Insurance and Medicare Information

Learn about the insurance and Medicare plans accepted at The Portland Clinic.

Oregon’s Health Exchange

The Portland Clinic will be participating with the following health plans through the Health Insurance Exchange in 2017:
Bridgespan (Value PPO Network)
PacificSource (SmartChoice Network)
Kaiser Permanente
Moda Health (Beacon Network)
Providence Signature and Providence Choice

If you need assistance selecting a plan, please work with an agent (at no cost).  You can find an available agent by going to OregonHealthcare.gov or calling 1-855-268-3767.

Plans Accepted at The Portland Clinic

Adventist Employee Health
Aetna
Assurant Health
Bridgespan Value PPO
CareMark PPO
ChoiceCare (Humana’s National PPO)
Cigna
Family Care (effective 3/15/17)
First Choice Health
First Health Network
Fortis Healthcare
GEHA
Guardian
HMA (Healthcare Management Administrators)
Health Net of Oregon
– HMO
– PPO
– Community Care
– MedAdvantage
Health Smart
Kaiser Permanente
– Individuals and families
– Senior Advantage (HMO)
– Added Choice (Tier 1)
– Connected Care
– Commercial
LifeWise of Oregon
Medicare (accepting established Portland Clinic patients only)
MHN (Managed HealthCare NW)
Moda Health (formerly ODS)
– Beacon
– OHSU PPO (Community Care Network)
– Connexus
– Synergy
Multiplan
Motor vehicle
PacifiCare of Oregon
PacificSource
– PPO
– PacificSource Smart Health
– PacificSource Student Health
– PacificSource Medicare’s MyCare (HMO) Plans
Providence Health Insurance
– Providence Health Plans of Oregon
– Providence Preferred
– Providence Signature
– Providence Choice
– Providence Medicare Extra
Regence BCBS of Oregon
– Participating (PAR) Network
– Preferred Provider Plan (PPP) Network
– Access Network
– MedAdvantage PPO
– BlueAdvantage HMO
– Value PPO
– BlueCard
– Federal
UHC AARP MedicareComplete HMO – (assigned to The Portland Clinic PCP)
United Healthcare
Oregon Workers’ Compensation Division

What is the Health Exchange?

As of November 15, 2014, anyone wanting to enroll in health insurance through the exchange will need to use the federal website, healthcare.gov, as the Cover Oregon website will no longer be taking enrollment applications. The Health Exchange Marketplace is mandated for all states, based on the Affordable Care Act which was passed into law in 2010 and went into effect in 2014. The law requires most people who can afford health insurance to have coverage or otherwise pay a penalty.

Which Health Exchange plans does The Portland Clinic accept?

As of November 15, 2014, anyone wanting to enroll in health insurance through the exchange will need to use the federal website, healthcare.gov, as the Cover Oregon website will no longer be taking enrollment applications. The Health Exchange Marketplace is mandated for all states, based on the Affordable Care Act which was passed into law in 2010 and went into effect in 2014. The law requires most people who can afford health insurance to have coverage or otherwise pay a penalty.

To view a list of the senior plans we accept, please see Medicare Services.
If your insurance plan is not listed, we may still accept it. Call our business office at 503-221-2189 to check.

Medicare Services

The Portland Clinic will continue to see current established patients enrolled with Original Medicare.  If you are a current patient of The Portland Clinic who is of Medicare age or “aging” into Medicare, you may be seen at The Portland Clinic with Original Medicare coverage.  Please note, our primary care providers no longer accept new patients with Original Medicare.

 Read about Medicare and Medicare Advantage options at The Portland Clinic

 

How to enroll in Medicare

 

 

For some people, Medicare enrollment occurs automatically, while others need to manually enroll.

You’re generally eligible for Medicare if you’re a United States citizen or permanent legal resident of at least five continuous years, and you generally qualify by age (65 or older). However, you may qualify for Medicare before turning 65 if you receive Social Security or certain Railroad Retirement Board disability benefits; if you have amyotrophic lateral sclerosis (ALS); or end-stage renal disease (ESRD).

Medicare enrollment will most likely be automatic in the following situations:

  • If you turn 65 years old & are already receiving Social Security or Railroad Retirement Board benefits, you’ll be automatically enrolled in Original Medicare (Parts A & B).
  • If you qualify for Medicare because of disability, you’ll be automatically enrolled in Medicare after 24 months of collecting disability. Your Medicare card should arrive in the 25th month.

You’ll have to manually apply for Medicare if:

  • You aren’t yet receiving Social Security benefits.
  • You live in Puerto Rico. You may get automatically enrolled in Part A, but you’ll need to sign up for Part B.

Some people delay enrolling in Medicare because they are still working and are covered under their employer health coverage.

If you’re working and have health coverage through an employer with more than 20 employees, you can sign up for Part B with a Special Enrollment Period when you stop working or that coverage ends, without a penalty.

You should always contact your employer or union benefits administrator before delaying Part A and Part B to find out how your insurance works with Medicare. Your employer coverage may require that you enroll in Part A and Part B in order to get your full coverage.

 

 

How do you enroll in Medicare?

If you worked for a railroad, you’d apply for Medicare through the Railroad Retirement Board. Otherwise, you’d sign up through Social Security.

 

 

The Portland Clinic has a partnership with SeniorChoices NW.  SeniorChoices NW is a trusted resource that can help you determine if you can enroll online, over the phone, or if you might need to go in to your local Social Security office. Once enrolled in Original Medicare, SeniorChoices NW can also assist you with enrolling in a Medicare insurance plan that your doctors at The Portland Clinic accept.

Please give SeniorChoices NW a call at (503) 682-1878 for more information, to schedule an appointment with a local agent, or need assistance in enrolling in Medicare.

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