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CareOregon Advantage Plus (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareOregon Advantage Plus (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareOregon Advantage Plus (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
CareOregon Advantage Plus (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by CareOregon, Inc. available for enrollment in 2025 to people living in Portland Metro Area, Jackson, Tillamook, Columbia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that CareOregon Advantage Plus (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
CareOregon Advantage Plus (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CareOregon Advantage Plus (HMO-POS D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For CareOregon Advantage Plus (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The CareOregon Advantage Plus (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you'll pay 25% coinsurance for preferred and standard generic and brand drugs at standard pharmacies and mail order. Non-preferred drugs have a $1.60 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $17.50.
Additional Benefits
The CareOregon Advantage Plus (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing options. Many services, such as primary care, outpatient services, and dialysis, require a coinsurance, typically 20%. There is no copay for emergency services, preventive services, or home health services. The plan also provides coverage for vision, dental, and hearing services, with specific limits and cost-sharing. In addition to traditional benefits, this plan provides over-the-counter items with a maximum benefit, and covers home infusion services with a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by CareOregon Advantage Plus (HMO-POS D-SNP) with prior authorization and a doctor referral required. Additional days, non-Medicare covered stays, and upgrades for inpatient hospital acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services (individual and group sessions), and outpatient blood services are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient substance abuse services (individual and group sessions) have a coinsurance between 20-20%. Outpatient blood services have a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the CareOregon Advantage Plus (HMO-POS D-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CareOregon Advantage Plus (HMO-POS D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the CareOregon Advantage Plus (HMO-POS D-SNP) plan with a 20% coinsurance, but no copay. Urgently Needed Services are covered with a 20% coinsurance and no copay, and Worldwide Emergency Services are not covered.
Primary Care See details
The CareOregon Advantage Plus (HMO-POS D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits all have a 20% coinsurance. Individual and group sessions for mental health and psychiatric services, and routine foot care have a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
CareOregon Advantage Plus (HMO-POS D-SNP) covers preventive services, including annual physical exams, with no copay. Kidney disease education services have a 20% coinsurance, while health education, in-home safety assessments, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services are partially covered by the CareOregon Advantage Plus (HMO-POS D-SNP) plan. Hearing exams are covered with at most 20% coinsurance, but routine hearing exams and fitting/evaluation for hearing aids are not covered.
Vision Services See details
Vision Services includes routine eye exams covered once per year, and eyewear benefits including contact lenses with a $100 maximum benefit per year and eyeglasses (lenses and frames) with a $175 maximum benefit per year, and upgrades. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are partially covered under the CareOregon Advantage Plus (HMO-POS D-SNP) plan. Medicare Dental Services are covered with a 20% coinsurance, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all covered services. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by CareOregon Advantage Plus (HMO-POS D-SNP), and require a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by CareOregon Advantage Plus (HMO-POS D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies and Diabetic Equipment with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but a referral is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CareOregon Advantage Plus (HMO-POS D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareOregon Advantage Plus (HMO-POS D-SNP) plan, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor's referral are required for SNF services, and you will pay the Medicare-defined cost share for tier 1.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with a maximum benefit of $344.50 every three months, including nicotine replacement therapy and naloxone, but does not cover acupuncture, meal benefits, or several other services.
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