traditional Medicare, which is funded and operated by the federal government.
What are the next steps?
According to their press release, St. Charles Health System is evaluating its Medicare Advantage contracts with PacificSource, Humana, HealthNet and WellCare this fall and winter. Patients who may be impacted by this change will receive a letter from St. Charles in the mail in the coming weeks.
Are they currently accepting Medicare Advantage plans?
The health system is still currently accepting Medicare Advantage plans and people with that insurance can still receive care.
What to do if you have questions about your traditional Medicare or Medicare Advantage plans
Visit St. Charles’ Answering your questions on Medicare Advantage page for more information.
If you would like to voice your concerns about this decision, we encourage you to reach out to St. Charles directly at 541-706-6316 or patientexperience@scmc.org. We also encourage you to reach out to your local legislators.
If you would like to talk with someone about what options are available, please contact our Oregon Senior Health Insurance Benefits Assistance (SHIBA) Program at (541) 678-5483. For Spanish, please call our SHIBA representative at the Latino Community Association at (541) 325-6837.
Our volunteer SHIBA counselors can help with selecting and making decisions about Medicare plans. You will be able to make changes to your Medicare plans during open enrollment from October 15th – December 7th. Due to increased call volume, you can expect a call back within three business days. For additional information, you can also reach out to an insurance broker of your choosing.
FAQ – Medicare Advantage Plans and Provider Contracts
Find answers to additional frequently asked questions (FAQs) that cover general information about options available to Medicare beneficiaries whose providers, or hospital, no longer contract with their Medicare Advantage plan.
