Medicare Open Enrollment 2026: What Oregon Residents Need to Know Before October 15
Medicare Open Enrollment 2026: What Oregon Residents Need to Know Before October 15
The Annual Enrollment Period (AEP) runs October 15 – December 7. If you’re on Medicare in Oregon — or turning 65 in the next 12 months — this is the most important window of the year. Miss it and you could be stuck with the wrong plan until next fall.
Here’s everything you need to know.
What Is Medicare Open Enrollment?
Medicare’s Annual Enrollment Period (AEP), also called Open Enrollment, runs every year from October 15 through December 7. Changes you make take effect January 1 of the following year.
During this window, you can:
- Switch from Original Medicare to a Medicare Advantage plan (or vice versa)
- Change your Medicare Advantage plan to a different one
- Switch your Part D Prescription Drug Plan
- Join a Part D plan if you didn’t when you first became eligible (though late penalties may apply)
This is your annual chance to reassess whether your current plan still fits your health needs and budget — because both your needs AND the plans change every year.
Why Your Plan May No Longer Be the Best Fit
Insurance carriers file updated plan details with CMS every year. For 2026, Oregon Medicare enrollees may see:
Premium changes: Some Medicare Advantage plans have increased premiums; others have decreased. The national average Medicare Advantage premium has shifted — your specific plan may have gone up, down, or stayed flat.
Network changes: Your doctors, hospitals, and specialists may no longer be in-network if your plan’s provider network changed. This is the #1 reason people end up with unexpected out-of-pocket costs.
Drug formulary changes: If you take prescription medications, your plan’s drug formulary may have changed — meaning drugs that were covered (or covered at a preferred tier) in 2025 may cost more or require prior authorization in 2026.
Benefit changes: Extra benefits like dental, vision, hearing, and fitness memberships frequently change year to year.
Bottom line: The “best” plan from last year may not be the best plan this year. A quick annual review takes 30 minutes and can save you thousands.
Medicare Advantage vs. Original Medicare: Quick Reminder
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Monthly Premium | Part B: ~$202.90/month | Often $0–$50/month |
| Coverage | Part A (hospital) + Part B (medical) | Bundles A+B, often adds Part D, dental, vision |
| Networks | Any provider accepting Medicare | Usually HMO or PPO network |
| Out-of-Pocket Max | No cap | Annual cap (varies by plan) |
| Flexibility | See any provider nationwide | Typically network-restricted |
Oregon has strong Medicare Advantage options from carriers like Regence, PacificSource, Humana, UnitedHealthcare, and others — but which one is best depends entirely on your zip code, doctors, and medications.
The Medicare Supplement (Medigap) Difference
Medicare Supplements work differently. You can only switch Medigap plans with guaranteed issue rights (like when you first enroll at 65) or if you can pass medical underwriting. The Annual Enrollment Period does NOT give you guaranteed issue rights for Medigap.
If you’re considering moving from Medicare Advantage to a Medigap plan, timing matters — call us before AEP begins so we can map out your options.
5 Steps to Take Before October 15
1. Pull out your current plan’s Annual Notice of Change (ANOC) Carriers are required to mail this to you in late September. It details every change to your plan for the coming year. Read it carefully — especially the drug formulary and network sections.
2. Run a drug formulary check Log into Medicare.gov’s Plan Finder and enter your current medications. Compare what you’re paying now vs. what each plan would charge for your specific drugs.
3. Verify your doctors are still in-network Call your primary care physician and any specialists you see regularly. Ask: “Are you still accepting [Plan Name] for 2026?”
4. Consider whether your health situation has changed If you’ve been diagnosed with a new condition, started new medications, or anticipate surgery, a plan with lower out-of-pocket maximums may be worth a higher premium.
5. Talk to an independent broker An independent agent like Rodney Cummings works with every major carrier in Oregon — not just one. He can run a side-by-side comparison of every plan available in your zip code in minutes.
Oregon-Specific Considerations
Oregon has strong Plan D options: Oregon’s Medicare beneficiaries tend to have access to highly competitive Part D plans. Premiums vary significantly — from under $15/month to over $80/month — depending on your medication needs.
PERS retirees: If you receive a pension from Oregon PERS, you have access to PEBB (Public Employees’ Benefit Board) retiree health insurance. Whether that’s better or worse than a standalone Medicare plan depends on your specific situation — worth comparing every year.
OHP/Medicaid coordination: Oregon has significant dual-eligible (Medicare + Medicaid) populations. If your income has changed, you may now qualify for Extra Help (LIS), which dramatically reduces drug costs.
Don’t Forget: Medicare Savings Programs
If your income is limited, Oregon offers Medicare Savings Programs through the Oregon Health Plan that can pay your Part B premium, deductibles, and co-insurance. For 2026, the income limits are:
- QMB (Qualified Medicare Beneficiary): Single monthly income up to ~$1,235; couple ~$1,663
- SLMB (Specified Low-Income Medicare Beneficiary): Slightly higher income limits, covers Part B premium
- QI Program: Covers Part B premium for those who don’t qualify for SLMB
These programs require application through Oregon DHS. If you think you might qualify, call us — we’ll help you navigate the paperwork at no charge.
When to Call Us
Now — before AEP begins: If you want to understand your options before the rush, we can do a pre-enrollment analysis so you’re ready to act quickly when October 15 arrives.
October 15 – November 30: Peak enrollment season. Call early — appointment slots fill up.
After December 7: If you missed AEP, don’t panic. The Medicare Advantage Open Enrollment Period (January 1 – March 31) allows you to switch from one MA plan to another or return to Original Medicare. It’s more limited but provides a safety net.
Schedule Your Free Medicare Review
Rodney Cummings is an independent Medicare broker serving Oregon and 25+ other states. He works with dozens of carriers including AARP/UnitedHealthcare, Humana, Anthem, Aetna, Cigna, Regence, PacificSource, and more.
A Medicare review with Rodney is completely free — he’s compensated by the carrier when you enroll, never by you.
📞 503-832-8555 (Office) | 503-209-7939 (Cell)
📧 rod@legacywealthservices.com
🗓️ Schedule online at legacywealthservices.com/schedule
Oregon Insurance License #18847712 | NPN 18847712
This article is for informational purposes only. Plan availability and benefits vary by location and are subject to change. Contact us for a personalized analysis based on your specific situation.