New plans. A new player. New rules. New drug savings.

If ever there was a year when Oregon seniors should review their Medicare coverage, this might be it.

It's open enrollment season for popular Medicare Advantage plans — the time between Oct. 15 and Dec. 7 when members can switch plans without penalty. Those in stand-alone Part D prescription drug plans can also make a change.

Though experts say you should always evaluate your options each year, only about 1 in 10 Medicare recipients actually do, surveys suggest. And this year, there's even more incentive to follow through.

Two providers have dropped plans or exited the Oregon market entirely. A new national player — Aetna — is offering a Medicare Advantage plan for the first time. A couple stalwarts — Moda Health and Regence BlueCross BlueShield — are offering new plans.

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Thanks to federal health care reform and last year's overhaul of the federal tax code, seniors with high prescription drug costs could see more relief sooner than they thought. But it's never that straightforward. Another rule change could require Medicare recipients to try lower-cost injectable drugs before more expensive treatments for cancer, rheumatoid arthritis, macular degeneration and other serious diseases.

"Medicare Advantage plans have evolved so much," said Jodine Sampson, who oversees Clackamas County's Senior Health Insurance Benefits Assistance program. "That's why it's worthwhile for people to take a look at this each year."

Here are a few of the changes seniors will find as they survey the landscape, along with a few tips as they shop:

GAP CLOSES

For many years, seniors with high prescription costs often fell into Medicare's drug coverage gap, or donut hole. That's the window in which their cost-share payments went through the roof.

The gap for brand-name drugs finally closes in 2019, and it's happening one year early.

Starting in 2011, the Affordable Care Act gradually began closing that coverage gap and reducing enrollee cost-share payments. Under that law, the gap was supposed to close entirely by 2020. But late last year, Congress sped up that closure as part of its comprehensive tax-reform package. Next year, the gap will close for brand-name drugs. In 2020, it will also close for all generic drugs.

Here's how Part D and Medicare Advantage drug coverage currently works: Enrollees pay all their costs until their plan's deductible is met. Then they pay up to 25 percent of the cost of brand-name drugs covered by their plan. Previously, the gap came in at around $3,750 of spending. That's when Medicare enrollees would have to pay a larger share of the cost. Not anymore. Even in this so-called "gap," their portion will still be capped at 25 percent.

Once an enrollee's out-of-pocket prescription drug costs exceed $5,100, then Medicare's catastrophic coverage kicks in. At that point, enrollees generally pay 5 percent of their medication's costs.

This should be good news. More seniors are reaching the Medicare drug coverage gap, and their out-of-pocket costs are going up, experts say. More also are reaching catastrophic coverage more quickly.

The Trump administration has considered ways of reducing the number of enrollees who qualify for catastrophic coverage. That's because it's costing the federal Treasury more and more money. But for now, drug coverage appears to be getting better, not worse.

HELLO AND GOODBYE

After more than 30 years, Portland-based FamilyCare Health this summer decided to stop offering Medicare plans, causing its 3,700 enrollees to scramble to find coverage elsewhere.

"They had some vision and reimbursement for gym membership," Sampson said. "They had some benefits that people were very comfortable with and used to."

This month, CareOregon said it would drop its Medicare Advantage plan with prescription drug coverage. The plan enrolled only 1,500, according to federal data. The Portland-based insurer said it would focus instead on its special-needs plan for those dually enrolled in Medicare and the Oregon Health Plan. CareOregon currently enrolls 11,000 in that plan, called Advantage Plus, data show.

A national giant appears poised to help fill the gap. Aetna Inc. will enter Oregon's Medicare Advantage market for the first time, offering plans in the Portland and Medford areas. The move comes as drug provider CVS Health Corp. and Aetna try to overcome antitrust concerns and seal a $69 billion merger. Aetna last month said it would sell its Part D drug plan business to WellCare Health Plans in an attempt to garner U.S. Department of Justice approval.

SAME INSURERS, NEW PLANS

Two local insurers have introduced new Medicare Advantage plans with prescription drug coverage. Regence, a subsidiary of Portland-based Cambia Health Solutions, is offering a cousin to its Classic PPO plan with a lower premium. Portland-based Moda is introducing a high-premium plan with enriched benefits.

The new offerings might be a result of a Trump administration rule change earlier this year, said Gretchen Jacobson, associate Medicare policy director with the Kaiser Family Foundation. The change dropped a 9-year-old requirement that insurers offer plans significantly different from one another.

"When that requirement was implemented, we did see a large drop in the average number of plans," she said. Now, she added, "we may see an increase."

DON'T OVERLOOK THOSE MOOPS

Traditional Medicare has no out-of-pocket limit. But federal law requires Medicare Advantage plans to cap the amount enrollees pay for covered services in one year.

The caps are easy to overlook when monthly premiums nab the most attention. But the maximum out-of-pocket limits can be a saving grace, experts say.

MOOPs have gradually increased over the years, and while many Oregon plans will keep theirs unchanged, there are a few notable differences. Providence Health Assurance held the premium on its Choice plan steady, but the plan's maximum out-of-pocket for in-network care increased by $1,100 to $4,500. The out-of-pocket limit on two Regence BlueCross BlueShield plans actually declined.

"I tend to highlight the maximum out of pocket as one of the things that's fairly easy to make a comparison between plans," said Arvin Hille, a volunteer with SHIBA in Clackamas County who counsels seniors on their Medicare options. "There are some pretty significant differences, and it could be important if they have a bad year."

NO RIDE-HAILING VIA MEDICARE — YET

Another federal rule change early this year allows Medicare Advantage plans to offer non-medical benefits that traditional Medicare doesn't. This prompted speculation that insurers might offer such perks as Uber or Lyft rides to doctor's appointments. Other possible benefits include respite care for family caregivers and the installation of grab bars or chair lifts in homes.

"There's a lot of excitement around what they possibly could do," said Jacobson of the Kaiser Family Foundation, "but it really matters what they actually will do."

What have they done so far for 2019? Not much. Spokespeople with Providence, Kaiser Permanente and Regence all say the rule change happened too late in the game for them to fully evaluate the new benefit options.

"They were unfortunately released too close to plan deadlines for us to implement in 2019," said Ben Furr, a spokesman for Regence. "We're actively exploring additional benefit options for 2020 plans that would make care more convenient and affordable for our members."

A LONGER DO-OVER PERIOD

If you feel rushed making your decision this year and end up feeling like you made a mistake, you'll have more time to correct it. In 2019, Medicare Advantage enrollees can change plans or disenroll entirely between Jan. 1 and March 31. That do-over window is twice as long as it used to be.

During this period, Medicare Advantage enrollees can move to another Medicare Advantage plan or move back to original Medicare and pick up a prescription drug plan. This opportunity, however, does not apply to enrollees in Medigap plans or to those on basic Medicare.

With the expanded second-chance period, seniors have more incentive to explore their options and even make a switch.

"Don't just sign up for a plan and never look at it again," said Lisa Lettenmaier, owner of health insurance brokerage HealthSource NW in Tigard. "You should be reviewing it every single year."

Brent Hunsberger is an investment adviser representative in Portland. For important disclosures and information about Brent, visit bit.ly/2dwmN7w. Reach him at OregonianMedicare@gmail.com or leave a message at 503-683-3098.