CareOregon Advantage Plus (D-SNP) Plan Details for Jackson County, OR
This page provides coverage and cost details for CareOregon Advantage’s H5859-001-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this CareOregon Advantage plan (H5859-001-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Dual-Eligible SNP qualification requirements to join this D-SNP plan.
CareOregon Advantage Plus Basic Plan Details
- Plan ID
- H5859-001-0
- Plan Type
- HMO-POS D-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$590.00 deductible - Supplemental Benefits
- Vision
- Availability
- Jackson County, OR
- Insured By
- CareOregon Advantage
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this CareOregon Advantage plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $0 Copay
Referral Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $0 Copay
- Urgent care
- $0 Copay
- Ground ambulance
- $0 Copay
- Inpatient hospital care
- Skilled Nursing Facility
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
- Routine Foot Care
- $0 Copay
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
Prior Authorization Required, Referral Required - Routine chiropractic
- $0 Copay
Prior Authorization Required, Referral Required
Mental Health Services
- Outpatient individual therapy
- $0 Copay
- Outpatient group therapy
- $0 Copay
- Inpatient psychiatric hospital care
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required, Referral Required - Occupational therapy
- $0 Copay
Prior Authorization Required, Referral Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
Prior Authorization Required - Durable medical equipment
- $0 Copay
Prior Authorization Required - Prosthetics
- $0 Copay
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $0 Copay
Prior Authorization Required, Referral Required - Lab services
- $0 Copay
Prior Authorization Required, Referral Required - Outpatient x-rays
- $0 Copay
Prior Authorization Required, Referral Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required, Referral Required
Medicare Part B Drugs
- Chemotherapy
- $0 Copay
- Other Part B drugs (Medicare-covered)
- $0 Copay
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
- Oral exam
- Not Covered
- Dental x-rays
- Not Covered
- Cleaning
- Not Covered
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Not Covered
- Hearing aids
- Not Covered
- Hearing exam
- Not Covered
Vision Services
- Medicare-covered eye exam
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Prescription Drug Costs & Benefits
CareOregon Advantage Plus includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $17.50 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before CareOregon Advantage begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, CareOregon Advantage Plus has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Generic | 25.00% | 25.00% |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Brand | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| Supplemental Drugs | $1.60 | $0.00 |
| *The Part D deductible does not apply. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this CareOregon Advantage plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
CareOregon Advantage Plus
To qualify for enrollment in CareOregon Advantage Plus in Jackson County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Oregon's state thresholds.
Before enrolling in CareOregon Advantage Plus, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About CareOregon Advantage
| Website: | CareOregon Advantage Plan Page (opens in new tab) |
|---|---|
| Providers: | CareOregon Advantage Providers Page (opens in new tab) |
| Formulary: | CareOregon Advantage Formulary Page (opens in new tab) |
| Pharmacy: | CareOregon Advantage Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (888)712-3258 |
| New Member Health Plan TTY: | (800)735-2900 |
| New Member Part D Help: | (888)712-3258 |
| New Member Part D TTY Users: | (800)735-2900 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- CareOregon Advantage, http://www.careoregonadvantage.org, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Oregon", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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