COLUMN: Fewer Medicare Advantage plans offered in Marion, Polk counties

Many people who play Wordle – the online word game where you have six chances to guess a five-letter word – enjoy comparing how well they did solving the daily puzzle.

How many Wordle guesses did they need? What is their streak of “wins”? That sort of thing.

We love comparing all manner of things – team rankings, gasoline mileages, mortgage rates, etc. Now, the healthcare-research organization KFF has reviewed what’s happening with 2026 Medicare Advantage insurance plans across America. 

People with Medicare in Marion and Polk counties have lots of insurance choices, although fewer Medicare Advantage choices than before.

• The average Medicare beneficiary, KFF reports, has access to 32 Medicare Advantage plans that cover both medical and prescription drugs, compared with 22 such plans in Marion County and 18 in Polk County.
• Two-thirds of Medicare Advantage plans nationally charge no monthly premium, compared with about half in Marion and Polk counties. Nationally, KFF says, three-quarters (76%) of enrollees choose a plan charging no monthly premium.
• Twenty-nine percent of Medicare beneficiaries can choose from among plans offered by 10 or more companies; KFF says even the average beneficiary can choose from among eight. Those in Marion and Polk counties can choose from four companies; in Marion County that’s down from six in 2025. (Two other Medicare Advantage companies do business in Marion County, but neither has a contract with the area’s two Salem Health hospitals.)
• Fewer than 1% of Medicare beneficiaries live in a county where no Medicare Advantage insurance plan is offered. Oregon is among 13 states where this is true, however, with coastal Curry County and six eastern Oregon counties having no access to MA insurance.
• About 2.6 million Medicare beneficiaries lost their Medicare Advantage coverage at the end of December because the plan left their area. That’s double the number who lost plans a year earlier. Those who had to look for new plans for 2026 include some in Marion and Polk counties, who lost either Providence or Aetna plans at year’s end. 

Significantly, according to the KFF analysis, fewer Medicare Advantage plans nationally this year are offering supplemental benefits such as over-the-counter pharmacy allowances; home-delivered meals following a hospital stay; remote-access technology such as medical-alert devices; and transportation to health-related destinations. Meanwhile, 98% or more of plans nationally continue to offer some level of dental, hearing and vision coverage, which Medicare covers only in rare instances. 

If you want to review Medicare insurance, or discuss something else Medicare-related, a Senior Health Insurance Benefits Assistance volunteer counselor should be able to help. For details about how to make a SHIBA appointment, please see the end of this column.

In May I will turn 65, so I’ve been doing a little homework. But I’m baffled! I want to buy Medicare insurance – but so many choices, it’s hard to understand the benefits, and prices seem all over the board.

So many choices, yes, although answering these three questions will greatly narrow down the options:

• How much are you willing to pay in monthly premium for Medicare insurance? (Monthly premiums for Medicare insurance range from no cost to $160 or more, depending on insurance type.)
• What insurance will your doctor(s) accept? (Medicare Advantage insurance companies have networks, and your doctor must be “in network” to be able to bill the insurance. Medicare supplement (Medigap) insurance policies require that doctors bill Medicare; most doctors will, although a few require Medicare Advantage insurance.)
• Does the insurance you’re considering cover your prescription drugs and at a competitive price? (This can be determined by entering your drugs, including dosage and frequency, on the Medicare.gov website.)

You have written that Medicare insurance companies must cover at least one drug in every drug classification. But do they? I have family members whose Medicare insurance won’t cover prescriptions such as a GLP-1 and Viagra.

Medicare insurers are required to cover at least one drug in every drug classification – but, as your question suggests, with exceptions. And the exceptions can include the two prescription drugs you cited.

The respected Medicare Rights Center has a list of the excepted drugs types on its website. Among the drugs excluded from the law are those for anorexia, for weight loss or gain, for erectile disfunction and over-the-counter medications for cough and cold. That said, even some of these may be covered under certain circumstances, with examples given on the website. 

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, please call 800-722-4134.

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