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CareOregon Advantage Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareOregon Advantage Plus (HMO 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 D-SNP) in 2026, please refer to our full plan details page.
CareOregon Advantage Plus (HMO D-SNP) is a HMO D-SNP plan offered by CareOregon, Inc. available for enrollment in 2025 to people living in Portland Metro Area, Jackson, Columbia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that CareOregon Advantage Plus (HMO 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 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 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 D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $615.00 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 D-SNP) prescription drug plan has an annual drug deductible of $615. During the initial coverage phase, you will pay a 25% coinsurance for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 5 specialty drugs filled at standard pharmacies or through standard mail order. Tier 4 non-preferred drugs require a 26% coinsurance for one-, two-, and three-month supplies. For Tier 6 select care drugs, members benefit from no copay for all supply durations at standard pharmacies and standard mail order. This straightforward cost structure helps you easily plan your healthcare expenses while ensuring access to key medications.
Additional Benefits
The CareOregon Advantage Plus (HMO D-SNP) plan offers comprehensive coverage where many key medical services, such as inpatient hospital stays, skilled nursing facility care, and home health services, feature no copay and no coinsurance. For other essential medical needs including primary care, specialist visits, outpatient services, and medical equipment, members will pay no copay alongside a standard 20% coinsurance. Emergency and urgent care also require no copay and a 20% coinsurance, while Medicare Part B drugs carry no copay and a 0% to 20% coinsurance, except for insulin which requires a $35 copay. This plan includes valuable extra benefits like annual preventive screenings, home infusion services, and diagnostic hearing exams with no copay and no coinsurance. Additionally, members receive an annual vision allowance of up to $100 for contacts and $175 for eyeglasses, as well as a monthly over-the-counter reimbursement of up to $15.50 with no copay. However, routine dental care, routine hearing exams, fitness benefits, and worldwide emergency coverage are not included under this plan.
Inpatient Hospital See details
CareOregon Advantage Plus (HMO D-SNP) partially covers inpatient hospital services for acute and psychiatric care with no copay and no coinsurance, though referrals and prior authorization are required. This benefit does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
CareOregon Advantage Plus (HMO D-SNP) outpatient services are covered with no copays, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, and prior authorization or referrals may be required for certain outpatient treatments.
Partial Hospitalization See details
CareOregon Advantage Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the CareOregon Advantage Plus (HMO D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
CareOregon Advantage Plus (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit, waived if admitted within 3 days) and no copay, and urgently needed services with a 20% coinsurance (up to $40) and no copay. Worldwide emergency, urgent, and emergency transportation services are not covered under this plan.
Primary Care See details
CareOregon Advantage Plus (HMO D-SNP) covers primary care, specialist, outpatient therapy, podiatry, mental health, and psychiatric services with no copay and 20% coinsurance, though chiropractic services are not covered. Opioid treatment program services are covered with no copay and no coinsurance, and additional telehealth benefits are also included.
Preventive Services See details
Preventive services are covered by CareOregon Advantage Plus (HMO D-SNP) with no copay and no coinsurance for annual physicals and screenings, while kidney disease education requires a 20% coinsurance and no copay. Additional preventive benefits are partially covered, providing personal emergency response systems and in-home support with no copay and no coinsurance, but excluding fitness benefits, health education, weight management, and therapeutic massages.
Hearing Services See details
Hearing services are partially covered by CareOregon Advantage Plus (HMO D-SNP), which offers covered diagnostic hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, fitting evaluations, and OTC hearing aids are not covered, and while some prescription hearing aid services are technically covered, no specific types (including inner ear, outer ear, and over-the-ear) are covered in practice.
Vision Services See details
CareOregon Advantage Plus (HMO D-SNP) offers vision services with no copay and no coinsurance, covering one routine eye exam per year and providing annual allowances for contact lenses (up to $100) and eyeglasses (up to $175). The benefit is partially covered, as other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
CareOregon Advantage Plus (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Routine preventive care—including oral exams, cleanings, and X-rays—along with comprehensive services like restorative, endodontic, and orthodontic care, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CareOregon Advantage Plus (HMO D-SNP) with no copay and no coinsurance, subject to prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
CareOregon Advantage Plus (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. A referral from your doctor is required to receive these covered services.
Medical Equipment See details
CareOregon Advantage Plus (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some covered items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
CareOregon Advantage Plus (HMO D-SNP) partially covers diagnostic and radiological services, requiring both a referral and prior authorization. Covered services, including diagnostic procedures, therapeutic radiology, and outpatient X-rays, carry a 20% coinsurance and no copay, while lab services are not covered.
Home Health Services See details
Home health services are covered by CareOregon Advantage Plus (HMO D-SNP) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CareOregon Advantage Plus (HMO D-SNP) with no copay, but require prior authorization and a referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by CareOregon Advantage Plus (HMO D-SNP) with no copayment and no coinsurance, though prior authorization and referrals are required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by CareOregon Advantage Plus (HMO D-SNP), which provides an over-the-counter (OTC) benefit of up to $15.50 per month via reimbursement with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services under this category are not covered.
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